Second Opinion®: unlocking the AI advantage

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Pearl Second Opinion

Second Opinion® is bringing artificial intelligence directly into Australian dental practices. While the technology promises to help dentists improve diagnosis accuracy, responsibility for treatment decisions and patient care still lies with the practitioner. By Shane Conroy

Artificial intelligence (AI) has landed firmly in Australian dentistry. One of the leading pioneers of the technology is US-based dental AI developer Pearl. Launched in 2019 by Ophir Tanz, founder and former CEO of contextual advertising firm GumGum, and Dr Kyle Stanley, a practising dentist and founder of Light Side Dentistry, Pearl has made a global splash with its Second Opinion® platform. 

Second Opinion® received approval from the Therapeutic Goods Administration (TGA) in 2021 for use in Australia as an assistive tool in dental radiology, and is currently available to dental practices across the country. 

The software uses AI to assess patient radiologic images and deliver instant chairside detection of decay, infection, hard-to-spot issues like incipient caries, and the early signs of a periapical radiolucency, among other pathologies. It’s built on Pearl’s innovative computer vision technology. 

“Computer vision is a subfield of AI that’s specifically focused on teaching computers to see and interpret the world in much the same way that humans do,” explains Pearl CEO and founder, Ophir Tanz. “Computer vision means we’re able to teach the machine things that are conceptual in nature versus what is explicitly programmed.”

The upside of AI

Teaching the software to recognise a range of dental conditions requires a lot of training data. So the Pearl team built what they say is the world’s largest collection of expertly annotated dental radiographs. “We feed millions of these annotated radiographs into the system to teach it how to detect all these pathologies,” Tanz explains. “It’s an evolving process. We take the daily radiograph data we receive globally into the system as training data, and deploy a new model every three weeks. So it’s always improving.” 

Second Opinion® also learns from its mistakes. Feedback from dentists using the software in daily practice is used to help update the system.  “When a dentist using the software identifies something they don’t 100 percent agree with, it’s registered in the system and goes through a panel of our clinicians,” says Tanz. “When they reach a consensus on a deficit or an area for improvement, it is fed back into the system.” 

Computer vision is a subfield of AI that’s specifically focused on teaching computers to see and interpret the world in much the same way that humans do. Computer vision means we’re able to teach the machine things that are conceptual in nature versus what is explicitly programmed.

Ophir Tanz, founder, Pearl

Pearl claims Second Opinion® has increased dentists’ diagnostic accuracy by as much as 37 per cent, eases the diagnostic burden on dentists, and helps dentists to identify the early signs of some pathologies that are otherwise difficult to visually detect.

“Second Opinion® can identify early indications that are often missed, like early bone loss, small carries, and interproximal carries or enamel reduction,” he explains. “That makes Second Opinion® a good visual communication tool dentists can use to engage the patient in preventative treatment. That enhances the level of trust and is going to lead to more case acceptance.”

The limitations of AI

However, as Tanz notes, AI technology is not infallible, and neither is Second Opinion®. He says the software has been designed to serve as a second set of eyes for dentists. Ultimate responsibility for the accuracy of the diagnosis is with the practitioner.

“Second Opinion® is a secondary reader; we don’t replace the autonomy of the practitioner,” he says. “We’re trying to unburden dentists and enable them to be more accurate by using AI to point out areas of interest. They make the treatment decision.”

Data privacy and security issues associated with AI can be another sticking point for dentists considering bringing it to their practices. Tanz says it’s an issue his company takes very seriously, and there are measures in place to maintain patient privacy. 

“Most of our data in our lives at this point is in the cloud, but when you’re dealing with medical data additional steps and protections are taken to de-identify and encrypt personal data,” he explains. “All our data is heavily encrypted and de-identified. So even if we were to be hacked successfully, it would be impossible to associate patient names with the actual data itself.” 

The future is now

Sydney-based Gamma Tech is supporting the Australian roll out of Second Opinion®. Makenzie Harris, founder and director of Gamma Tech, says that while Australia is about three to four years behind the US in terms of AI, he’s seeing strong interest from early adopters. 

I think the key thing for dentists to understand is that the radiology technology—how we take X-rays—hasn’t changed. This is just the software catching up to help us get a better read on the image that’s already in front of us.

Makenzie Harris, founder, Gamma Tech

“I think the key thing for dentists to understand is that the radiology technology—how we take X-rays—hasn’t changed. This is just the software catching up to help us get a better read on the image that’s already in front of us,” he explains. 

“There’s really not a steep learning curve involved. Our technical team can install the plugin remotely overnight, then when you arrive in your practice the next morning, Second Opinion® is ready to go. Then it’s as simple as opening a web browser.”

Harris adds that there’s an option to import several years’ worth of historical data into Second Opinion® to provide a basis for comparison, and enable dentists to show patients a visual representation of deterioration or pathology progression over time.

“It’s all about detecting more disease so you’re able to treat more preventatively, and being able to visually communicate that with the patient so they’re more informed and engaged in their treatment,” Tanz adds. 

“It’s hard to imagine that in five to 10 years from now you’ll walk into a practice that doesn’t utilise it,” Harris concludes.   

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