Locally-made digital-age dentistry device exceeds expectations
A team of Thai researchers has developed a computerized tomography (CT) scanner capable of taking high-quality images of the interior of patients’ heads, and the device is proving to be so successful that the project from which it sprang is said to have exceeded expectations.
The machine, called DentiiScan, is being used more and more widely, making dental implants easier, reducing expensive imports, and ensuring equal access to quality treatment for Thai people living in cities or rural areas.
The research and development project that created DentiiScan began with concern that good dental health often required dental implants, and the cost of these was too high for poorer patients.
- BodiiRay: Digital x-ray machines by Thai innovators play vital role in COVID-19 crisis
- Captioning service gives deaf people access to information
It involved a complex pooling of resources by four government research agencies: the National Electronics and Computer Technology Center (NECTEC), the National Metal and Materials Technology Center (MTEC), the Assistive Technology and Medical Devices Research Center (A-MED), and the National Science and Technology Development Agency (NSTDA).
The Director of A-MED, Professor Dr. Pairash Thajchayapong, who is also a senior adviser to NSTDA, worked at the heart of the project with researchers from NECTEC and MTEC. The team succeeded first in writing an algorithm for a CT scanner capable of scanning a human head, after which Dr. Pairash requested research funding of Bt10 million from the NSTDA.
His team went on to invent the first DentiiScan, which was capable of taking images of the interior of the body with high resolution. It also met exacting standards for medical devices, including tests for x-ray radiation limits under Thai law at the Electrical and Electronic Products Testing Center, ISO 13485 standards for medical devices, and TÜV SÜD testing, to prove its compliance with international standards.
After successful human testing, the machine was first used on a real patient by Associate Professor Dr. Pathawee Khongkhunthian, at Chiang Mai University’s Faculty of Dentistry.
Later, 10 more DentiiScan machines were built, and in 2018, the Minister of Higher Education, Science, Research and Innovation, Dr. Suvit Maesincee, allocated state funds for the production of 50 more machines. After that, permission was granted to private companies wishing to build DentiiScan machines and, according to Dr. Pairash, these are working very well.
Dr. Pairash says his inspiration for creating the machine dated back more than 30 years, when he was studying digital signal processing. Later, while teaching at King Mongkut’s Institute of Technology Ladkrabang, he and a team of students produced a basic CT scanner that was capable of taking images of a mouse and its internal organs. The project won him an Outstanding Technologist Award.
“We were aware [at the time] that the project could not develop further, partly because of a lack of funds. Besides, our scanner’s best ability was taking images of a mouse, and not a human,” Dr. Pairash recalls.
Later, he became the founder and first head of NECTEC, Director of the NSTDA, and finally Permanent Secretary of the Science and Technology Ministry. In the course of his work, he found that there were cone-beam CT scanners on the market for use in dental implants, and his interest in developing a Thai machine to perform the same function was rekindled.
He regards the outcome with pride. “DentiiScan is a very good platform. Up to 50 or 60 machines have been produced and have been used more than 13,000 times, to make almost 3,000 dental implants.”
In addition to developing the DentiiScan, Dr. Pairash has a parallel project to train 500 dentists and dentistry personnel in dental implants, using 3,000 viewing sets operating through a dentistry digital platform.
Potential expanding beyond dentistry
In addition to facilitating dental implants, the locally-made DentiiScan has other uses, such as imaging human skulls. Dr. Pairash said a doctor at Phrae Hospital found that his treatment of a patient whose jaw was broken in a motorcycle accident was hindered by the limited two-dimensional capacity of an ordinary x-ray machine. So he turned to DentiiScan, which was capable of giving him a three-dimensional image, enabling him to locate the problematic spot that required treatment.
DentiiScan can also be used to assist a sister device called MobiiScan in correctional surgery for facial and skull deformations, such as cleft lip and palate. MobiiScan is similar to DentiiScan, but is mobile, and can be moved easily to different operating theatres.
“People ask why we didn’t produce more,” Dr. Pairash says. “We wanted to do so, but the problem is our machine can scan the whole head — and not just the teeth — so it suits large hospitals [with a range of demands]. In the future we may make a smaller device with a lower price that can be used for teeth only. It may bring better impacts.”
A Thai innovation with many winning qualities
DentiiScan is a computerized three-dimensional x-ray machine for dentistry as well as oral and facial surgery. Its development has involved deep research, the design of mechanical and electrical systems, and the creation of software applications.
Senior A-MED Researcher Dr. Saowapak Thongvigitmanee says there are currently two DentiiScan models — 1.1 and 2.0. The devices are installed at about 60 locations and have been used more than 15,000 times.
DentiiScan works with a flat panel detector revolving overhead while x-raying. Raw data from two-dimensional images is then used to create three-dimensional profiling of the patient’s oral cavity. The resulting panoramic profiles can be used in disease analysis or planning for dental implants, as well as treatment of oral tumours or cancer and abnormalities of the jaw or sinuses.
An A-MED Senior Engineer for Medical Imaging Systems, Atthasak Kiang-ia, says the DentiiScan model 2.0 is about half the size of model 1.1, but is more efficient. The later model also produces better images due to more stable detector rotation and emits less radiation.
The DentiiScan models comply with the ISO 13485 standard for design and manufacture of medical devices, as well as the Department of Medical Science’s radiation safety standards.
“It’s rather difficult to pass the standard requirements for medical devices. We needed additional study and development,” Atthasak says.
Saowapak points out that the DentiiScan research team has continued to make improvements, even after the transfer of know-how on manufacturing and maintenance to private companies. For example, with upgraded software, the time spent on processing 3D profiles is reduced from two and a half minutes — comparable to imported devices — to only 18 seconds.
Also, the 3D imaging software can be used through a cloud system, which allows the dentist to view the images from any place.
Software boosts DentiiScan as a digital-age device
Without good software, DentiiScan would be an incomplete scanner. Therefore, the research team has developed supporting systems that connect with DentiiScan machines, called RadiiView and DentiPlan.
An A-MED researcher working on these systems, Dr Walita Narkbuakaew, describes RadiiView as a cloud-based application capable of displaying 3D images from DentiiScan. It allows dentists to access these images at any time and from any place, after ID verification. Users can access RadiiView through their smartphones, tablets or computers without having to install any software on their devices.
The scan data in the cloud system can be accessed by the patient’s registered doctors, who are notified of its availability by email. The images may be viewed online or downloaded for later diagnosis.
“The doctors may view scanned images from different angles, in real time,” Walita says, adding that DentiiScan images are in the DICOM (digital imaging and communications in medicine) format, ready for use as a surgical guide.
She adds that DentiPlan is a desktop software application that facilitates planning for dental implant surgery.
Advancing towards the goal of a digital dentistry platform
The research team regards the development of DentiiScan for hospitals throughout the country as just the beginning of something much bigger. It aims to create a digital dentistry platform – something that doesn’t yet exist in Thailand. The country has e-commerce platforms that connect shops, transport and other service industries to form ecosystems, but it has no equivalent for medical purposes, connecting hospitals and private companies capable of producing dentistry-related devices.
The Head Researcher of A-MED’s Assistive Technology and Accessibility for All team, Dr. Natthanan Thatphithakkun, says development of a digital dentistry platform has been hindered by legal requirements under the Personal Data Protection Act (PDPA). Such a platform, he says, needs a cloud system that is highly secure.
The system must also be customizable in relation to designs, placing orders, confirmation and production checks. People outside of medical circles are unfamiliar with those processes, and they are a time-consuming task for outsourced companies. Moreover, there is concern over privacy and data security.
However, a digital platform will get rid of all of these obstacles as CT scanned images are stored securely and accessed through a cloud system, with prior consent from the patients involved.
“In the planned structure, all orders for digital management will be listed by a hospital. The officials involved will see from where the orders are placed. The system will also separate orders from inside and outside of the hospital,” Dr. Natthanan says.
The Principal Researcher of A-MED’s Integrated Medical Technologies team, Dr. Kriskrai Sitthiseripratip, says the relevant research teams aim to push for a digital dentistry platform that is acceptable nationwide by doctors and Thai people.
Dr. Kriskrai also points to another advantage of the developing systems. In the past, dentists performed dental implants manually, but many of them are now open to 3D analysis. The next step is to use DrillGuide for accuracy and precision. The goal is to design dental crowns and bridges that fit completely.
“We train dentists in the use of technologies developed by Thais. Some digital technologies may be integrated to achieve the required quality for dental implants and crowns,” Kriskrai says.
He notes that Thailand is becoming an ageing society. People aged 40 to 50 have at least one dental implant and they now tend to want more. Therefore, investment in this technology will benefit the elderly in Thailand. At present, dental implants are limited to middle-class Thai patients as they cost Bt30,000 to Bt50,000 each. If the cost is reduced to Bt25,000 or Bt15,000, people in lower income brackets will be able to access the technology.
Moreover, Thailand is well known for medical tourism and many foreigners fly into the kingdom for dental implants. The locally-developed technologies are expected to help to promote Thailand internationally as a hub for medical and dentistry services.
“We have worked with the private sector on technology transfers involving DentiiScan and DrillGuide, as well as the future platform. Our corporate partners, who meet the standards for medical devices, serve as a link to the regional and private sectors. We expect to see technological growth in the future, with greater access for Thais,” Kriskrai says.
His colleague, Dr. Natthanan, goes further: “We envision an e-marketplace for dentistry in the future. Production of [dentistry] items is often personally customized, and companies that produce these products will be on the increase. We are thinking of creating a marketplace for dentistry products and tools,” he says.
Hopes that DentiiScan will expand opportunities for Thais
Use of DentiiScan means that Thai people living in rural areas no longer have to seek treatment in Bangkok or regional cities. It helps them to access modern technology, reduces inequality between patients and improves their quality of life.
Senior A-MED researcher Saowapak is full of praise for Thailand’s success in producing advanced medical devices like DentiiScan, saying that this creates jobs and income and reduces the country’s dependence on imported technologies.
“We didn’t expect the DentiiScan project to expand this much,” she says. “We are happy that the machines are installed in as many as 60 places and are still in use. The development began in 2007 and the first machine was made in 2011. That very first machine is still working.
“Private companies are producing more machines for the sake of sustainability. We expect to see more acceptance and support from Thai society regarding Thai innovations.”
Atthasak says his team is proud to have been a part of DentiiScan’s development. “The machine was born of multiple disciplines — mechanical, electrical, control systems and software. The big challenge was teamwork,” he adds.
Dentists point to DentiiScan’s many benefits
Unlike many research works, DentiiScan and its accompanying dentistry management software have proven to be both practical and beneficial.
The director of Chiang Mai University’s Center of Excellence in Dental Implantology – and DentiiScan’s first real user – Dr. Pathawee, says that DentiiScan can produce clear, high-quality images comparable to those of imported equivalents. Due to its advanced technology, the machine can help dentists and patients with improved planning of treatments.
Dental implants are the best alternative for replacing original teeth, with a success rate of 97 to 98 per cent — much higher than false teeth in the form of dental bridges.
For patients who lose most of their natural teeth, dental implants keep their dentures firmly fixed, ensure efficiency in chewing food and prevent embarrassments caused by loose plates.
“The machine is made in Thailand, so patients at the Center of Excellence in Dental Implantology are not charged when it is used. Normally, the X-ray charge is thousands of baht per use,” Dr. Pathawee says.
Dentist Gunniga Sumanont from Khon Kaen Hospital says a DentiiScan machine was installed at the hospital’s Radiology Department in May 2019. The machine has since been used for 3D imaging in many cases of treatment in the oral and facial areas.
“There have been no complaints from radiologists after almost two years of use. The images are clear and they can be recorded on CD or sent to the cloud,” she says.
Dentist Peerapong Janpoom from Huai Yot Hospital in Trang province says radiologists are “very pleased” with DentiiScan after having used it for more than two years.
“When compared to foreign-made machines, DentiiScan works like an imported device, with high quality. It scans accurately and the images are clear. Also, you can view the files on a smartphone.”
Dentist Piyanan Kuasakul, from Bangkok’s Vajira Hospital, says DentiiScan has been used in some 40 cases at the hospital, and it has proven easy to use. The software RadiiView allows dentists to view images from anywhere and DentiPlan helps them measure accurately when planning treatments.
“When planning dental implants with 2D images, we had to calculate estimates, but this device uses a digital platform that makes the work faster and more accurate. This, in turn, boosts the dentist’s confidence,” he says.
Piyanan expresses gratitude to the DentiiScan researchers for making “this good tool” for Thailand. He suggests adding more dentistry capabilities, such as orthodontics, where braces are installed to overcome irregularities.
Gunniga says that DentiiScan makes dental implants easier and more affordable, and calls for further improvements in the ease of use and higher resolution images for certain cases.
“At present, DentiiScan is mainly used in dentistry, but we plan to discuss it with doctors in other branches of medicine, such as surgery and intensive care, so that they can use the machine in diagnoses,” Peerapong says.
Dr. Pathawee points to the benefits of the project, including new technological know-how for dentists, better access to dentistry services for patients in rural areas, and reduced inequality regarding treatments with advanced technology.
He adds that doctors can also share their knowledge and experience in using new treatment techniques through the digital platform.
“Eventually, we will gain enough big data to develop artificial intelligence to help with specific health plans for people in different areas. This will be a huge benefit,” he says.
Private sector reinforces the manufacturing
Commercial production of prototypes arising from state-funded research requires the involvement of private companies through technology transfers.
Pixamed Co Ltd has gained the right to manufacture and market DentiiScan devices, based on the NSTDA blueprint. The company also offers maintenance services and training in how to use the machine.
“We can produce four machines a month, and so far we have made 57. They are completely made and tested in Thailand,” says Pixamed’s General Manager Pinyo Yampri.
Building sustainable knowledge
Pinyo says his company has the obligation to support Thai research works, and in his view, DentiiScan represents Thailand’s success in building advanced technology that reduces reliance on imported innovations.
“Imported products are accepted as good, but it’s better to have Thai products with comparable quality. The NSTDA still has many other projects [with commercial potential],” Pinyo says.
He urges more support for projects that turn Thai research into commercial products. “Let’s make Thai people feel good about buying Thai products. We should encourage the materialization of our knowledge, and enjoy sustainable growth together.”
