Dentsply Sirona

www.dentsplysirona.com

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Jeremy Booth, Dental Tribune International

Fri. 9. August 2024

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Many dentists will be surprised to learn that a new dental imaging tool is set to revolutionise dental diagnostics. A prototype magnetic resonance imaging (MRI) device for dental indications was unveiled in Germany in June by collaborators Dentsply Sirona and Siemens Healthineers. The planned MAGNETOM Free.Max Dental Edition* will not use ionising radiation and will potentially allow dentists to visualise inflammation and soft tissue in the mouth. This could allow clinicians to see periodontal disease and other oral diseases before they manifest visually in radiographs or CBCT scans. In this interview, Andreas Schneck, head of MRI at Siemens Healthineers, and Max Milz, group vice president of connected technology solutions at Dentsply Sirona, describe the journey of developing an MRI device specifically for dentistry and comment on a new future in dental diagnostics.

When and how did the collaboration begin?
Milz: This scientific collaboration started more than three years ago and was based on the connections and shared trust between the companies. Years ago, Sirona tried to bring MRI into dentistry, but the effort was aborted; however, the knowledge of what would be needed for MRI to make sense in dentistry remained. When bringing a new technology into dentistry, it often helps to build on what has been done in general medicine. Siemens Healthineers is the leader in MRI, and some really interesting technological innovations showed us that it would be possible, with a few necessary adaptations. It was within this framework that the meeting of minds took place. We had great technology, the necessary dental know-how, a general interest in bringing this to the market and access to universities and key opinion leaders interested in doing research in this area. It became about combining the strengths of the two companies to explore something new.

Schneck: Siemens Healthineers is the global leader in MRI and we constantly assess the market and ask ourselves where we want to grow and what the areas are in which patients could also benefit from MRI. We aspired to have more patient touchpoints and to expand our footprint not only geographically but also clinically. The idea had already been triggered by our earlier discussions with Sirona, and this helped both sides to come together and decide to make that actual proof point, expanding the reach of MRI and bringing it into dentistry.

The planned MAGNETOM Free.Max Dental Edition will not use ionising radiation and could allow dentists to visualise inflammation and soft tissue in the mouth. (Image: Dentsply Sirona/Siemens Healthineers)

What were some of the challenges that the team had to overcome?
Schneck: On the technological side, the development of the new receiver coil [which captures the signals emitted by the tissue during scanning] required some alterations. It seems rather simple, but quite a lot of know-how and technology went into it in order to tailor it to dental use, to make it patient-friendly and to align it with image quality requirements. Challenges like this are a normal part of the development process.

Milz: I would add that, when bringing something from a different field into dentistry, you notice that people speak different languages. Siemens Healthineers engineers are trained to help radiologists, and they use a lot of the same lingo. Dentists think differently and talk differently, and it was sometimes necessary to “translate”. A second challenge was taking a technology and applying it to dental use. This is important from a procedural perspective and from a patient experience perspective. A patient who has damaged his or her spine, for example, will have different expectations from an MRI than a patient who has a problem in his or her mouth will have. How do you make it suitable for this particular ecosystem? This was challenging from a technological perspective and in terms of the technology’s application.

What can you tell us about the development process?
Milz: People love working on something that is truly new, and often they are willing to go the extra mile and bring a sense of excitement to it. The prior development of the MAGNETOM Free.Max inadvertently resolved quite a few of the challenges that future dental users may have faced. It is a great machine to apply to dentistry, but one of the constraints in a clinical dental setting is infrastructure. How heavy and how large can the machine be? Do you need a quench pipe? What are the other infrastructure requirements? Serendipitously perhaps, it just so happened that the platform had already resolved some of those issues.

Schneck: It was a timely coincidence, because we developed the MAGNETOM Free.Max with the intention of breaking barriers to wider adoption of MRI. It turned out that certain barriers are the same across disciplines. A private radiologist operating in a remote or under-resourced area benefits from fewer infrastructure requirements—not needing to build that quench pipe, for example—and this line of thinking also inspired us to create simplified workflows, which are a key part of the MAGNETOM Free.Max. This provided us with a good starting point to say, “Hey, if we did this for standard radiology, what more can we do to tailor it to the specific needs of the dental community?” It gave us a foundation upon which we could build and develop a dedicated MAGNETOM Free.Max Dental Edition.

How do you think this technology will change dental diagnostics?
Milz: My long-term vision is to create a digital twin of the mouth that really brings the different modalities together. I believe that, in the future, when patients go to the dentist, they will always receive a radiation-free intra-oral scan. Depending on their oral health, they may have a radiograph, a CBCT image or an MRI scan taken. In this way, dentists will start creating a complete digital record of the mouth, allowing them to reach a different standard of care. The dentist should be the steward of the oral health of a patient, and these images are really a key part of this. It is not just about creating visual records and comparing them to see what has changed. In the future, these technologies will also leverage artificial intelligence and machine learning so that clinicians can actually make projections about what might happen. MRI is particularly interesting in this sense because it can provide early indications of oral health problems.

Schneck: MRI has proved its value not only by providing soft-tissue imaging to detect these subtle changes but also by providing information partially on the cellular or even metabolic level. MRI is well qualified to identify the early onset of oral disease, and the fact that it does not use ionising radiation makes it an excellent diagnostic tool. When we consider the future standard of care, MRI may not be used for all patients, but the majority will receive an initial screening examination that can be repeated at future appointments to make sure that dentists have the latest status on potential early onset of disease. That image database will support the patient’s lifelong oral health. I think that MRI has a lot to offer!

“My long-term vision is to create a digital twin of the mouth that really brings the different modalities together.”—Max Milz, Dentsply Sirona

What is required to get this technology into dental settings?
Milz: I think that Prof. Donald Tyndall would have something to add here, given that we see many parallels to the introduction of CBCT. On the one hand, there is the science, in terms of the indications for which MRI will be the most useful; on the other hand, it becomes about dental curricula. How do you train and educate dentists on what they see in an MRI image? How do they look at it? What is relevant? What is not relevant? I think that the key now is to take this technology into university clinics, to do the research and develop the protocols.

Schneck: Universities are very well suited to be the first market segment because they tend to embrace new technologies from a scientific perspective and are interested in working with them. They will also be the ones to introduce dental MRI to curricula. This follows the analogy for the introduction of CBCT and is something that we hope to duplicate. Dentsply Sirona’s connections to universities will be of the utmost importance. With proper education and curricula, training dentists to use an MRI scanner will support adoption of the technology.

Milz: The most interested pioneers are usually, firstly, universities and, secondly, students new to the field. They want to work on the latest and greatest, to say: “Hey, here’s something new. Let me see what can be done with it.” From there, we envisage a natural evolution to dental support organisations, the next step for most US dental graduates, and finally to private practices.

Where to now for the collaboration, and when will the device be available?
Milz: Dentsply Sirona will be the exclusive sales and marketing agent for the system to dental schools. This is the first step, and obviously, the proof of the pudding remains to be seen. Will people actually buy it and use it? The technology will be available for sale very soon, and some universities are already saying that they want to buy it, so we believe there is good market potential. The next step is commercialisation, because, at the end of the day, we are two companies that make a living from selling equipment and technology in the medical space.

Schneck: We see this as just the start of our collaboration. We are bringing MRI into the dental industry, and there will be new requirements and new insights. Even on this kind of platform, there will be demands to change things, to adapt the workflow. There will be scientific collaborations, where we work together to modify sequences. I foresee our collaboration to be the start of a longer journey that we will master together as partners, as we hopefully succeed in bringing the benefits of MRI into the dental space.

Milz: We needed to “crawl” before “walking”, and we have now reached the stage where we can walk with this technology and bring it to the dental world. Now confidently walking, we need to begin to “run” in order to make sure that this becomes as broadly used and as accessible as possible.

Schneck: In terms of the timeline, the prototype that we introduced at this event is being finalised as we speak. We expect to get the CE regulatory label for Europe by the end of this calendar year, and this will be followed by a clinical use test phase with several selected customers. Then we will go into serial delivery, starting from spring next year. We have a similar timeline for US Food and Drug Administration clearance, and we are aiming for commercial availability in the US around May. Customers will be able to place orders from July onwards. Dentsply Sirona has a tradition of being first and paving the way for clinical adoption, and the affinity that Siemens Healthineers has for innovation makes this an extremely powerful combination of two innovation and market leaders. It is not just a pure technology game. Ultimately, it about customer intimacy and familiarity with what matters in the dental community—and I think you need both to be successful.

Editorial note:

*The product is still under development and not commercially available. Its future availability cannot be ensured.