Emerging Technologies, Education, and Governance in Latin American Dentistry: Perspectives from Venezuela and Nicaragua - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Int Dent J . 2026 Apr 9;76(3):109542. doi: 10.1016/j.identj.2026.109542 Search in PMC Search in PubMed View in NLM Catalog Add to search Emerging Technologies, Education, and Governance in Latin American Dentistry: Perspectives from Venezuela and Nicaragua Carlos David Zavarce Velasquez Carlos David Zavarce Velasquez a Graduate School of Law, Tohoku University, Sendai, Japan Find articles by Carlos David Zavarce Velasquez a , Juan Ramón Vanegas Sáenz Juan Ramón Vanegas Sáenz b Division of International Collaborative and Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan Find articles by Juan Ramón Vanegas Sáenz b, ⁎ , José Victorio Salazar Luces José Victorio Salazar Luces c Department of Robotics, Graduate School of Engineering, Tohoku University, Sendai, Japan Find articles by José Victorio Salazar Luces c , Carlos Eduardo Zavarce Castillo Carlos Eduardo Zavarce Castillo d Facultad de Ciencias Económicas y Sociales, Universidad Central de Venezuela, Caracas, Venezuela Find articles by Carlos Eduardo Zavarce Castillo d , Guang Hong Guang Hong b Division of International Collaborative and Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan Find articles by Guang Hong b Author information Article notes Copyright and License information a Graduate School of Law, Tohoku University, Sendai, Japan b Division of International Collaborative and Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan c Department of Robotics, Graduate School of Engineering, Tohoku University, Sendai, Japan d Facultad de Ciencias Económicas y Sociales, Universidad Central de Venezuela, Caracas, Venezuela ⁎ Corresponding author : Graduate School of Dentistry, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan. [email protected] Collection date 2026 Jun. © 2026 The Authors This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). PMC Copyright notice PMCID: PMC13091825 PMID: 41962511 Abstract Introduction and aims This article aims to answer how emerging technologies, education, and governance can be strategically integrated to improve oral health in Latin America and the Caribbean (LAC). By focusing on Venezuela and Nicaragua, it identifies the structural gaps that must be addressed to unlock the full potential of these technologies. The authors argue that the thematic intersection proposed in this article remains underexplored, particularly in the LAC context, where further research is needed to combine critical analysis with context-specific approaches to public policy. Methods This study employed a comparative case study based on a mixed-methods design with both descriptive and explanatory components, grounded in 2 epistemological stages. In the first stage, a qualitative approach was applied through documentary research drawing on primary and secondary sources. In the second stage, the authors conducted fieldwork using structured online surveys with dental professionals, including both practitioners and scholars. The online surveys focused on 4 dimensions within the field of dentistry: (1) knowledge and application of emerging digital technologies, (2) education, (3) governance, and (4) public policies. Results The results combine qualitative analysis with descriptive statistics, enabling country-level comparisons. The findings show that the adoption of emerging technologies in LAC dentistry, especially in Venezuela and Nicaragua, faces significant transnational challenges, including cost, education and training, infrastructure limitations, and regulatory gaps. Addressing these issues would benefit from coordinated responses from governments, the private sector, universities, professional associations, and other stakeholders. A collaborative approach at both national and regional levels is therefore essential for advancing digital transformation in oral health across the region. Conclusion Despite these challenges, a growing number of cases demonstrate the successful application of digital technologies, such as intraoral scanners (IOS), minimally invasive dentistry (MID), computer-aided design / computer-aided manufacturing (CAD/CAM), and artificial intelligence (AI) applications in scanning, diagnosis, and treatment. These, however, remain isolated experiences rather than evidence of a fully integrated digital ecosystem. In this vein, policymakers should prioritize emerging technologies to ensure public policies that guarantee oral health for all. Clinical relevance This study identifies system-level barriers to the clinical adoption of digital dentistry in Venezuela and Nicaragua and proposes actionable policies and institutional measures to enable the safe, effective, and equitable integration of IOS, CAD/CAM workflows, and AI-assisted diagnostics. Key words: Emerging technologies, Education, Governance, Dentistry, Venezuela, Nicaragua Introduction In an increasingly complex and interconnected world, rapid technological advances have turned emerging digital technologies into disruptive forces with significant impacts on states, civil society, the business sector, academia, and other stakeholders. According to the Organization for Economic Cooperation and Development, “the development, deployment, and adoption of digital technologies create considerable opportunities for productivity, scientific discovery, climate change mitigation, public service delivery, new business models, and remote work, education, and healthcare.” Nevertheless, it cautions that “countries must address their associated risks, including those related to privacy, security, online safety, digital divides, information integrity, social cohesion, and human rights in the digital age.” 1 Within this context, the fourth industrial revolution (4IR) has generated prevailing global narratives that portray emerging technologies, such as AI, robotics, the internet of things, and 3D printing, as inevitable and universally advantageous solutions for oral health systems. The 4IR, conceptualized by Schwab, 2 represents a structural transformation that goes beyond simple automation. It is characterized by the convergence of technologies that blur the boundaries between the physical, digital, and biological domains, giving rise to cyber-physical systems that reconfigure entire production and service systems. Taken together, these technologies can be understood as global megatrends. Their cross-cutting reach, profound impact, and long-term effects position them as guiding forces capable of shaping the future of societies and economies. 3 They therefore demand new analytical frameworks for strategic planning and the formulation of public policies. Given this situation, a critical intersection emerges among the themes of particular interest to the authors: emerging technologies, education, governance, and oral health. The global health sector is not immune to this disruption and has already transitioned toward a new paradigm often referred to as “Health 4.0.” 4 This paradigm is grounded in personalization, predictability, prevention, and participation (the P4 model of care), all of which are enhanced by digital technologies. As an integral component of overall health and a critical determinant of quality of life, oral health stands at a pivotal position within this transformation, where the integration of digital innovation is no longer optional but essential for advancing equitable and effective care. The World Health Organization (WHO) emphasized that oral diseases affect nearly 3.5 billion people worldwide, representing a major global health burden that falls disproportionately on the most vulnerable populations. 5 In LAC, the WHO identifies enduring and urgent challenges: curative and fragmented models of care, inequitable access to essential services, and a significant gap between demand for oral health care and the capacity of public health systems to meet it. 6 This situation positions oral health systems as a space with high potential for the application of 4IR solutions, but also as an area of high risk for exacerbating inequities. The accelerated incorporation of “4.0 agents” into oral health systems promises to redefine clinical practice in dentistry and, by extension, public health management. Examples include applying machine learning algorithms to radiological images, like cone beam computed tomography (CBCT) and radiographs, to enhance diagnostic accuracy for caries, periodontal disease, and malignant pathologies. 7 Similarly, analyzing large-scale population data (big data) enables predictive and precision dentistry, optimizing resource allocation and the design of evidence-based policies. 8 , 9 Additive manufacturing and 3D printing are transforming the production of prostheses, surgical guides, and planning models by reducing costs and fabrication times while personalizing treatments and increasing accessibility. 10 Combined with advances in robotics, these technologies enhance professional education and training through immersive simulations and assist with complex surgical planning by superimposing digital information onto the patient’s real anatomy. All of this suggests that the 4IR presents a historic opportunity to move toward more efficient, predictive, and equitable oral health systems in LAC. However, success will not be an automatic outcome of technological progress. It will depend on the capacity of states and other key actors to build governance mechanisms that ensure the transformative potential of the 4IR reduces inequalities and guarantees the right to oral health for the entire population. While major advances in the application of emerging technologies to oral health are taking place in North America, Europe, and East Asia, countries in the Global South, including those in LAC, are also experiencing significant progress of their own. However, a critical examination of the intersection between emerging technologies, education, governance, and oral health in LAC countries reveals a series of interconnected challenges. The first challenge lies in the fragmentation of public policies and legal frameworks on digital oral health. The absence of comprehensive national strategies that integrate education, technology, and health has produced weak coordination among public, private, and academic initiatives. 11 This disarticulation has slowed the modernization of national oral health systems. A further obstacle is the divergence in research and development priorities, driven by limited funding for oral health technologies and a lack of systemic collaboration among universities, industry, and governments. 12 This dynamic has constrained scientific research and patent development in digital dentistry, limiting the region’s ability to shape global standards. Policy fragmentation is further compounded by weaknesses in clinical infrastructure. Public policies provide only minimal support for advanced equipment that integrates AI, big data, internet of things, robotics, and 3D printing. 13 Dependence on costly imports restricts access to advanced diagnostic and treatment technologies, generates inequities in the quality of care, and contributes to the migration of skilled professionals to countries with stronger oral health systems. Another critical issue is the gap between dental education and the competencies demanded by Industry 4.0. Universities in the region continue to rely on traditional curricula with limited digital content, while also facing a shortage of faculty trained in emerging technologies. 14 As a result, many health professionals graduate without the competencies necessary to integrate 4.0 technologies into clinical practice. This misalignment between education and labor market needs has intensified the demand for professionals who can effectively adopt technological innovations. At the same time, it has widened the gap between higher education and employment opportunities, as well as between developed and developing countries. Considering this complex dynamic, this article aims to answer how emerging technologies, education, and governance can be strategically integrated to improve oral health in LAC. By focusing on Venezuela and Nicaragua, this study identifies the structural gaps that need to be addressed to unlock the full potential of these technologies. The authors argue that the thematic intersection proposed in this article remains underexplored, particularly in the LAC context, where further research is needed to combine critical analysis with context-specific approaches to public policy. Consequently, this study seeks to address the structural challenge of designing effective strategies to strengthen scientific development in LAC. To do so, it is essential to recognize the deep inequalities that exist not only within countries but also among them, as these disparities profoundly affect their capacity for scientific advancement. In this context, smaller nations or those with less stable economies, such as Venezuela and Nicaragua, face particular difficulties due to the limited number of medical, research, and training institutions, as well as the scarcity of financial and technological resources. 15 Therefore, it is necessary to raise awareness of the region’s scientific and professional potential, supported by a community of researchers and oral health practitioners distinguished by creativity, resilience, and a strong commitment to improving public health outcomes. The study comprises 6 main sections: (1) introduction; (2) materials and methods; (3) results; (4) discussion; (5) conclusion; and (6) references. Materials and methods This study adopts a comparative case study design, 16 structured along 3 complementary axes of social scientific analysis: a horizontal axis (spatial comparison primarily between Venezuela and Nicaragua, acknowledging limited comparative references to other LAC countries), a vertical axis (analytical differentiation within the dental profession, encompassing both practitioners and scholars, without implying hierarchical ordering), and a transversal axis (temporal scope covering current developments as of 2025). Following Bryman’s 17 postulates, this comparative case study employed a mixed-methods design with both descriptive and explanatory components, grounded in 2 epistemological stages. In the first stage, a qualitative approach was employed through documentary research, drawing on primary and secondary sources, including databases such as PubMed and ScienceDirect, as well as repositories of international organizations. This phase involved a review of specialized academic literature, official reports, policy documents, and relevant laws and regulations. This process enabled a more comprehensive understanding of the state of the art regarding the implementation of digital technologies in dentistry, as well as a preliminary mapping of international, regional, and national legal frameworks and dental education programs in the selected countries. In the second stage, the authors carried out fieldwork based on structured online surveys focusing on 4 dentistry-related dimensions: (1) knowledge and application of emerging digital technologies, (2) education, (3) governance, and (4) public policies. Built upon these dimensions, the survey instrument consisted of 24 questions, divided into simple selection and open-ended items. The population consisted of dental professionals, including both practitioners and scholars, spanning young professionals, mid-career professionals, and senior experts. Initially, this study targeted 100 dental specialists distributed across 3 countries: Venezuela (n = 40), Nicaragua (n = 40), and Argentina (n = 20). The authors considered dental professionals who graduated from top-ranking universities in these countries, including Universidad Central de Venezuela and Universidad Católica Andrés Bello (Venezuela), Universidad Nacional Autónoma de Nicaragua and Universidad Americana (Nicaragua), and Universidad de Buenos Aires and Universidad Nacional de La Plata (Argentina). Nevertheless, the study achieved a response rate of 75%, with higher participation in Venezuela (77.5%) and Nicaragua (75%), and more limited participation from Argentina (30%). Consequently, due to the final number of responses received, a purposive sample of 75 specialists was retained for analysis, with concentrations in Venezuela (n = 31) and Nicaragua (n = 30), along with an additional group of respondents (n = 14) from other LAC countries, including 6 from Argentina. The fieldwork relied exclusively on voluntary online surveys and did not involve any medical intervention, experimentation, or the collection of sensitive personal or health-related data. Prior to participation, respondents were provided with a written explanation of the research’s purpose, scope, academic nature, and potential dissemination, emphasizing the voluntary character of the instrument. Accordingly, informed consent was obtained through the voluntary completion and submission of the survey. The study followed internationally accepted ethical principles for noninterventional research involving human participants, with particular attention to confidentiality and data protection. Although respondents could optionally provide identifying information (eg, name), disclosure was not required; any identifying information was excluded prior to analysis and is not reported. Data were handled confidentially and analyzed in an anonymized form. The online survey was specifically developed for this study, drawing on the authors’ expertise in dentistry, political science, social sciences, and robotic engineering, and guided by the study’s conceptual dimensions (governance, education, and technology applications in dentistry). A preliminary pilot pretest was conducted with a small cross-national sample (n = 10; 5 in Venezuela and 5 in Nicaragua) to assess item clarity, comprehension, and the feasibility of the survey instrument. While efforts were made to conduct and gather an extensive number of structured online surveys, special consideration was given to the principles of Corbin and Strauss 18 and Glaser 19 regarding qualitative research, particularly Grounded Theory, which suggests that researchers should prioritize the quality, expertise, and credibility of key informants over sample size. Likewise, following the guidelines of Glaser 19 and Corbin and Strauss, 20 the qualitative data analysis of the information obtained through the online surveys was conducted through the following process: 1. Data collection through a voluntary online survey administered via Google Forms 2. Systematic text analysis focused on content relevant to the study’s purpose 3. Identification and selection of analytically relevant excerpts and illustrative quotations aligned with the study’s objectives 4. Categorization of data into pre-established analytical dimensions (e.g., country-level implementation of emerging technologies and proposed public policies) 5. Axial coding to identify patterns and relationships within and across analytical dimensions 6. Interpretive synthesis, resulting in an empirically grounded explanation of the object of study The analysis conducted from points 2 to 6 was made with the support of Atlas.ti, computer software for qualitative data analysis. Beyond the qualitative analysis, quantitative methods were employed at a descriptive level to summarize and organize the data. Specifically, descriptive statistics were used to identify common patterns, frequency distributions, and gaps in the assessments provided by the 75 specialists. No inferential statistical analyses were conducted, as the study was not designed to test hypotheses or to generalize findings beyond the study sample (primarily Venezuela and Nicaragua). Rather, the descriptive results served to complement and triangulate the qualitative insights by highlighting measurable trends within the dataset. This combination of documentary analysis, qualitative interpretation, and descriptive statistics enabled methodological triangulation, thereby enhancing the robustness and internal coherence of the findings. Results Sample The field research included 75 dental professionals from LAC countries, with a relatively balanced distribution between Venezuela (41.3%, n = 31) and Nicaragua (40.0%, n = 30), and a smaller sample from other countries, including Argentina (n = 6), Brazil (n = 3), Ecuador (n = 2), and Peru, Chile, and Costa Rica (n = 1 each), representing 18.7% of the total. Participants reported an average professional experience of 12.5 years (SD = 9.2), ranging from 1 to 40 years. Among them, 49.3% had worked in both clinical and academic settings, 46.7% were engaged exclusively in clinical practice, and 4.0% worked solely in academic roles ( Table 1 ). Table 1. Distribution of participants by country, professional profile, and experience. Country Number of participants Average experience (years) Clinical practice only (%) Academic practice only (%) Both fields (%) Venezuela 31 18.7 17 (54.8%) 0 (0%) 14 (45.2%) Nicaragua 30 7.3 13 (43.3%) 2 (6.7%) 15 (50.0%) Others 14 10 5 (35.7%) 1 (7.1%) 8 (57.1%) Total 75 12.5 35 (46.7%) 3 (4%) 37 (49.3%) Open in a new tab Source: Elaborated by the authors (2025). Knowledge and implementation of emerging technologies Throughout the structured online surveys, the specialists were consulted about their knowledge of emerging technologies and their implementation in professional settings. The results identified a significant gap between the level of knowledge and the actual implementation of emerging technologies in the dental field. For example, while 94.7% of the specialists surveyed reported familiarity with intraoral scanners, a smaller percentage, 84%, indicated having implemented them in their practice. This gap becomes even more pronounced with more advanced technologies, such as robotic surgery, where 38.7% of specialists reported awareness of the technology, but none have adopted it. Similarly, in the case of AI, although 74.7% of respondents stated that they were familiar with it, only 45.3% had applied it in their professional activities. These findings underscore the need to enhance continuous education and institutional capacities to promote the effective adoption of technological innovations in the dental profession across the region. When focusing specifically on Venezuela and Nicaragua and considering the most widely adopted technologies presented in Table 2 , the comparative analysis reveals slightly higher levels of knowledge (100%) and implementation (93.3%) of IOS in Nicaragua than in Venezuela (93.5% knowledge and 83.9% implementation). In contrast, regarding the knowledge and implementation of MID, CAD/CAM, and AI, Venezuela shows higher percentages, with the largest gaps observed in the implementation of MID (Venezuela, 64.5% vs Nicaragua, 40%) and AI (Venezuela, 54.8% vs Nicaragua, 33.3%), as reflected in Table 3 . Table 2. Comparison between self-reported knowledge and practical implementation of emerging digital technologies in dentistry. Technology Knowledge Implementation Gap Intraoral scanners (IOS) 94.7% 84% 10.7% Minimally invasive dentistry (MID) 81.3% 54.7% 26.6% Computer-aided fabrication (CAD/CAM) 80% 52% 28% Artificial intelligence for diagnosis and treatment planning 74.7% 45.3% 29.4% Immersive technologies (virtual reality, augmented reality, 3D visualization) 42.7% 16% 26.7% Teledentistry/remote consultation 40% 25.3% 14.7% Robotic surgery 38.7% 0% 38.7% Open in a new tab Source: Elaborated by the authors (2025). Table 3. Country-level distribution of self-reported knowledge and implementation of emerging digital technologies in dentistry. Country Participants Know IOS Implement IOS Know MID Implement MID Know (CAD/CAM) Implement (CAD/CAM) Know AI Implement AI Venezuela 31 29 93.5% 26 83.9% 26 83.9% 20 64.5% 27 87% 17 58.8% 23 74.2% 17 54.8% Nicaragua 30 30 100% 28 93.3% 22 73.3% 12 40% 24 80% 15 50% 23 76.6% 10 33.3% Open in a new tab Source: Elaborated by the authors (2025). Consequently, based on the data presented in Table 2 , Table 3 , knowledge consistently surpasses implementation, suggesting the presence of operational barriers that limit the translation of knowledge into effective practice. The specialists’ responses also provide a better understanding of how these technologies are implemented in dental practices on a daily basis. Fig. 1 , Fig. 2 illustrate the most relevant quotations of dental professionals in Venezuela and Nicaragua regarding technological implementation. Fig. 1. Open in a new tab Implementation of digital technologies—representative quotations (Venezuela) Source: Elaborated by the authors (2025). Fig. 2. Open in a new tab Implementation of digital technologies—representative quotations (Nicaragua) Source: Elaborated by the authors (2025). At this point, it is important to note that the codes highlighted in green in Fig. 1 , Fig. 2 , Fig. 3 represent the most frequently mentioned categories. Codes in yellow indicate themes repeatedly noted by a substantial number of specialists, while codes in orange correspond to those that received fewer mentions. Likewise, the quotations presented in Fig. 1 , Fig. 2 , Fig. 3 were selected to represent the identified codes and to illustrate and elaborate on the specialists’ responses. Entries consisting of a single word or a limited number of words were included in the analytical process but were not displayed in the figures. Fig. 3. Open in a new tab Public policy—representative quotations (proposals) Source: Elaborated by the authors (2025). In Venezuela, responses indicate that digital technologies are used across various stages of clinical care, particularly in diagnosis and treatment. Most specialists reported using tools such as AI-based radiographic software, IOS, and digital planning systems for implantology, orthodontics, prosthodontics, and rehabilitative treatments. These technologies appear to support more precise assessments and facilitate the preparation of surgical guides, digital models, and restorative designs. At the same time, the patterns suggest that implementation varies among practitioners, with some using digital tools routinely while others rely on them only for specific procedures or educational purposes. Online consultations and remote planning also emerge in a smaller number of cases, indicating an expansion of digital workflows beyond the physical clinic. Overall, the responses reflect a gradual but noticeable incorporation of digital and AI-based tools into everyday practice, though their use remains more focused on particular clinical tasks rather than forming a fully integrated digital ecosystem. Regarding Nicaragua, emerging technologies are most consistently linked to IOS for digital impressions, the creation of diagnostic models, the preparation of prosthetic restorations, and support for laboratory workflows. Diagnosis is frequently enhanced by these scans and by AI-assisted radiographic and cephalometric applications, which help clarify case evaluation and inform planning. On the treatment side, specialists describe applications in restorative dentistry and prosthodontics, often emphasizing MID techniques, in which CAD/CAM systems and digital models enable more precise designs and shorter clinical times. Surgical uses are primarily noted in implantology, where digital planning and guided surgery aim to enhance accuracy; in some cases, haptic simulators are utilized for training and practice. Overall, Nicaragua demonstrates a practical and task-oriented integration of digital methods across scanning, diagnosis, treatment, and surgical preparation. Acknowledging that both countries operate in resource-constrained settings, the slightly broader implementation scope observed in Venezuela compared with Nicaragua can, in part, be attributed to structural factors in human resources and training infrastructure. According to the latest available data from the WHO for these countries, the total number and per-capita availability of dentists are higher in Venezuela (4116 dentists; 1.35 per 10,000 population as of 2017) than in Nicaragua (245 dentists; 0.36 per 10,000 population as of 2022). 21 Additionally, the number of public and private universities offering dental education is higher in Venezuela than in Nicaragua. These structural differences in professional supply and educational infrastructure likely shape differential access to training and professional networks, thereby influencing the scope for implementing emerging digital technologies in dental practice. The data also enabled the identification of the most pressing barriers to technological adoption. The high cost of technology emerged as the most frequently cited obstacle (92%). The second most significant challenge was the lack of training and technical knowledge, reported by 62.7% of specialists. Insufficient technological infrastructure (42.7%), resistance to change (38.7%), and the absence of clear regulatory frameworks (32%) ranked as the third, fourth, and fifth barriers, respectively ( Table 4 ). Table 4. Barriers to emerging technology adoption by country. Barrier Total 75 participants Venezuela 31 participants Nicaragua 30 participants Others 14 participants Cost of technology 69 92% 30 96.7% 28 93.3% 11 78.5% Lack of training and technical knowledge 47 62.7% 20 64.5% 19 63.3% 8 57.1% Technological Infrastructure 32 42.7% 15 48.3% 13 43.3% 4 28.6% Resistance to change 29 38.7% 12 38.7% 12 40% 5 35.7% Absence of regulatory frameworks 24 32% 11 35.4% 8 26.6% 5 35.7% Open in a new tab Source: Elaborated by the author (2025). The data show that the percentages reported for each barrier by specialists from Venezuela, Nicaragua, and other LAC countries are broadly similar, with variations of approximately 10%. The only barrier that appears considerably higher in Venezuela and Nicaragua relative to the third group is technological infrastructure, with differences ranging from 15 to 20%. The higher gap in technological infrastructure identified in this study is supported by independent assessments, including a recent United Nations Economic Commission for Latin America and the Caribbean report 22 on AI and digital infrastructure. The report indicates that countries such as Argentina and Brazil exhibit high levels of infrastructure capacity, including extensive optical fiber networks, robust connectivity, computing capacity, and access to digital devices. In contrast, Venezuela is classified as a country with limited digital infrastructure capacity, whereas Nicaragua was not included in the report. Education and training in emerging technologies When asked about their academic knowledge of the subject of study, 74.7% of specialists reported receiving some form of education or training in emerging technologies. The primary mode of learning was university-based education (32%), followed by extension or continuing education courses (24%) and self-learning (18.7%). In addition, the majority of specialists expressed either very high (score of 5; 73.3%) or relatively high (score of 4; 17.3%) interest in participating in continuing education on emerging technologies. By contrast, only 2.7% reported a moderate level of interest (score of 3), and 6.7% indicated no interest (score of 1). Consequently, most specialists have received some form of training related to emerging technologies in oral health. However, only a relatively low proportion has received formal instruction through university-based education (32%) or continuing education programs (24%). This highlights a structural weakness within education systems in the LAC region. These systems have not yet sufficiently integrated emerging technologies into their academic curricula. Accordingly, the specialists highlight the need to better integrate emerging technologies into undergraduate and graduate dental education programs. They emphasize the importance of specialized courses, updated syllabi, and formal instruction in digital workflows. Alongside this, specialists stress the relevance of continuing education for practicing professionals. Short courses, certifications, and extension programs help clinicians stay up to date on current technological developments. A substantial group further underscores the value of hands-on learning opportunities. They argue that theoretical instruction alone is insufficient for meaningful adoption. In addition, a minority of specialists emphasize the usefulness of online courses, webinars, and more affordable or flexible learning options. Others advocate for specialized training in advanced areas such as AI, CAD/CAM systems, and digital design. Governance on oral health This study adopts the conception of governance promoted by the WHO, which establishes that “health systems governance means ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition-building, provision of appropriate regulations and incentives, attention to system design, and accountability.” 23 Given the study’s multidisciplinary focus on various aspects of dental practice, the analysis of governance primarily centers on policy frameworks and regulations. When consulted about the relationship between the development of emerging technologies and regulatory frameworks, the majority of specialists (65.3%) perceived that oral health legislation progresses significantly more slowly than technological development, creating regulatory gaps. It is also noteworthy that 29.3% of specialists reported not knowing or not being sure about this issue. In contrast, only 5.3% considered that regulations advance at a similar pace, allowing for constant adaptation. Moreover, 97.3% of specialists reported being unaware of any legal instrument regulating the use of emerging technologies in oral health in their country of practice. Given this situation, 57.3% of specialists rated the importance of regulations on emerging technologies in dentistry as very high (score of 5), 20% as relatively high (score of 4), and 16% as medium (score of 3). Although the data reveal structural governance deficiencies, especially in Venezuela and Nicaragua, it is essential to note that a growing number of resolutions, strategies, and relevant soft-law guidelines are influencing the use of emerging technologies in oral health. At the international level, LAC countries, including those examined in this study, have participated in debates that shape the governance of emerging technologies in health, and, more specifically, in dentistry. Key reference instruments include the 2030 Agenda for Sustainable Development; 24 the Mobile Technologies for Oral Health (mOral Health Programme) developed by the WHO and the International Telecommunication Union; 25 the WHA74.5 Resolution on Oral Health; 26 the Global Strategy on Oral Health; 27 and the Global Oral Health Action Plan 2023-2030, 28 all issued under the WHO. Similarly, at the regional level, in 2021, the Pan American Health Organization (PAHO) established a Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas. 29 This guiding document was reinforced with the release of the PAHO Plan of Action for Strengthening Information Systems for Health (2024-2030), 30 which aims to contribute to the fulfillment of the roadmap through 4 main objectives: • Objective 1.1 Strengthen the management and governance mechanisms of information systems for health. • Objective 2.1: Enhance the standardization and interoperability of information systems for health to allow subnational, national, and regional cross-border data exchange and disaggregation. • Objective 3.1: Promote the implementation of strategies and mechanisms that ensure timely and appropriate open access to data, information, and knowledge across the health sector. • Objective 4.1: Implement a comprehensive national roadmap and strategy for the digital transformation of the health sector by 2030. At the national level, while widely unknown, as shown in the answers from the specialists, Venezuela has a distinctive law, the Telehealth Law (Ley de Telesalud), effective as of December 28, 2015, that explicitly regulates the use of digital technologies within the domain of telehealth services, rather than across the broader spectrum of clinical practice or digital health integration. 31 Although it is not extensive in content, comprising only 19 articles, its stated purpose is: To establish the principles, foundations, guidelines, control, and regulation of the operation of the Telehealth Network, in order to, guarantee its proper use regarding access, coverage, and quality of care for the population, through the support of information and communication technologies, framed within free software tools, without prejudice to the provisions established in the corresponding legal framework. Likewise, the law defines the telehealth network as the set of actions and strategies in the field of health that make combined use of information and communication technologies in free software, with the purposes of comprehensive care, health promotion, disease prevention, education, self-care, treatment, rehabilitation, research, epidemiological surveillance, participation, and management, developed by competent workers in the health sector. Although the law encompasses a broad range of medical domains, it is important to recognize that the provision of medical treatment and rehabilitation via telehealth may give rise to various challenges and gaps due to the inherent nature of these activities. Furthermore, limited awareness of the law among dental professionals might create discrepancies across sectors, with both public and private actors often pursuing isolated initiatives driven by individual or organizational interests, while government authorities face constraints in effectively regulating and coordinating such practices. In contrast to Venezuela, Nicaragua still lacks a regulation that links the use of digital technologies in healthcare. The General Health Law (Ley N° 423) does not mention the implementation of digital technologies in health practices. 32 The only law that partially applies to the research topic is the Law on Data Protection and Confidentiality (Ley N° 787). 33 This law establishes that: Personal data related to health, in hospitals, clinics, health centers, and posts, both public and private, as well as professionals linked to the health sciences: may only concern the physical or mental health of patients who attend them or who are or have been under their treatment, while respecting professional secrecy. Similarly, the law requires data compilation and management with clear purposes and imposes obligations regarding security, confidentiality, and integrity. Public policies During fieldwork, specialists were also asked about public policies that could unlock the full potential of emerging technologies in dentistry. Figure 3 and Table 5 presents some of the most relevant responses from the specialists on this matter. Table 5. Public policy recommendations. Area Recommendations Investment, technology access, cost reduction, and import facilitation Provide financial support to facilitate the acquisition and implementation of emerging technologies, and implement structural measures that reduce costs and simplify access to these technologies Legal frameworks and ethical AI governance Establish laws, regulations, and guidelines, and create administrative organizations responsible for ensuring the safe, ethical, and responsible use of emerging technologies Education and training Strengthen human-capital development by modernizing academic programs and providing ongoing professional training Connectivity and digital ecosystems Ensure that digital transformation reaches underserved regions and actively reduces existing inequalities Research and development Promote a national ecosystem that actively encourages technological research and development in oral health Open in a new tab Source: Elaborated by the authors (2025). The responses reveal a broad consensus on the need for policies that strengthen the dental sector’s digital transformation through coordinated action on investment, governance, and education. Specialists often emphasize the need to increase public investment to expand access to digital equipment, streamline import processes, and modernize clinical infrastructure. Another pressing aspect is the need to develop clear regulatory frameworks, including standards for professional certification, guidelines for the ethical use of AI, and safeguards for patient data. Education and human-capacity development also emerge as important themes, with respondents calling for national training programs, university curriculum reforms, and expanded opportunities for continuing education. Additional recommendations focus on improving equitable access by consolidating a digital ecosystem that ensures better connectivity and remote assistance. Some specialists also advocate for policies that support research, innovation, and collaboration between the central government, the private sector, and academia. Taken together, these patterns suggest that comprehensive public policies must integrate financial support, regulatory clarity, academic modernization, and equity considerations to enable the meaningful and responsible adoption of emerging technologies in dentistry. It is important to emphasize that the public policy recommendations in this paper emerged directly from the specialists’ responses. Nevertheless, the findings are fully aligned with existing international and regional frameworks, such as the 2030 Agenda for Sustainable Development, 24 the Roadmap for the Digital Transformation of the Health Sector in the Region of the America, 29 and the PAHO Plan of Action for Strengthening Information Systems for Health (2024-2030), 30 which prioritize infrastructure development, interoperability standards, capacity building, policy and regulatory frameworks, public-private partnerships, equity, and accessibility, among other key aspects. Discussion Integration of findings into the regional context The results of this study suggest a complex landscape of emerging technology adoption in dentistry across LAC, with an emphasis on Venezuela and Nicaragua, characterized by notable gaps between theoretical knowledge and practical implementation. The consistency of these patterns across the 2 examined countries suggests shared structural challenges that require coordinated responses at national and regional levels. The knowledge-implementation gap identified in this study (averaging 25%) reflects an incomplete technological transition, in which professionals recognize the value of technological innovations but remain constrained by financial, infrastructural, and institutional barriers that impede their adoption in clinical practice. This finding aligns with the literature on the diffusion of innovations in health systems in developing countries, which frequently describes phases of “symbolic adoption” without full operational integration. 34 The responses from the specialists demonstrate that adoption often occurs as isolated technological acts, such as using IOS for impressions or AI for radiographic analysis, rather than as part of an integrated digital ecosystem. This pattern suggests a fragmented technological transition process, characteristic of systems with limited institutional support. The critical triangle: cost, training, and infrastructure The identification of cost, lack of training, and insufficient infrastructure as the 3 principal barriers forms a “critical triangle” that explains much of the difficulty in adopting emerging technologies in dentistry. This pattern is consistent with previous documentation in global health contexts, 26 but it becomes particularly relevant in oral health due to the predominantly private nature of professional practice in the region, where investment decisions often fall to individual clinicians rather than public institutions. The low percentage of university-based education as the principal mode of learning (32%), followed by extension or continuing education courses (24%), and self-learning (18.7%), represents an important warning sign for university education systems responsible for preparing oral health professionals. These figures suggest that academic institutions are not adequately responding to the demand for digital competencies, leaving professionals to pursue technological training informally or through market-driven mechanisms outside formal higher education. The findings also reveal important gaps regarding 3 major dimensions: 1. Curricular dimension: Outdated content that fails to critically incorporate emerging technologies and digital workflows 2. Pedagogical dimension: Teaching methodologies that do not foster computational thinking, digital problem-solving, or critical digital literacy 3. Philosophical dimension: Lack of ethical and epistemological reflection on the implications of the 4IR for contemporary dental practice The limited incorporation of emerging technologies into undergraduate and graduate curricula reflects a well-documented regional trend of curricular lag. This misalignment between technological innovation and academic training exacerbates disparities in adoption and reduces the ability of new graduates to function effectively within digitally oriented clinical environments. Moreover, the low percentage of university-based education and the reliance on self-learning and continuing education outside academia contrast with recommendations from international bodies, such as Vision 2030, promoted by the FDI World Dental Federation, 9 that emphasize the formal integration of emerging technologies into dental education at all levels. Governance and regulatory gaps The majority perception (65.3%) that technological development advances more rapidly than regulatory frameworks reflects common patterns observed in health systems facing disruptive innovations. This finding aligns with the literature on health technology governance, which frequently documents the slow pace of regulatory processes in comparison to the accelerated pace of innovation. 35 The near absence of knowledge regarding specific legal instruments (97.3% reporting no awareness) indicates that, even when regulations exist, they are not being effectively communicated to professionals in the field. This raises important questions regarding the operational implementation of regulatory frameworks and their ability to effectively guide clinical practice. This situation is clearly illustrated by Venezuela, where a regulatory instrument such as the Telehealth Law appears insufficient in the absence of robust information campaigns and targeted training for oral health professionals. This gap between regulation and implementation suggests that, despite the existence of a legal framework, professional practice is not effectively guided, a challenge that Venezuela, as well as other countries in the region, should seek to avoid. In this regard, the findings point to the need for legal frameworks, national agendas, and multidimensional sets of public policies that simultaneously address the following barriers: 1. Investment, technology access, cost reduction, and import facilitation: financing mechanisms, fiscal incentives, and facilitation of technology imports 2. Legal frameworks and ethical AI governance: development of agile and proportional frameworks that balance innovation with patient safety and ethical considerations 3. Education and training: mandatory curricular integration of emerging technologies and accessible continuing education programs, coupled with accessible and high-quality continuing education opportunities for practitioners 4. Connectivity and digital ecosystems: investment in connectivity and essential equipment that enable the implementation of digital solutions 5. Research and development: Pushing for partnerships between governments, private sectors, and academia, enabling major collaborations that foster research, development, and innovation Despite notable differences in political structures, institutional capacities, and technological readiness, Venezuela and Nicaragua display convergent patterns in the barriers affecting technological adoption. This convergence indicates that these challenges are not isolated phenomena but rather manifestations of systemic characteristics shared across the broader LAC region. The similarities observed not only between Venezuela and Nicaragua reinforce the potential contribution of this study and suggest that regional cooperation initiatives may offer economies of scale, promote standardization, and create opportunities for mutual learning in the digital transformation of oral health. Limitations and future directions The authors acknowledge several limitations when interpreting the results. The relatively small sample size, limited to 75 responses, particularly the 14 respondents from countries other than Venezuela and Nicaragua, including Argentina, Brazil, Ecuador, Peru, Chile, and Costa Rica, restricts the generalizability of the findings to the entire LAC region. Consequently, rather than aiming to provide a comprehensive regional analysis beyond Venezuela and Nicaragua, which constitute the main case studies of this research, the findings from the remaining countries should be understood as exploratory. These initial results are intended to serve as a foundation for the development of a larger research project examining the region as a whole. Moreover, the preliminary patterns identified through this comparative analysis may offer valuable insights for designing more in-depth country-level studies. Future research would benefit from expanding mixed-methods approaches that combine quantitative analysis with qualitative inquiry to capture the experiences and perspectives of dental professionals, IT specialists, and policymakers across a broader range of LAC countries. Additionally, longitudinal studies would be particularly valuable for monitoring the evolution of technological adoption and assessing the impact of specific interventions. Taken together, the results highlight the importance of developing coordinated regional strategies that integrate investment, governance, and educational reform. Without such alignment, the potential of emerging technologies to improve quality, efficiency, and equity in oral health across LAC may remain unrealized. Conclusion The adoption of emerging technologies in LAC dentistry, especially in Venezuela and Nicaragua, faces significant transnational challenges, including cost, education and training, infrastructure limitations, and regulatory gaps. Addressing these issues calls for coordinated responses from governments, the private sector, universities, professional associations, and other stakeholders. A collaborative approach at both national and regional levels is therefore important for advancing digital transformation in oral health across the region. Although adoption levels vary across countries, structural barriers remain widespread. In the case of Venezuela, the country has an initial legal framework for telehealth, although practitioners are widely unaware of its provisions. At the same time, while still incipient, technology implementation includes diagnosis, planning, treatment, surgery, rehabilitation, and teaching. In contrast, technological applications in Nicaragua focus primarily on scanning, with emerging initiatives in diagnosis and treatment. In both cases, however, these practices remain isolated experiences driven by individual actors rather than evidence of a fully integrated digital ecosystem. Given this context, creating enabling conditions, such as affordable access, strong university-based education, infrastructure development, and clear institutional frameworks, will be central to building a more robust digital health ecosystem. The high interest in continuing education expressed by most specialists also represents a valuable opportunity to expand and strengthen professional development programs. As discussed in the “Public policies” section, the findings suggest that greater policy attention to ethical governance frameworks and financing mechanisms is warranted to address the interconnected challenges of cost, training, and infrastructure. The data reveal not only a gap between knowledge and implementation but also an underdeveloped technological cycle. Insufficient investment in education and infrastructure results in fragmented adoption, limits demand and local innovation, and reinforces dependence on expensive imports. Breaking this cycle requires bold and coordinated public policies. Despite these challenges, a growing number of cases in both countries demonstrate the successful application of digital technologies, such as IOS, MID, CAD/CAM, and AI applications in scanning, diagnosis, and treatment, indicating the existence of a feasible pathway toward broader digital health adoption. Finally, it is important to note that while this study focuses on Venezuela and Nicaragua, the findings reflect patterns observed in other LAC countries, as supported by assessments from regional organizations such as the United Nations Economic Commission for Latin America and the Caribbean. Furthermore, the policy proposals arising from this study are not isolated recommendations from dental practitioners but align with governance frameworks promoted by international and regional organizations, including the UN, the WHO, and the PAHO. Consequently, while regulatory gaps persist, existing international and regional guidelines can serve as a foundation for more robust national governance that guarantees oral health for all. Authors contributions Conceived and designed the study; contributed to data acquisition, analysis, and interpretation; and drafted the manuscript : Zavarce Velasquez. Conceived and designed the study; contributed to data acquisition, analysis, and interpretation; and critically revised the manuscript for important intellectual content : Vanegas Sáenz. Contributed to the conception and design of the study and to data acquisition; and critically revised the manuscript for important intellectual content : Salazar Luces. Contributed to data acquisition, analysis, and interpretation; and participated in drafting the manuscript : Zavarce Castillo. Critically revised the manuscript for important intellectual content : Hong. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work. Declaration of generative AI and AI-assisted technologies in the writing process During the preparation of this work, the authors used Grammarly and ChatGPT-5 to improve language and readability. 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