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Rieder M, Remschmidt B, Gsaxner C, Gaessler J, Payer M, Zemann W, Wallner J. Augmented Reality-Guided Extraction of Fully Impacted Lower Third Molars Based on Maxillofacial CBCT Scans. Bioengineering (Basel) 2024; 11:625. [PMID: 38927861 PMCID: PMC11200966 DOI: 10.3390/bioengineering11060625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/07/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: This study aimed to integrate an augmented reality (AR) image-guided surgery (IGS) system, based on preoperative cone beam computed tomography (CBCT) scans, into clinical practice. (2) Methods: In preclinical and clinical surgical setups, an AR-guided visualization system based on Microsoft's HoloLens 2 was assessed for complex lower third molar (LTM) extractions. In this study, the system's potential intraoperative feasibility and usability is described first. Preparation and operating times for each procedure were measured, as well as the system's usability, using the System Usability Scale (SUS). (3) Results: A total of six LTMs (n = 6) were analyzed, two extracted from human cadaver head specimens (n = 2) and four from clinical patients (n = 4). The average preparation time was 166 ± 44 s, while the operation time averaged 21 ± 5.9 min. The overall mean SUS score was 79.1 ± 9.3. When analyzed separately, the usability score categorized the AR-guidance system as "good" in clinical patients and "best imaginable" in human cadaver head procedures. (4) Conclusions: This translational study analyzed the first successful and functionally stable application of the HoloLens technology for complex LTM extraction in clinical patients. Further research is needed to refine the technology's integration into clinical practice to improve patient outcomes.
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Affiliation(s)
- Marcus Rieder
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
| | - Bernhard Remschmidt
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
| | - Christina Gsaxner
- Institute of Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria
| | - Jan Gaessler
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Wolfgang Zemann
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
| | - Juergen Wallner
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
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Tang WL, Chao XY, Ye Z, Liu MW, Jiang H. The Use of Dynamic Navigation Systems as a Component of Digital Dentistry. J Dent Res 2024; 103:119-128. [PMID: 38098369 DOI: 10.1177/00220345231212811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
The development of dynamic navigation system (DNS) has facilitated the development of modern digital medicine. In the field of dentistry, the cutting-edge technology is garnering widespread recognition. Based on the principles of 3-dimensional visualization, virtual design, and precise motion tracking, DNS is mainly composed of a computer, a tracking system, specialized tracer instruments, and navigation software. DNS employs a workflow that begins with preoperative data acquisition and imaging data reconstruction, followed by surgical instrument calibration and spatial registration, culminating in real-time guided operations. Currently, the system has been applied in a broad spectrum of dental procedures, encompassing dental implants, oral and maxillofacial surgery (such as tooth extraction, the treatment of maxillofacial fractures, tumors, and foreign bodies, orthognathic surgery, and temporomandibular joint ankylosis surgery), intraosseous anesthesia, and endodontic treatment (including root canal therapy and endodontic surgery). These applications benefit from its enhancements in direct visualization, treatment precision, efficiency, safety, and procedural adaptability. However, the adoption of DNS is not without substantial upfront costs, required comprehensive training, additional preparatory time, and increased radiation exposure. Despite challenges, the ongoing advancements in DNS are poised to broaden its utility and substantially strengthen digital dentistry.
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Affiliation(s)
- W L Tang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - X Y Chao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Z Ye
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - M W Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - H Jiang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
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Zhang HX, Yan ZY, Cui NH, Sun F, Wu BZ. Accuracy of computer-assisted dynamic navigation when performing coronectomy of the mandibular third molar: A pilot study. J Dent 2023; 139:104762. [PMID: 37898432 DOI: 10.1016/j.jdent.2023.104762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVES The study represents a preliminary evaluation of the accuracy of the dynamic navigation system (DNS) in coronectomy of the mandibular third molar (M3M). METHODS The study included participants with an impacted M3M near the inferior alveolar canal. The coronectomy planes were designed before the surgery using cone-beam computed tomography (CBCT) imaging data and then loaded into the DNS program. Intraoperatively, the navigation system was used to guide the complete removal of the target crown. Postoperative CBCT imaging was used to assess any three-dimensional deviations of the actual postoperative from the planned preoperative section planes for each patient. RESULTS A total of 12 patients (13 teeth) were included. The root mean square (RMS) deviation of the preoperatively designed plane from the actual postoperative surface was 0.69 ± 0.21 mm, with a maximum of 1.45 ± 0.83/-1.87 ± 0.63 mm deviation. The areas with distance deviations < 1 mm, 1-2 mm, and 2-3 mm were 71.97 ± 5.72 %, 22.96 ± 6.57 %, and 4.52 ± 2.28 %, respectively. Most patients showed extremely high convexity of the surface area located in the mesial region adjacent to the base of the extraction socket. There was no observable evidence of scratching of the buccolingual bone plate at the base of the extraction socket by the handpiece drill. CONCLUSIONS These results provide preliminary support for the use of DNS-based techniques when extracting M3M using a buccal approach. This would improve the accuracy of coronectomy and reduce the potiential damage to the surrounding tissue. CLINICAL SIGNIFICANCE DNS is effective for guiding coronectomy.
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Affiliation(s)
- Hao-Xiang Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Zi-Yu Yan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Nian-Hui Cui
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Feng Sun
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Bin-Zhang Wu
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China.
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Pacheco A, Soós B, Lempel E, Simon I, Maróti P, Möhlhenrich SC, Szalma J. The effect of individual drilling sleeves on the precision of coronectomy tooth sections. An in vitro 3D-printed jaw model experiment. Clin Oral Investig 2023; 27:6769-6780. [PMID: 37783802 PMCID: PMC10630220 DOI: 10.1007/s00784-023-05289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES The aim of this in vitro study was to evaluate the effect of a 3D-printed drill sleeve (DS) on the precision and duration of coronectomy sections. MATERIALS AND METHODS Thirty-six trainees and oral surgeons performed 72 coronectomy cuts in a 3D-printed, entirely symmetric mandible model. Coronectomy was performed freehand (FH) on one side and with a DS on the other side. The occurrence of "too superficial" (≥ 4 mm unprepared lingual tooth tissue) and "too deep" (drilling ≥ 1 mm deeper as tooth contour) cuts and sectioning times were registered. RESULTS In 7 cases, the sections were "too deep" with FH, while none with DS (OR: 18.56; 95%CI: 1.02-338.5; p = 0.048). The deviation between virtually planned and real cut depths was significantly greater in the FH group (1.91 ± 1.62 mm) than in DS group (1.21 ± 0.72 mm) (p < 0.001). A total of 18 "too superficial" buccolingual sections occurred with FH, while 8 cases with DS (OR: 3.50; 95%CI: 1.26-9.72; p = 0.016). Suboptimal sections did not correlate with experience (p = 0.983; p = 0.697). Shortest, suboptimal drillings were most frequently seen distolingually (OR: 6.76; 95% CI: 1.57-29.07; p = 0.01). In the inexperienced group, sectioning time was significantly longer with FH (158.95 ± 125.61 s vs. 106.92 ± 100.79 s; p = 0.038). CONCLUSIONS The DS effectively reduced tooth sectioning times by less experienced colleagues. Independently from the level of experience, the use of DS obviated the need for any preparation outside the lingual tooth contour and significantly decreased the occurrence of "too superficial" cuts, leaving thinner unprepared residual tooth tissue lingually. CLINICAL RELEVANCE Coronectomy sections may result in lingual hard and soft tissue injury with the possibility of damaging the lingual nerve. The precision of the buccolingual depth-control can be improved, while surgical time can be reduced when applying a drilling sleeve.
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Affiliation(s)
- Ana Pacheco
- Department Oral and Maxillofacial Surgery, Medical School, University of Pécs, 1. Tüzér St, 7623, Pécs, Hungary
| | - Balázs Soós
- Department Oral and Maxillofacial Surgery, Medical School, University of Pécs, 1. Tüzér St, 7623, Pécs, Hungary
| | - Edina Lempel
- Department of Conservative Dentistry and Periodontology, Medical School, University of Pécs, 1. Tüzér St, 7623, Pécs, Hungary
| | - Imre Simon
- 3D Printing and Visualization Centre, University of Pécs, 2. Boszorkany St, 7624, Pécs, Hungary
| | - Péter Maróti
- 3D Printing and Visualization Centre, University of Pécs, 2. Boszorkany St, 7624, Pécs, Hungary
- Medical Skills Education and Innovation Centre, Medical School, University of Pecs, 12. Szigeti St, 7624, Pécs, Hungary
| | | | - József Szalma
- Department Oral and Maxillofacial Surgery, Medical School, University of Pécs, 1. Tüzér St, 7623, Pécs, Hungary.
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Anand M, Panwar S. Role of Navigation in Oral and Maxillofacial Surgery: A Surgeon's Perspectives. Clin Cosmet Investig Dent 2021; 13:127-139. [PMID: 33883948 PMCID: PMC8055371 DOI: 10.2147/ccide.s299249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/06/2021] [Indexed: 12/21/2022] Open
Abstract
Surgeries related to the maxillofacial area deal with an intricate network of anatomical structures. With the complexity of the vital structures, it necessitates a surgical team to respect each anatomical boundary. In the past, there was an exceptionally high number of cases with surgical errors. These errors were not because of flaws in the surgeon’s skills or techniques but owing to lack of resources. Visualisation is one of the key factors that determines the precision of any surgical outcome. Advances in surgical planning have led to the introduction of a “Navigation” system that helps surgeons to see more, know more and ultimately do more for their patients. The usefulness of the navigation system in oral surgeries has been indicated by its surgical applications in craniomaxillofacial trauma, orthognathic surgeries, head and neck pathological resections, complex skull base surgeries and surgery involving temporomandibular joint. A vast majority of research literature has suggested remarkable improvement in surgical outcomes under the guidance of 3d planning and navigation. However, with such an inordinate advancement, financial expenses and a gradual learning curve are always a constraining factor in surgical navigation. This article overviews indication of navigation in craniofacial surgeries with a focus on applied aspect, planning and solution to the future problem.
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Affiliation(s)
- Manish Anand
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Shreya Panwar
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
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Dynamic-Assisted Navigational System in Zygomatic Implant Surgery: A Qualitative and Quantitative Systematic Review of Current Clinical and Cadaver Studies. J Oral Maxillofac Surg 2021; 79:799-812. [DOI: 10.1016/j.joms.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023]
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Computerized Navigation for Minimal Invasive Retrieval of Displaced Dental Implants in the Lower Jaw. Oral Maxillofac Surg Clin North Am 2019; 31:447-455. [DOI: 10.1016/j.coms.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Retana A, Emery RW, Keir V. Removal of Impacted Supernumerary Teeth Using a Dynamic Surgical Navigation System: A Case Report. J Oral Maxillofac Surg 2019; 77:1130-1134. [PMID: 30738066 DOI: 10.1016/j.joms.2019.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 11/26/2022]
Abstract
Removal of impacted supernumerary teeth can present a unique set of challenges to the dentoalveolar surgeon. Complications associated with these challenges have been well documented in the literature. The use of dynamically guided surgical navigation technology for the removal of impacted supernumerary teeth has the potential to mitigate these challenges and improve clinical outcomes. Although not a currently Food and Drug Administration-approved indication, the use of dynamic surgical navigation systems for the removal of impacted supernumerary teeth will be elucidated in this case report.
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Affiliation(s)
- Armando Retana
- Oral and Maxillofacial Surgeon, Capital Center for Oral and Maxillofacial Surgery, Washington, DC
| | - Robert W Emery
- Senior Attending Surgeon, Department of Oral and Maxillofacial Surgery, Washington, Hospital Center, Washington, DC
| | - Victoria Keir
- Resident, Department of Dental Medicine and Oral and Maxillofacial Surgery, Brookdale University Hospital Medical Center, Brooklyn, NY.
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Szalma J, Lovász BV, Lempel E, Maróti P. Three-Dimensionally Printed Individual Drill Sleeve for Depth-Controlled Sections in Third Molar Surgery. J Oral Maxillofac Surg 2019; 77:704.e1-704.e7. [PMID: 30610836 DOI: 10.1016/j.joms.2018.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/09/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
During surgical third molar removal and coronectomy procedures, tooth sectioning is an important and, in some cases, an inferior alveolar nerve-endangering step. This article introduces a drilling sleeve that was printed according to the individual tooth-sectioning situation preoperatively, using diagnostic cone-beam computed tomography data. Not only did the sleeve function in our case as a mark on the drill; it was also a reliable physical limiter, serving as a determinant of the required depth during tooth sectioning. This fast and cost-effectively produced drilling sleeve may help younger colleagues when the depth of tooth sections should be precisely controlled.
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Affiliation(s)
- József Szalma
- Associate Professor and Head of Department, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary.
| | - Bálint Viktor Lovász
- PhD Student, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
| | - Edina Lempel
- Associate Professor, Department of Restorative Dentistry and Periodontology, University of Pécs, Pécs, Hungary
| | - Péter Maróti
- PhD Student, Department of Biophysics, University of Pécs, Pécs, Hungary
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