This article was exclusively written for The European Sting by Ms. I Mamoona Habib a 3rd year student studying BDS in Army Medical College, Pakistan. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.
Have you ever imagined a robot doing your restoration or root canal? Have you any idea about robots? What is a robot?
Robot is defined as “a machine that resembles a living creature in being capable of moving independently (as by walking or rolling on wheels) and performing complex actions (such as grasping and moving objects)”.
Robots, the most wonderful inventions of human beings have made its way into dentistry. The so called “phantoms” are being currently used for dental therapy training, consisting of a simple functional cephalic region and an arrangement of teeth.
Moreover, realistic human-like robots have been designed with advanced motion-capture technology. Showa Hanako a realistic robot, design to stimulate a number of typical patients gestures and responses. Geminoid-F and HRP-4 can mimic human facial expressions. (rawtiya m, 2014) (Bhat B D, 2017)
More effects are being put in micro endodontic and nano robot technologies. Upcoming years, these inventions will provide the most safer, accurate and reliable diagnosis and treatment for patients.
These machines will perform automatic probing, drilling, cleaning and filling of root-canals.
Artificial Intelligence (AI):
What is AI? It is defined as “a field of science and engineering concerned with the computational understanding of what is commonly called intelligent behavior and with the creation of artifacts that exhibit such behavior”. (Khanna SS, 2017) History dates back to as early as 400 BC when Plato envisaged a basic model of brain function. (Brickley MR, 1998) Since then, the field of science has witnessed various inventions with the advent of technology for creating a model that can stimulate the function of human brain. Artificial intelligence is capable of mimicking the function of human brain. Computer-based diagnosis is paving way for a holistic practice, AI is gaining momentum in the field of medicine and dentistry due to its ability to detect and diagnose lesions which may go unnoticed to the human eye.
AI and technologies:
Artificial Neural Networks, Genetic Algorithms, CDSS and fuzzy logic are various techniques of AI. These technologies are designed to assist the health care professionals to comprehend vast amounts of information more efficiently than human assistants and simultaneously bridge the gap between the doctor and the patient.
- CDSS:
The ongoing competition in research worldwide paved new ways to inventions and information. Many links are being identified between genes and susceptibility with dental diseases. Process of finding any relevant genetic information insighted into the accurate diagnoses and treatment of dental diseases. CDSS has become necessity in medicine and dentistry. Clinical decision support system (CDSS) consist of a network between a dynamic knowledge base and an inferencing mechanism that are usually a set of rules derived from evidence-based medicine by experts and they are implemented through medical logic modules based on a language such as Arden Syntax. (S, 2010)
- GA:
Genetic Algorithm mimics the process of natural evolution. Till the last decade, the most tedious part of this process was to enter structured information into the system but with the advent of voice recognition and the ability of artificial intelligence programs to identify and extract information from scanned paperwork, this process has been simplified. It is used to predict genetic disorders.
- Artificial Neural Networks(ANN):
Artificial neural networks are highly interconnected network of computer processors that help dental professionals to stay connected to their patients from all over the world.
Today there are many mobile applications like Mole Check App, Online DermClinic, Skin XM that helps the patients to identify malignant melanomas by comparing the pictures of lesions from around the world. (Kassianos, 2015)One of the most important breakthrough in this technology was brought about when in 1958, a psychologist, named Dr. Frank Rosenblatt developed Perceptron which worked on a multilayer feed forward mechanism. (F, 1958) Another breakthrough in this technology came when Paul Werbos in 1974 introduced “backpropagation” learning. Today these new technologies aid health care professionals all over the world to better understand diseases, to diagnose them early and to treat them effectively.
AI in dental education:
Since its inception in the 1980, the field of intelligent tutoring systems has come a long way. Incorporation of AI in tutoring systems like in the Unified Medical language system(ULMS), there is a huge improvement in the quality of feedback that the preclinical virtual patient provides the students.
It allows the students to evaluate their work and compare it to the ideal. Thus, creating high-quality training environments and to attain a competency based skill level at a faster rate than with traditional simulator units.
AI in the fields of dental industry:
Be it endodontics for apex location or implantology for making precise surgical guides and identifying type of bone to cortical thickness, AI has major role to play.
- In head-and-neck imaging:
AI is slowly nudging its head in the field of radiology. Lots of information can be gathered and computed to create an AI for aiding quick diagnoses and treatment planning, with more emphases on diagnostic records in terms of digital IOPS, three dimensional scans and Cone Beam Computed Tomography (CBCT). (SV, 2018) MRI used to identify minute deviations from conventionality that could have gone unnoticed to the human eye. This can also be used to accurately locate landmarks on radiographs; which can be used for cephalometric diagnoses.
- In the field of orthodontics:
In orthodontics diagnosis forms the core of the treatment. AI can perform analysis on radiographs and photographs that aid in diagnoses and treatment planning. Intra-oral scanners and digital cameras are replacing the conventional methods of taking dental impressions. These help dental health professionals in making an ideal impression and it also reduces the number of errors by eliminating the laboratory steps. This AI driven customized orthodontic treatment uses precise 3D scans and virtual modals that intelligently decides how a patients tooth or teeth should be moved, with how much pressure, even identifying pressure points for that particular tooth or teeth. (SV, 2018) These softwares not only aid in efficient treatment but also reduces treatment time as well as appointment schedules.
- In the field of restorative and prosthetic dentistry:
Restorative and prosthetic dentistry have acknowledged itself in the past few years. It has made its way in cosmetic and aesthetic industry. The use of computer-aided design computer-aided manufacturing (CADCAM) technology for precision and fit of prosthesis no doubt, is a breakthrough is the field of dentistry. But with innovation in generative adversarial networks, laboratories are using AI to automatically generate advanced dental restoration, designed to perfect fit and ideal function while exceeding aesthetic expectations. This not only will help dentistry but will have a huge potential and impact on orofacial or craniofacial prosthesis. (SV, 2018) Finally, one of the innovative applications of AI seen in the field of “bio printing”, where living tissue and even organs can be constructed in consecutive thin layers of cells which in the future may be used for reconstruction of oral hard and soft tissue lost due to pathological or accidental reasons.
- AI in the field of implantology and surgery:
One of the greatest applications of AI is in the field of oral and maxillofacial surgery with the advent of robotic surgery. AI software has helped plan surgeries to the smallest detail prior to the actual surgery. Today there are many robotic surgeons that perform semi-automated surgical tasks with increasing efficiency under the guidance of an expert surgeon.
Will AI replace dentists:
Although AI can assist in numerous ways, final call has to be made by a dentist as dentistry is a multidisciplinary approach. It can never replace the role of a dentist since clinical practice is not only about diagnosing but also correlating with clinical findings and proving personalized patient care.
Conclusion:
Applications of AI in everyday life are growing leaps and bounds. No doubt AI has pros of accuracy in diagnosis, standardization of procedures and it saves time but one should not close his eyes from the cons of these technologies. Hence, understanding the various concepts and technologies involved will have a clear advantage in the future when it is time to adapt to the change with redefined roles for a rewarding practice.
References:
. Khanna, S.S. and Dhaimade, P.A., 2017. Artificial intelligence: Transforming dentistry today. Indian J Basic Appl Med Res, 6(4), pp.161-7.
Bhat, B.D., Bhandary, S., Naik, R. and Shetty, D., 2017. Robotics in dentistry: Fiction or reality. Journal of Dental Research and Review, 4(3), p.67.
Brickley, M.R., Shepherd, J.P. and Armstrong, R.A., 1998. Neural networks: a new technique for development of decision support systems in dentistry. Journal of dentistry, 26(4), pp.305-309.
Deshmukh, S.V., 2018. Artificial intelligence in dentistry. Journal of the International Clinical Dental Research Organization, 10(2), p.47.
Kassianos, A.P., Emery, J.D., Murchie, P. and Walter, F.M., 2015. Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review. British Journal of Dermatology, 172(6), pp.1507-1518.
Rawtiya, M., Verma, K., Sethi, P. and Loomba, K., 2014. Application of robotics in dentistry. Indian J Dent Adv, 6(4), pp.1700-1706
Rosenblatt, F., 1958. The perceptron: a probabilistic model for information storage and organization in the brain. Psychological review, 65(6), p.386.
Russell, S. and Norvig, P., 2002. Artificial intelligence: a modern approach.
https://www.merriam-webster.com/dictionary/robots
About the author
I Mamoona Habib am studying in 3rd year BDS in Army Medical College.I am member of IFMSA SCOPH and Amcolians Alumni Association (AAA).I am also interested in research, also awarded with certificate for participating in an online workshop series conducted by SRF of Agha Khan University. Currently working on some research papers.I am also good at content writing and do poetry too.
COVID is an opportunity to re-orient the manufacturing strategy,of Pakistan – Part 1
1st some basic facts.
1stly,there is no material requirement of Pakistan,whose complete import can swing international prices,or create temporary shortages or warrant preniums.Thus,besides the Agri,defense and Nuke industry,no other industry is strategic.Until there is cross border
wheeling of power,from the North Pole to the South Pole,power will have to be produced in Pakistan – although that can also imported, at a far cheaper rate from Iran.
2ndly,when a nation makes some product,which can be imported at a far cheaper rate,it is essentially FORCING the users of that product,to pay a higher price,in the Billions of USD,so that other citizens of the importing nation,can be employed in those factories,and their supply chains.This is a conscious decision to keep humans occupied,and living from cheque to cheque,TDS to TDS,home loan to car loan etc.Else,people will revolt or be captivated and captured,by demagogues.Of Course the consumers,paying the higher price,have to clue about this sacrifice – as they are also,slaves to some car loan ponzi.
3rdly,Economies of Technological scale (based on latest technology that maximises yield and throughput and reduces wastages,losses, power and material requirement) will always exceed, by a huge margin,the economies of labour scale (which relies on technology,which leverages large numbers of low to medium paid labour).Exception is the Pakistan sports industry,which is labour driven and exports soccer balls etc.But that is because,no one is APPLYING HIS MIND, to Robotics in that area, and handcrafted products,are commaning a premium price,TODAY.Ultimately ROBOTS will take over,as there is no competition to 24 hours service (and no ESI and PF and Medical and other staff costs)
4thly,No matter what Pakistan does,no agri output produced by Pakistan,will have a COST OF PRODUCTION AT MANDI,which is even LESS THAN 150% of the CIF price of the imported product at KPT.In the future,USA and PRC (ignoring Africa),will be able to produce the ENTIRE FOOD OUTPUT,OF THE HUMANS AND ANIMALS AND SEA LIFE,at a cost, less than half of current costs, and in a time span of less than half,of what is takes today. However, the farmers have to be OCCUPIED and kept HAPPY,as else,they can overthrow any state, and easily get radicalised. The FACT is that,7 Billion humans COULD get food,at less than a fifth of the current prices (NOT COSTS),and double the quantity,that they eat today.They are suffering, to ensure that the farmers of North America, South America,LATAM, Russia, Australia are kept HAPPY,and that the farmers of INDIA do not hang from the trees and create a revolution. On principles of evolutionary perfection,farming is viable ONLY in nations with large land tracts and LOW DENSITY OF POPULATION.India is NOT in that GRID.PRC is in that grid,as it can CREATE LOW DENSITY OF POPULATION,AND ALSO,CREATE LARGE LAND TRACTS – as it is ruled by the CCP.
Fiftly,Unlike the Technology Exports services,all service sectors,hinge upon manufacturing. Manufacturing drives all else.Even a Technology Export sector,has to have a domestic anchor – which is contingent upon Manufacturing.A manufacturing plant brings to life,a society and its eco-system,and over few decades leads to large wealth creation,which primarily begins from land and real estate prices and ends with bank credit.So unlike the Isle of Man – there are no Manx companies in Pakistan – and so,manufacturing is critical.
So the Manufacturing Strategy,has to be created within the above pentagonia,based on the competitive and comparative advantages of the raw material supply chain NSIDE Pakistan – as also,the ECONOMIC costs of the raw materials,which are NOT AVAILABLE,INSIDE PAKISTAN.
COVID is an opportunity to re-orient the manufacturing strategy,of Pakistan – Part 2
The Manufacturing Matrix in Pakistan
Option 1 – The Pre-Requisite
Captive Raw Materials – For Captive Raw Materials in the Agri and Mining Sector,the State has to support the complete value addition of the product,near the source.These 2 cordinates,combined with Tax Holidays,will make it a viable venture,for any Foreign Capitalist – subject to Politiical Risk.Take the Sugar sector – for Political Risk – and so, only Pakistani Politicans,can set up Sugar Mills.
However, one needs to be practical here. Just because Pakistan has the best Cotton in the world (along with long staples, from Egypt),does not mean that yarn or fabric units, will be viable in Pakistan. Large Technologies of Scale, allow imported raw material from the Moon (like Helium),and still be viable. So there is no harm in exporting the cotton or some minerals. If the same technologies of scale, were set up in Pakistan – it will involve
large capital costs – and would accentuate the financial and politcal risk,of the project. And if it sinks,it will doom the Pakistani Banks (like in India).dindooohindoo
Pakistani Capital should be used where Pakistani has an exceptional edge,like in the Cement Sector (with complete maaterial and logistics integration).Another example is the Agri Processing,Foos and Agri Waste Insustry.These also provide large scale employment,as they have extensive supply and value chains.
Option 2 – Strategic Leverage
Some Manufacturing is required as a strategic leverage,to ensure that Pakistan is not coerced, in pricing,in international procurements.Therefore,there have to be sufficient capacities,in some critical sectors,like steel,oil,food,fertilisers etc. Howvever, this is an offset,to procurement price risk.If there is a Force Majeure event or a Trade embargo – then,there will be no raw material imports,in any case – and the fertiliser plants etc,will be mothballed.
Option 3 – Manufacturing Hydrogen for the Balloons
So let us say,you have floated a billion balloons,by importing hydrogen – and now, the balloons are used,for entertainment,space travel and advertisements. Next Step,is to manufacture the Hydrogen.Just like Pakistan,is sponsoring the manufacture of mobile phones and accessories,in Pakistan to STOP their imports,as it is a waste of USD and much cheaper to make.Just like the Auto sector,it is an assembly operation – and so,the capacities are modular for the phones and their parts.At any stage,of the manufacturing, any process can be outsourced to PRC,at any time,by IMPORTING the interemediate products.
Thus,there is large scale employment – with impact on entrepreneurship and tax revenues and FX savings and reduction in economic costs.
The Crux is to LET THE PRIVATE SECTOR EXPAND THE BALLON (THE MARKET).LET THEM USE ANY MEANS (SMUGGLING ETC.).Then when the supply chain,logistics,servicing,spares,maintenance,skilled and unskilled labour value chain,is in place – BRING IN MANUFACTURING OF THE PRODUCT.
Option 4- Manufacturing to Stop Smuggling
There are several imports into Pakistan where the market is highly matured and seasoned.No one likes to pay import duty.The Philosophy is,that the importer has spent time and monet to locate and hide the supplier,and is giving JOY to 200 million people,by selling cheaper and attractive products.If you travel to Yiwu or Guangzhou, you will find Pakistanis relabelling their cargos (to be shipped),so that competition CANNOT trace the supplier.They stuff the container far away from the port – drive it to the port – seal the container – and then,track it on GPS sites ! There is a large group of the Pakistani traders – as they carry large amounts of cash (which has to be stored and guarded) – as the suppliers are paid in cash – and since,there is no insurance or underinsurance, there is a lot of tension in the supply chain.
So Y Should they pay Import Duty ?
However,after the market in Pakistan,is seasoned and matured – the Pakistani state should ban imports,and allow manufacturing.The same importers can bring in the Chinese,as a JV into Pakistan.For FMCG and Consumer Goods,like Toys,Stationery etc.,all the raw materials, which are used in PRC,are available in Pakistan.Labour Cost in China is 10 times that of Pakistan.It is simple Maths
But the real gain is that – IT WILL BOOST GOVTT REVENUE.As the manufacture will leave a forensic trail,from power meters to pollution,and so,the state will earn large revenues which were lost before,and also save FX.
Option 5 – Manufacturing Intermediation
If you look at the state of pollution and effluents, in Karachi – it is a BAD and SAD situation. However,that is what has led to the COVID immunity in Pakistan.So the Good news just does not end.But this poisoning of the air,water,food,fish and meats – will take an incalculable toll on the intellectual,spiritual,social,sexual and physical evolution of Pakistanis.
Therefore,it is time to OUTSOURCE pollution,using Manufacturing Intermediation,by carrying out Manufacturihg from Intermediates.Hence,Pakistani manufacturing should use imported intermnediate products – wherein,all the poison,effluents and pollution,are in the exporting nation.PRC has the effluent treatment and waste recovery plants and dump sites on a scale,cost and technology,WHICH NO NATION IN THE WORLD HAS (not even the USA – as the USA,imposes a TAX,on storage of Hazardous Cargos).Of course,then COVID breaks out – but then,the PRC export it,and recover all the costs,of the effluent treatment.
Pakistani capital should be used where Pakistanis have an extraordinary advantage, such as in the cement sector (with full material and logistical integration). Another example is the agri-processing, foss, and agri-waste industry. They also provide large-scale employment, as their supply and value chain is wide. Some manufacturing is required as strategic leverage, to ensure that Pakistan is not forced into international procurement in pricing. Therefore, in some important fields, such as steel, oil, food, fertilizer, etc., it is necessary to have sufficient capabilities.