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8General discussion131General discussionThe aim of this thesis was to improve fundamental knowledge of tooth removal. We hypothesized that challenges in gaining high quality data regarding these complex procedures could be overcome using robot technology. Our second hypothesis was that we could use modern machine learning techniques to improve our understanding of these complex procedures. State of the Art – Robot technology in dentistry Summary of findingsIn Chapter 2, we provided dental practitioners and researchers with a comprehensive, transparent and evidence-based overview of the main characteristics of literature regarding robot initiatives in dentistry. The overall quality of the study designs and the average level of technological readiness was low. In those cases where technology reaches the level of commercial availability, articles supporting their value in clinical or economical terms are either non-existing or very limited. We found that, on average, six articles were published on this topic per year in the last decade [1]. The largest group of articles (80%) was classified as basic research. This means that the technology has not yet been compared to any existing techniques nor tested in, for example, a series of patients. In 84% of all papers, the first author had a technological background and 36% of all papers did not have an author with a medical/dental background. In Chapter 3, we constructed a comprehensive overview of the different robotic initiatives in all fields of dentistry. Our review showed that most research in this field has been limited to those situations where physical contact with a human can be avoided, i.e., education or manipulation of dental materials such as orthodontic wire. We described a shift from the use of industrial robots in early experiments towards more human-compliant robotic systems and systems specifically designed for dentistry [2]. Despite the important limitations found in literature, commercial robotic solutions are available, mainly in orthodontics and implantology. The implantology robot ‘Yomi’ (Neocis, Miami, Florida, USA), for example, is marketed as being the first and only Food and Drug Administration approved robot device for dental surgery. Its capabilities have been described in other reviews, referring to either grey literature or non-scientific papers [3-5]. Scientific data supporting the functionality of commercially Tom van Riet.indd 131 26-10-2023 11:59