Can the next generation of dental robots bring a better smile to your face?

I was asked last week - "Steve - why have you expanded into dental robotics? That's a very tough market and robots don't do well." I had some down time so thought I'd try and explain what has me excited about this emerging space. Just my own opinions and only what I think.

The question comes as people see that the only robotics company I've joined the board of (to date) is Lupin Dental - where I sit as a board industry advisor. And the comment about "Robots being tough" seems to centre around some misconceptions about existing dental robots - or Robot. As currently there is only one option which is YOMI by Neocis .

No matter which dental professionals I talk to - be it DSOs (Dental Service Organisations), Dentists, or industry implant teams - I get the same response when I talk about YOMI.

"Ah it just adds expense to an already expensive procedure that has very thin margins. The dentist would need to charge the patients a lot more to have a robotic implant."

Okay let me explain a few things. When we talk about implants - let's think about (for the lay industry) when you drill into the jaw bone to place a screw to fix a dental implant to "A false tooth." - Sorry I'm speaking in basic terms as not everyone fully understands dentistry.

But it is in some ways the moral equivalent of a spinal pedicle screw. And getting that screw in the right place in both cases) to the right depth is important for a good functional outcome. Today much of this has been done by hand drilling (carpentry craftsmanship) and then we've moved to navigation systems (feel like spine?) with planning tools. And this has led to better accuracy - better physiological outcomes. (so some data says.)

YOMI takes this one further by using a robotic arm to control the implant procedure to a finer level based upon pre planned navigation. And much like spine robots it improves accuracy for the "less accurate" dentists out there.

The push back has been that it adds a level of complexity and cost for minimal gains in patient outcomes. Which I could write here and challenge a little - but I'm not going to die on this hill today. Because I'm interested in the next generation of robots. Dental robots are coming and it's going to become more wide spread.

A second, newer system is in development called Perceptive Technologies which is pre-clinical with a robot that is using its robotic arm to do more than "create a robotic jig." (as robots are often described to me.)

Perceptive is using a planning tool with AI to do "Tooth prep" for implantology. Basically they mill your native tooth to prepare it for receiving a crown. And if you've had a crown you know that the hand held drill rubs away your tooth to prepare a "stump" foundation. But again - that's based on the hand skill of the dentists. (dentist are hating my descriptions here I know - but most people that read this, like me, are not dental experts.)

"But you can also do that by hand..." I hear many cry. Well those that are into tooth prep may say that. And yes you can. But now we start to get into benefits of the robots. Both for YOMI and for Perceptive. By matching up the planning software and the motion of the arm of the robot - you start to improve accuracy. Let me give you some numbers that will mean nothing to most of us but it shows order of magnitude.

Hand held milling - prep - (burrs which is the little spinning bit on the drill) is between 1000 and 800 microns at best. And that rubbing away of the tooth is just down to the dentists following whatever pattern they want to try and get to the final shape of the milled tooth. Not repeatable - not super accurate - and not for every skill level of dentist to get it "good."

Instead with the robot, which is acting like a very cool, CNC machine (look it up) - the arm follows a predicted and programmed pattern and leaves the tooth milled to an accuracy of about 100 Microns (10X improvement) and it is the exact PRE PLANNED form of the tooth that is left. It's systematic - it's robotic.

So with hand held - the dentist would have to make an impression and make a mock up of the crown to make sure that the "lock and key" where the crown attached to the tooth - are as matched as possible. And that then requires that impression to be sent off to a dental lab to make your crown to your tooth - and that means a week or so with a temporary crown - and then a second procedure (hold that though) to come back and have the real deal fitted after it has been made. And well that second visit is expense to the dentist office and comes out of the profit - just like the impression and temporary crown.

So what has the robot done? Well first because it follows a precise - pre planned - perfect milling pattern based on that patient's tooth combined with AI. The process becomes way way faster. Instead of up to an hour of prep - this system claims to get that down to about 15 minutes.

Second the finished tooth shape is known way before the procedure happens - so the "Lock" is known so the "Key" can be made ahead of the procedure. The crown and tooth are going to mate up perfectly (better result) but also (and this is the biggie for the patient and the office) it all happens in one - way shorter visit - with a way better final result - for EVERY dentist - independent of their skill.

So we start to see bigger and bigger advantages to dentists and the economics of the dental office. In the old way - 2 visits - a few hours - impressions - temporary crowns - refitting - and all of that eats profit.

With Perceptive - 15 mins prep - and the crown fits to perfection in that same sitting. 1 visit - no temporaries - and way better results (the lock n key will last longer and bond better.) But you can charge the same if not more - for the robot effect. So basically you can take your current business and make it more profitable (in theory) by adding in the robot.

The balance will be the cost of the robot compared to improved profit (Because the dentist already does these procedures manually) - but hey even at a net net zero if that means you can market "faster - 1 sitting robotic crowns" -- it's a winner as you could attract more patients. Important for dental offices and DSOs.

But that helps with the existing business and margins. Can this be applied to something that few dentists can do today, and create them an actual new profit centre?

This is where we step into the world of Lupin Dental and by bonding super thin ceramic or composite veneers to the front of the tooth they get perfect alignment, colour and shape. Basically it is one of the fastest growing areas in dentistry. But doing it well is a whole level of craftsmanship up from tooth prep for crowns.

Now this is a not the multiple crowns onto tooth pegs that are often thought of. This is a form or micro dentistry at the sub 100 micron level.

Let me get into this - and it will all become clear. If I'm going to add these thin slivers of ceramic to the front of the teeth - if I just stick them, on (no prep) then I will basically bulk up the teeth and it will look odd, feel odd and not be functionally physiologic.

So what has to happen - is that the enamel of the tooth needs de-bulking - or milling to reduce the tooth thickness by microns - so that the veneers fit flush and give a natural and physiological finish. The ultimate concept is that the patient would not know they are even wearing these veneers.

Part of the issue is the tooth morphology means that you can't just take the same amount of enamel off all areas of the tooth.

This is finessed craftsmanship at its finest - and getting ten teeth milled to 100 micron accuracy with complex patterns so that there is a perfect fit to veneers is - well just for the few. It also takes a long time (2 hours) to get each tooth prepped (so that the veneers will last). And if you go too deep you get pain. If you don't take enough from the right spot you get bulk. It's a real Goldilocks art.

In hand veneers - Once the prep is done - a mold of the teeth must be done (for each tooth) to make sure that the veneers are then made tooth by tooth so the back of the veneer fits exactly to the prepped surface of the tooth. You can't have gaps. And imagine - hand done - it is not going to be geometrically perfect. That means two or three dental visits - and hours of prep work and fitting.

You have to do an impression of the teeth and send people away with "mock" veneers while the real ones are off being prepped but the dental lab.

Step up the robot. Now if ever a robot brings immense accuracy and repeatability - it is in this sort of application. The robot can follow a pre planned, custom design for each tooth of each patient - and follow the contour - taking more off this part of the tooth - less off this. In bold - accurate - first pass movements. It's what robots do very well. It's what Lupin is designed to do.

So not only does the robot do better - more accurate prep in single passes - following perfect tooth plans - it does that way faster and more accurately than most people can do. In fact most dentists cannot get to the accuracy needed to make good veneers procedures (important part) so they do not offer them.

And.. let us not forget that lock and key accuracy. The veneers can now be made ready before the tooth prep is even done - so the robot offers the tantalising opportunity for single sitting prep and bonding. Only possible with a robot's accuracy.

This is where the next generation of dental robots - unlike surgery - have transformative economics. Because many dentists, offices and DSOs would love to offer veneers. Why? Because they are self pay - out of pocket high value procedures that are growing in demand. If you as an office cannot offer them... you are basically throwing away business and profit.

Look how many dentists offer Invisiline by Align Technology or the 3M version by Solventum - dental aligners. Huge huge businesses that are growing in demand. Because people want that "Hollywood" smile. Well Aligners are just part of the story - and often to get the surface of the teeth to be as good as the alignment - you need to augment with veneers.

Often the block to offering this servce is the dentist's ability to perform the prep at the level needed. But now with the robot - you get transformative economics because the DSO, or Dentist can now offer lucrative veneers. And they offer a 1 sitting service with higher accuracy, better fit and faster procedures. All controlled by a robot. This can literally double the EBITDA of a dentists office.

But beyond the profit - it means that patients can get those in demand veneers at top quality - by any dentist in any town. It is no longer the reserve of the few - or a choice to have terrible blocks of crowns that are marketed as veneers. Patients can feel confident with the real deal.

When we think of dental robots - we have to not map them onto surgical robots - especially spine robots. The technology is comparable - the economics is nothing even close to related. Different markets, different motivators, different volumes, different payment systems, different in every way.

For me it is obvious why this is not another "surgical robot." And why I've got involved. It's a transformative robot that can bring huge quality of life to millions of people. It's different.

So I hope this has answered somewhat the question of "Why did you choose Lupin?" Hopefully now it is obvious why I think next generation - Lupin / Perceptive dental robots are a next frontier in healthcare robotics. And hope you also find this an exciting area to follow.

These are opinions of the author for educational purposes only. They are not the opinions of the companies. Some of these robots are not yet commercially available. Lots of the benefits are theoretical and not yet proven clinically. All trademarks remain the property of their respective companies.