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14 February 2021

Interview with Doctor Mariam Margvelashvili-Malament

Dr. Margvelashvili-Malament is an Assistant Professor in the Department of Prosthodontics at Tufts University School of Dental Medicine (TUSDM). She is the Diplomate of the American Board of Prosthodontics and Fellow of the American College of Prosthodontics.

Dr. Margvelashvili-Malament received her DMD from the Tbilisi State University in Georgia in 2007, Master of Science and Ph.D. Degrees in Dental Materials from the University of Siena, Italy in 2009 and 2013, respectively. She was a post-Doctoral researcher at TUSDM conducting researches in Tissue Engineering during 2009-2011. 

Dr. Margvelashvili-Malament is a co-author of the national residency program in Prosthodontics in Georgia. She was also the Founding Chair and Full Professor of the International Dental Program at the University of Georgia during 2013-2014. Currently, she serves as the Program Chair and Associate Professor at the University of Georgia. 

She is the ITI International Team for Implantology Scholarship recipient that allowed her to pursue implant training at the Department of Prosthodontics at TUSDM. She then completed Advanced Graduate training in Prosthodontics at TUSDM and graduated with high honors. 

Dr. Margvelashvili-Malament has lectured internationally in Continuing Education Courses. She has published numerous scientific articles as well as serves as a reviewer for international journals.

1) Let's start with an actual topic: Is it more difficult today to be a Prosthodontics at the time of Covid? What advice can you give to your colleagues?

     I think it is difficult to be anyone in the current pandemic world as we live through COVID-19, anyone, a dentist and leave alone a prosthodontist. Initially, when everything started, we didn't know what we were dealing with, and now we're learning how the virus  spreads. We have more understanding, and we see that aerosolization is one of the worst enemies for us. In dentistry and specifically prosthodontics, most of our procedures involve aerosolization, making it harder and riskier to practice. At the same time, we've learned how to upgrade office and personal protective equipments. We stocked our offices with additional equipments, changed its environment, maximizing safety. This all is difficult as it entails the direct costs and  scheduling changes. We schedule  patients apart, dedicate  more time to cleaning procedures.  Overall, ergonomically, it affects how the offices and prosthodontics function, but regardless my advice would be to  follow the recommended protection safety protocols as much as we can. If we make shortcuts, we jeopardize our patients and our staff's health. My recommendation would be to follow what's been advised by the experts in this field.

2) Compared to a few years ago, today, technology in dentistry is fundamental. What are the clinician and his/her team's role in the management of these new technologies?

   The digital world is on the uprise, and dentistry is not an exception. We depend on digital technology now more than ever. As a team person, one of the critical aspects is keeping yourself up to date because digital dentistry is fast evolving. Dentistry has always been a fast-evolving field, but digital dentistry is even quicker. I'm managing the faculty literature club at Tufts University, and we were discussing an article on artificial intelligence in dentistry earlier this week. The article was from the beginning of 2020. When we were talking about it, we all realized that  it's already outdated. This shows how fast we're evolving.

If you don't follow where the profession goes, you fall behind fast. To follow the profession's footsteps, you need to be part of all the conferences and learn from your colleagues. Luckily, it is probably easier to follow knowledge through lectures and articles, but  to upgrade technology each time a new model hits the market entails extremely high costs. One could do it as long as one were leasing the technologies but not all the companies are willing to rent their equipment. If you don't have the equipment, you fall behind, so it's very challenging to find the line where one can be technologically advanced and at the same time keep the expenses feasible.   

 Since you mentioned the team, I think it's very important that everyone in the team has their own role. Our profession is interdisciplinary, so we should respect everyone's role in the team.

3) Technique versus technology, which is the relationship today. Is it always the clinician's knowledge that determines the success of rehabilitation?

I think technology is a great tool to make the overall outcome  better, more accurate, and faster. However, it is not full-proof. There's a learning curve to using the technology and it cannot cover the lack of experience or knowledge. It can improve the overall treatment but cannot replace a doctor.  One actually needs to know more because there can be errors at any step and  if you don't have experience and knowledge, you won't be able to detect where the error occured. During the procedure, if things don't go the way the computers planned them, you should be able to take over and act using plan B – following your clinical judgment. Basically, having the technology doesn't mean that you shouldn't be experienced, there's still the regular learning curve. The learning curve is even longer because you need to know both, conventional as well as digital workflows.  It's crucial, that we  respect this. And, it's not just the knowledge, but it's the understanding of the whole profession and how the technologies can be applied.

4) What will be the next revolutions brought by technology in Dentistry?

In general, everything will be directed towards improving current technologies and simplifying the workflows. There will be more  computerization, more digitization, and automatization in both private practices and educational institutions. We're entering the era where fiction is becoming nonfiction.  

I definitely think artificial intelligence holds a considerable value and future in dentistry. How will we diagnose and interpret the patient, how we demonstrate future treatment to the patient through the virtual/augmented reality will change not only the way we practice but also the patients expectations. We're going to have the virtual patient with virtual data analyzed at the pre-appointment. Initial diagnosis can be given to a doctor through the analyses of artificial intelligence. So, at the actual appointment, the doctor can have a summary of the patient data. Of course, we can’t fully rely on the computer generated diagnosis, but this will certainly shorten the overall time. Computerized world can also allow faster communication between various specialist. That's why we see more and more cloud-based software's where patient data can be interchanged fast. New technologies can also allow haptic guidance, which means that the the doctors movement is guided by a robotic arm, not allowing the doctor to deviate from the chosen/safe treatment plan. 

 I don't think that dentists and doctors will ever be replaced by computers, I think the dentists that don't use artificial intelligence and technology will be replaced by the dentists that do. The beauty of it is that we can prevent  computers from making  computer errors, while computers can control us from making human errors. However, artificial intelligence and digitization  brings some liabilities. More computerized we are, more chances are of losing the patient's privacy, but it’s give and take, you win something and lose something. In this event, benefits outweigh the risks. 

5) Finally, a personal question. Your CV is impressive: among your professional goals achieved, which ones do you remember most proudly?

      The beauty of professional development is that each step and each goal brings you to another one.  I'm certainly very proud of my Ph.D. because I acquired it at a very young age, I was 27 and it was rather challenging to achieve the goal. By the way it was in Siena, Italy, which leaves a piece of me that is always Italian. 

I'm very proud that I'm board certified by the American Board of Prosthodontics, it is the highest honor in our profession. And I think another big pride is to be  student of great mentors. I have been blessed with inspiring teachers.  

6) Last extra question, what advice would you give to your younger self?

    When you're younger, you have less patience, which makes things harder. But lack of patience is part of youth. After I put dozens and dozens of Lego kits for/ together with my son, I am certainly becoming more patient (this is humour of course:). But I would tell to myself: Be patient, focus on what’s important and it will all work out. 

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