Accelerating Dental Innovation — A Student’s Perspective

EDITOR’S NOTE: Due to the nature of this perspective piece, the following content has not undergone peer review.

As healthcare problems grow increasingly complex, partnerships between dentists and engineers are limited — despite dentistry being an engineering-intensive field of medicine. While leaders in dental medicine and engineering have begun to increase collaboration, change at the predoctoral level could accelerate dental innovations. Some dental institutions have started to improve their curricula to meet the needs of this change. Equipping dental students with the knowledge to assess unmet clinical needs is essential to a more innovative future in dentistry. By specializing in one area of the body and learning operative procedures from an early stage in professional education, dentists are primed to innovate.

To address new challenges, dentists would greatly benefit from formal education on identifying unmet clinical needs early on in their professional training. Through exposure to interdisciplinary opportunities and new technologies, students are better equipped to challenge the status quo and continue to elevate the standard of oral care. Our goal is to educate dental practitioners on successful ventures between dentistry and engineering and how dental schools can impact the future of dental innovation.

UNIVERSITY RESEARCH COALITIONS

Recently, the NIDCR established two coalitions among prestigious research institutes. The first is the Center of Dental, Oral, and Craniofacial Tissue and Organ Regeneration (C-DOCTOR), and the second is Michigan-Pittsburgh-Wyss Regenerative Medicine (MPWRM) Resource Center¹. Both centers are focused on developing innovative technologies to address unmet clinical needs. These interdisciplinary initiatives consist of leaders with clinical, basic science, engineering, and business expertise who help researchers with the entire product development process. This includes navigation of the market research, intellectual property strategy development, FDA regulatory process, and clinical trials. All projects in the MPWRM Resource Center have corporate engagement, 90% have patents issued or pending, and 80% have FDA regulatory applications submitted².

INNOVATIVE DENTAL COMPANIES

Dr. Alfred C. Griffin III founded LightForce Orthodontics (LFO) during his orthodontic residency at Harvard University. LFO offers a 3D printed, patient-specific prescription orthodontic bracket system. By producing brackets unique to each patient’s tooth morphology and using a patented injection molding technique to design precise wire slots, there is improved bracket retention without compromising torque and decreased chairtime³. LFO also offers software dubbed as the “Google Docs of digital dentistry” ⁴, allowing for effortless collaboration between clinicians in remote locations. 

Although robotics have taken the medical field by storm, implementation into dentistry has not occurred until now. Neocis, a precision healthcare robotics company, focuses on dental implant surgeries. Neocis was founded by Alon Mozes, Ph.D., a biomedical engineer, and son of an endodontist. Dr. Mozes’s idea to augment dental surgeons’ ability to place implants was realized through their robotic dental implant system, Yomi. The Yomi system augments a skilled clinician’s ability to place and angle dental implants through haptic robotic guidance. 

The ADA is making efforts to standardize care and implement evidence-based guidelines. Overjet, founded by Dr. Alexander Jelicich during his prosthodontic residency at Harvard, is taking these efforts a step further. Overjet applies artificial intelligence (A.I.) to help clinicians diagnose, determine an appropriate treatment plan, and identify necessary but missed treatments. Insurance companies use the data procured by the clinical analyses to help process claims quicker and better identify potentially fraudulent cases. Overjet recently appointed Dr. Robert Faiella, former president of the ADA, as Chief Dental Officer and continues to make market inroads in the competitive field of A.I.

EXCELLENCE IN EDUCATION

Boston University Henry M. Goldman School of Dental Medicine (GSDM) is a preeminent example of demonstrated commitment to revolutionizing dental education. In 2020, GSDM implemented the Carbon M series 3D printer and the Neocis Yomi for their post-doctoral and predoctoral educational programs. Additionally, GSDM added Alon Mozes, CEO of Neocis, to the Dean’s Advisory Board. By forming partnerships with prominent figures in the dental industry, the Dean’s advisory board ensures that their students are working with the latest innovations in the oral healthcare field.

Columbia University College of Dental Medicine (CUCDM) paves the path for a new future of dental education through their Center for Precision Dental Medicine. Equipped with custom technologies, this innovative clinic was designed to collect data without interrupting student learning or patient care. Utilizing RFID technology, everything from patient flow through the waiting room to individual movements of hand instruments in a patient’s mouth is recorded and collected. This allows the student dentist to self-evaluate their use of a specific instrument per procedure, the speeds of their handpieces, and overall efficiency. Additionally, the clinic implements data analytics to take into account diseases, environment, lifestyle, racial demographics, and genetics to tailor treatment plans specific to the patient.

Harvard School of Dental Medicine (HSDM) is historically known as an innovator in dental education. Dental students are taught the didactic sciences alongside their medical school classmates. This unique learning environment is intended to stimulate collaboration and challenge how students apply their knowledge of science. First-year dental students take part in a primary care medical rotation, allowing them to observe and learn from dental and medical professionals in a clinical setting. In addition to a mandatory research requirement that enhances the process of innovation, HSDM offers a plethora of curricular options. One distinguishing program is the Health Sciences and Technology (HST) Program. This program is geared towards students interested in biomedical research and primes them to be innovators in dentistry. An extracurricular opportunity available to any Harvard student is the Innovation Labs (i-Labs), the incubator where LightForce Orthodontics and Overjet were developed.

The University of Michigan School of Dentistry (UMSOD) is internationally known as a cutting-edge dental research institution, having received the most NIDCR research grants in the United States for the last three years⁵. This robust research reputation has created an environment that attracts students and faculty who prioritize research and innovation. This is demonstrated by UMSOD being the managing director of the MPWRM Resource Center mentioned previously. In the DDS Class of 2023, a group of students formed the Michigan Dental Device Club (MDDC), a student organization focused on informing the UMSOD community on next-generation dental devices and educating them on the biodesign process. However, outside of the dental school, Michigan students also have access to programs such as the Medical Device Sandbox (MDS) program, a workshop where healthcare providers are put through exercises to redesign medical devices or solve unmet clinical needs. 

The University of Pennsylvania School of Dental Medicine (UPenn) is another forward-thinking university that offers its students the opportunity to dual enroll in most graduate departments with no additional time or cost. Two dual-enrollment options that demonstrate this commitment to dental innovation are an option for a Master of Science in Bioengineering, fully funded by Penn Dental, and a Master of Science in Translational Research through the Perlmann School of Medicine. Additionally, Penn actively seeks to bridge engineering and dental medicine through their Center for Innovation & Precision Dentistry. This center consists of experts from Penn Dental Medicine and Penn’s School of Engineering and Applied Sciences dedicated to advancing oral healthcare through engineering, biotechnological and computational approaches.

DISCUSSION

Dental schools are vehicles of innovation. Graduates are not only proficient at procedures but also in material science and biomechanics, which are staples in biomedical engineering (BME). Our unique skill set is not replicated in other medical education systems at the predoctoral level. This presents an opportunity for dental professionals to be advocates for the advancement of dental patient care. 

We see an opportunity for dental institutions to draw parallels from BME departments and capitalize on the engineering principles taught in dentistry. To graduate, American BME students must participate in capstone design projects to solve unmet clinical needs by developing a medical device prototype with a client or clinician⁶. Some BME programs, such as the University of Michigan, have opportunities for their students to identify needs in a hospital setting before beginning their capstones. At the end of their project, many students go into industry to help develop medical devices, and some go on to commercialize their prototypes in spin-off companies. 

The first year of dental school presents an opportune moment where students do not yet have any clinical biases and thus may be able to identify previously ignored clinical needs. We believe that this is a perfect opportunity to introduce students to biodesign principles, specifically needs finding and problem framing. When students are exposed to a multidisciplinary team or get involved early in designing and implementing new technologies, companies such as LightForce Orthodontics and Overjet are produced. Both founders were exposed to the product development process and had access to professionals across various areas of expertise through Harvard’s i-Labs. Neocis, the third company mentioned in this paper, was founded by an engineer who was largely influenced by his father, an endodontist, and a close family friend, a general dentist. By having clinicians involved at the early stages of ideation, a need to augment a skilled surgeon’s ability to place dental implants with a high degree of accuracy and precision was identified. Without their input, dentistry may have been overlooked as an avenue to apply the use of robotics. These three companies demonstrate that dentists and engineers can not only work together really well, but they are fit to work together.

The five schools mentioned in this paper have strong components to create an educational system conducive to innovation. Boston University has formed formal industry alliances by including key opinion leaders in the Dean’s advisory board to help identify additional new technologies. CUCDM actively implements Big Data and A.I. to analyze diverse and massive EHR data, which helps identify previously unforeseen problems. Harvard University provides diverse curricula options and actively markets resources such as their i-Labs facility to their dental students. UMSOD offers the Michigan Dental Device Club, where both faculty and students are taught elements of needs finding and problem framing. UPenn exposes students to unconventional, interdisciplinary collaborations and funds dual-degree programs enriching them in diverse ways of thought. Additionally, university coalitions such as the MPWRM Resource Center and C-DOCTOR help clinicians and researchers to commercialize high-impact clinical innovations.

The Stanford Biodesign Innovation process is a teaching methodology used to increase medical device innovation⁷. The first step in this process requires a multidisciplinary team of scientists, clinicians, and engineers to immerse themselves in a clinical environment to identify potential unmet clinical needs. From this needs-driven approach, potential solutions are developed, as opposed to adapting a promising technology into solving a need⁸. Throughout the ideation and conceptualization of the device, clinicians provide valuable input on the prototype’s feasibility, potential to treat the disease, and ability to integrate into the current workflow⁹. We believe that teaching this design process at dental schools would be extremely beneficial. This could be accomplished through an elective class series, 4-year pathway program, or student organizations similar to the MDDC. An alternative would be to develop a school dedicated to the biodesign process similar to the Carle Illinois College of Medicine, a school with an engineering-based curriculum.

Dentistry is a rapidly changing, innovative field suited for the application of a disciplined innovation curriculum. Data indicates that people exposed to the biodesign process have been productive in inventing new technologies translated into patient care¹⁰. By reproducing elements of the biodesign process at all dental schools, education leaders can accelerate advancements and better patient care. We hope this paper encourages dental educators to institute programs dedicated to oral technology commercialization.

Acknowledgment: The authors thank Robert M. Eber, DDS, MS, for mentoring us through this process and for his general support and feedback.

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