Teleconsultation Reloaded TRUPPE, M.

AI-supported Early Detection of Postoperative Complications:

Improving Outcomes and Patient Satisfaction after Dental EWERS, R.
© 2023 Michael Truppe, MD
Implant Surgery (Presentation Dentistry 4.0 Vienna June 3, 2023)
 Hypothesis
• Artificial Intelligence is a disruptive technology comparable to the Biological Big Bang 500 million years
ago
• 300 million jobs will disappear (Report Goldman Sachs)

AI will empower individualized healthcare software

Artificial Intelligence will pave the way for

• Personal Medicine
• Predictive Medical Modeling
1. Patient (precision medicine)
2. Individual clinician's task resolution capability
> Primary focus of this presentation
 Welcome to the future: We are now in a world where surgeons
can perform procedures aided by augmented reality, giving
them unprecedented 3-D “X-Ray vision.” 
…The result is an unprecedented view of the patient’s
internal anatomy under their skin with full depth and detail

2023 ? for the surgeon via holographic surgical navigation.

Source https://mediview.com/mediview-xr90/
Augmented Reality
150/SPIE Vol. 2395

1995

Augmented Reality Visualization

Medical University Vienna
European Forum Alpbach 1996

Prof. Dr. Rolf Ewers

Emeritus Head
Department of Oral and Maxillofacial Surgery
Vienna Medical University Hospital
Head Mounted Display 1995

★ DOI: 10.13140/RG.2.1.3117.8403
Teleconsultation 1995

Medscan can use plain telephone lines, ISDN

lines, bundled ISDN lines, Ethernet, ATM,
> Internet was not yet generally available
xDSL and any other telecommunication
available, like cell phones, GPRS cell phones,
and when available, UMTS cell phones.
Teleconsultation
Department of Oral, Maxillary and Facial Surgery
Medical University Vienna
Artificial
Intelligence
“Give me a lever long
enough and a fulcrum on
which to place it, and I shall
move the world. ”
― Archimedes

„New game, new luck“

Lifespan Predictive Analysis for Dental Implants
with Artificial Intelligence
AI-supported Early Detection of
Postoperative Complications: Improving
Outcomes and Patient Satisfaction after
Dental Implant Surgery
AI-Based Implant Recall
Truppe, M. Ewers, R.
Predictive Lifespan Analysis
for Peri-Implantitis

7 days postsurgery Implant Lifespan

AI-supported Early Detection of Postoperative Complications:
Improving Outcomes and Patient Satisfaction after Dental Implant Surgery

Open Source Proprietary

Private Cloud Knowledge
(Nextcloud) Base Omnichannel
LLM (Intercom)
Patient Medical IBM Watson Large
History (WatsonX) Language WhatsApp
Model Webchat
(ChatGPT) SMS
GDPR compliance
General Data Protection Regulation

NEXTCLOUD ENTERPRISE
• Federation Sharing
• Self-hosted Nextcloud
Enterprise platform
• Supporting standards like
GDPR, CCPA, HIPAA,
FERPA, COPPA, etc.
• EU cybersecurity act
Post Surgery Monitoring
• For 7 days post surgery the patient answers questions on a Likert scale from 0 to 5
• Pain
• Swelling
• Discomfort

• Moderate to severe postsurgical pain lasting more than 72 hours displays high odd ratio
of poor osseointegration. The radiological examinations alone failed to offer any
valuable evidence for the early detection of osseointegration failure in this study.
Shang, Y., Gao, Q., Lengas, T. & Deng, S. Postsurgical Pain and Implant
Osseointegration Failure: A Case Control Study. Int. J. Dent. 2022, 5271892 (2022)
 Sample post operative Likert values

AI BASED ANALYSIS OF HEALING

6 6

PARAMETERS
5
5
5

4 4
4 4 4 4
Likert Values

3 3
3 3 3 3 3

2 2
2 2

1 1
1 1

0 0
1 2 3 4 5 6 7

Discomfort Pain
Swelling Day 1 to Day 7 Post Surgery (demo)
AI Based Likert Scale Interpretation
• Likert Scale Evaluation
• The patient answered for three
days questions about pain,
swelling, discomfort:
06 05 2023
07 05 2023
08 05 2023
• Free text answer
• Patient: Are there any specific
signs or symptoms that would
indicate if the implant has failed or
been rejected by my body?
ANSWER on CLOUD SMILE WIEN (link)
• Postoperative Symptoms Progression
• Based on the Likert scale evaluations, it seems that your
symptoms have followed a typical postoperative course, with an
initial increase in pain, swelling, and overall discomfort, followed
by a gradual reduction in these symptoms.
• On the first day (Likert 06 05 2023), your reported pain level was
2, swelling level was 2, and impairment level was 1. These are
expected findings on the first day after surgery.
• On the second day (Likert 07 05 2023), your pain level increased
to 3, swelling increased to 3, and impairment increased to 2. This
increase is also expected as the inflammatory response to the
surgical procedure peaks within 48 hours after surgery.
• On the third day (Likert 08 05 2023), your pain level decreased to
4, swelling decreased to 4, and impairment decreased to 4. This
reduction in symptoms suggests that your body is healing and
responding well to the implant treatment.
Free Text Patient A

• I'm in a lot of pain. I have

sent you the answers on the
Likert scale the last days.
There was no answer. I’m
now bleeding from the
nose. When I blow my nose,
air comes out of my mouth.
The implant was placed in
the upper right jaw. I want
to fly to New York
tomorrow. Is there anything
I need to consider?
AI Generated Response
• https://cloud.smile.wien/s/fPmq6r3zBpNDeQW
• Intents recognized
• Nosebleed
First, let's address the nosebleed. Nosebleeds can
occasionally occur after an implant placement in
the upper jaw due to the close …
• Oroantral communication
Regarding the air coming out of your mouth when
you blow your nose, this might be due to an
oroantral communication. This is a connection
between the oral cavity and the maxillary sinus, …
Free Text Patient B
• I recently underwent a
surgical procedure in which
two implants were placed
in my lower jaw. However, I
am experiencing significant
discomfort and swelling
each time I attempt to
insert my lower denture.
Could you please advise me
on the best course of action
to alleviate this issue?
AI Generated Response
• https://cloud.smile.wien/s/APew9iqp8tdKR8F

• Intents recognized
• Potential Causes of Your Symptoms
• Incomplete healing
• Ill-fitting denture
• Infection
• Soft tissue irritation
Virtual Patient Trial (work in progress)

https://cloud.smile.wien/s/rCFJbSQrRfzDNMr

We have simulated 50 patient questions with

ChatGPT. This questions can be opened via this
link
https://link.truppe.at/50questions

The AI response will be completed. The first

question response above is an example
Conclusion
• Work in progress
Predicting implant treatments based on
individual clinician's task resolution capability

pre-surgery evaluation

• Personalized
medicine
• Biostatistics
• Predictive
modeling
 Email
watson@implantat.md
© 2023 Michael Truppe, MD
Be careful to stay in
the driver seat