Augmented reality in dentistry: a current perspective

Implant Placement using Mixed Reality-Based Dynamic Navigation: a Proof of Concept

OBJECTIVES

To present the first clinical application of a novel mixed reality-based dynamic navigation (MR-DN) system in the rehabilitation of a single tooth gap.

METHODS

The protocol consisted of the following: (1) three-dimensional patient data acquisition using intraoral scanning (IOS) and cone-beam computed tomography (CBCT), (2) implant planning using guided surgery software, (3) holography-guided implant placement using the novel MR-DN system (ANNA®, MARS Dental, Haifa, Israel) and (4) placement accuracy verification.

RESULTS

The novel MR-DN system was safe and time-efficient, as the surgery took 30 minutes from anaesthesia to suturing. The accuracy of implant placement was high with minimal deviations recorded in the three planes of space compared to the presurgical planning: the error at the entry point planar distance (XY) was 0.381 mm, and the entry point planar distance (Z) was 0.173 mm, for a 3D entry point distance (En) of 0.417 mm. A 3D apex deviation (An) of 0.193 mm was registered, with an angle difference of 1.852°.

CONCLUSIONS

This proof-of-concept study demonstrated the clinical feasibility of MR-DN for guided implant placement in single tooth gaps. Further clinical studies on a large sample of patients are needed to confirm these positive preliminary results. Statement of clinical relevance: The use of MR-DN can change the perspectives of guided dental implant surgery as a possible alternative to the classic static and dynamic guided surgical techniques for the rehabilitation of single tooth gaps.

Taxonomic discordance of immersive realities in dentistry: A systematic scoping review

OBJECTIVES

This review aimed to map taxonomy frameworks, descriptions, and applications of immersive technologies in the dental literature.

DATA

The Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines was followed, and the protocol was registered at open science framework platform (https://doi.org/10.17605/OSF.IO/H6N8M).

SOURCES

Systematic search was conducted in MEDLINE (via PubMed), Scopus, and Cochrane Library databases, and complemented by manual search.

STUDY SELECTION

A total of 84 articles were included, with 81 % between 2019 and 2023. Most studies were experimental (62 %), including education (25 %), protocol feasibility (20 %), in vitro (11 %), and cadaver (6 %). Other study types included clinical report/technique article (24 %), clinical study (9 %), technical note/tip to reader (4 %), and randomized controlled trial (1 %). Three-quarters of the included studies were published in oral and maxillofacial surgery (38 %), dental education (26 %), and implant (12 %) disciplines. Methods of display included head mounted display device (HMD) (55 %), see through screen (32 %), 2D screen display (11 %), and projector display (2 %). Descriptions of immersive realities were fragmented and inconsistent with lack of clear taxonomy framework for the umbrella and the subset terms including virtual reality (VR), augmented reality (AR), mixed reality (MR), augmented virtuality (AV), extended reality, and X reality.

CONCLUSIONS

Immersive reality applications in dentistry are gaining popularity with a notable surge in the number of publications in the last 5 years. Ambiguities are apparent in the descriptions of immersive realities. A taxonomy framework based on method of display (full or partial) and reality class (VR, AR, or MR) is proposed.

CLINICAL SIGNIFICANCE

Understanding different reality classes can be perplexing due to their blurred boundaries and conceptual overlapping. Immersive technologies offer novel educational and clinical applications. This domain is fast developing. With the current fragmented and inconsistent terminologies, a comprehensive taxonomy framework is necessary.

Accuracy of implant placement using a mixed reality-based dynamic navigation system versus static computer-assisted and freehand surgery: An in Vitro study

PURPOSE

This in vitro study aimed to compare the accuracy of dental implant placement in partially edentulous maxillary models using a mixed reality-based dynamic navigation (MR-DN) system to conventional static computer-assisted implant surgery (s-CAIS) and a freehand (FH) method.

METHODS

Forty-five partially edentulous models (with teeth missing in positions #15, #16 and #25) were assigned to three groups (15 per group). The same experienced operator performed the model surgeries using an MR-DN system (group 1), s-CAIS (group 2) and FH (group 3). In total, 135 dental implants were placed (45 per group). The primary outcomes were the linear coronal deviation (entry error; En), apical deviation (apex error; Ap), XY and Z deviations, and angular deviation (An) between the planned and actual (post-surgery) position of the implants in the models. These deviations were computed as the distances between the stereolithographic (STL) files for the planned implants and placed implants captured with an intraoral scanner.

RESULTS

Across the three implant sites, the MR-DN system was significantly more accurate than the FH method (in XY, Z, En, Ap and An) and s-CAIS (in Z, Ap and An), respectively. However, S-CAIS was more accurate than MR-DN in XY, and no difference was found between MR-DN and s-CAIS in En.

CONCLUSIONS

Within the limits of this study (in vitro design, only partially edentulous models), implant placement accuracy with MR-DN was superior to that of FH and similar to that of s-CAIS.

STATEMENT OF CLINICAL RELEVANCE

In vitro, MR-DN showed greater accuracy in implant positioning than FH, and similar accuracy to s-CAIS: it could, therefore, represent a new option for the surgeon. However, clinical studies are needed to determine the feasibility of MR-DN.

The effect of augmented reality book on the proficiency of local anesthesia administration of the inferior alveolar nerve

BACKGROUND/OBJECTIVE

Advancements in augmented reality (AR) technology enable developers to create augmented reality books (AR Books). AR Books can show interactive 3D objects and multimedia content to the user. The purpose of this study was to investigate the effect of a developed AR Book on the theoretical and practical abilities in the administration of local anesthesia of the inferior alveolar nerve block.

METHODS

An exclusive AR Book was developed based on Chapter 14, Handbook of Local Anesthesia, seventh edition, Stanley F. Malamed, which enabled students to use their book (printed or electronic) as an AR Book. Forty dental students were randomly divided into control and study groups. In the control group, students were asked to use regular books, while in the study group, students were instructed to use interactive AR Books. All students took the written exam, scoring 0 to 10. Also, the administration of mandibular local anesthesia was evaluated in students. The level of concentration during the study, the written exam score, the practical score, the success rate of local anesthesia, and the needed time for injection were compared between the two groups.

RESULTS

There was a significant difference in the level of concentration during the study (p < 0.001), practical skill score (p = 0.037), and needed time for injection (p = 0.040) between the two groups. Conversely, the success rate of local anesthesia was almost similar (p = 0.705). Although the written exam score was higher in the study group than in the control group, the difference was not significant (p = 0.414).

CONCLUSION

Using AR Books can engage students and help them to remain focused during the study. AR Books may be beneficial in enhancing the practical abilities of dental students.

Artificial intelligence and mixed reality for dental implant planning: A technical note

AIM

The aim of this work is to present a new protocol for implant surgical planning which involves the combined use of artificial intelligence (AI) and mixed reality (MR).

METHODS

This protocol involves the acquisition of three-dimensional (3D) patient data through intraoral scanning (IOS) and cone beam computed tomography (CBCT). These data are loaded into AI software which automatically segments and aligns the patient's 3D models. These 3D models are loaded into MR software and used for planning implant surgery through holography. The files are then exported and used to design surgical guides via open-source software, which are 3D printed and used to prepare the implant sites through static computer-assisted implant surgery (s-CAIS). The case is finalized prosthetically through a fully digital protocol. The accuracy of implant positioning is verified by comparing the planned position with the actual position of the implants after surgery.

RESULTS

As a proof of principle, the present protocol seems to be to be reliable and efficient when used for planning simple cases of s-CAIS in partially edentulous patients. The clinician can plan the implants in an authentic 3D environment without using any radiology-guided surgery software. The precision of implant placement seems clinically acceptable, with minor deviations.

CONCLUSIONS

The present study suggests that AI and MR technologies can be successfully used in s-CAIS for an authentic 3D planning. Further clinical studies are needed to validate this protocol.

Navigate biopsy with ultrasound under augmented reality device: Towards higher system performance

PURPOSE

Biopsies play a crucial role in determining the classification and staging of tumors. Ultrasound is frequently used in this procedure to provide real-time anatomical information. Using augmented reality (AR), surgeons can visualize ultrasound data and spatial navigation information seamlessly integrated with real tissues. This innovation facilitates faster and more precise biopsy operations.

METHODS

We have developed an augmented reality biopsy navigation system characterized by low display latency and high accuracy. Ultrasound data is initially read by an image capture card and streamed to Unity via net communication. In Unity, navigation information is rendered and transmitted to the HoloLens 2 device using holographic remoting. Concurrently, a retro-reflective tool tracking method is implemented on the HoloLens 2, enabling the simultaneous tracking of the ultrasound probe and biopsy needle. Distinct navigation information is provided during in-plane and out-of-plane punctuation. To evaluate the effectiveness of our system, we conducted a study involving ten participants, assessing puncture accuracy and biopsy time in comparison to traditional methods.

RESULTS

Ultrasound image was streamed from the ultrasound device to augmented reality headset with 122.49±11.61ms latency, while only 16.22±11.25ms was taken after data acquisition from image capture card. Navigation accuracy reached 1.23±0.68mm in the image plane and 0.95±0.70mm outside the image plane, within a depth range of 200 millimeters. Remarkably, the utilization of our system led to 98% and 95% success rate in out-of-plane and in-plane biopsy, among ten participants with little ultrasound experience.

CONCLUSION

To sum up, this paper introduces an AR-based ultrasound biopsy navigation system characterized by high navigation accuracy and minimal latency. The system provides distinct visualization contents during in-plane and out-of-plane operations according to their different characteristics. Use case study in this paper proved that our system can help young surgeons perform biopsy faster and more accurately.

Dental implant placement with immersive technologies: A preliminary clinical report of augmented and mixed reality applications

A preliminary clinical report of implant placements with 2 immersive reality technologies is described: augmented reality with head mounted display and mixed reality with a tablet PC. Both immersive realities are promising and could facilitate innovative dental applications. However, mixed reality requires further development for clinical optimization.

Augmented reality in implantology: Virtual surgical checklist and augmented implant placement

OBJECTIVES

Aim of the present study was to create a pedagogical checklist for implant surgical protocol with an augmented reality (AR) guided freehand surgery to inexperienced surgeons using a head mounted display (HMD) with tracking.

METHODS

The anatomical model of a patient with two missing mandibular teeth requiring conventional single-tooth implants was selected. The computed tomography (CT) scans were extracted and imported into segmentation and implant planning software. A Patient-specific dental splint through an intermediate strut, supported 3D-printed QR code. A checklist was generated to guide surgical procedure. After tracking, the AR-HMD projects the virtual pre-surgical plan (inferior alveolar nerve (IAN), implant axis, implant location) onto the real 3D-printed anatomical models. The entire drilling sequence was based on the manufacturer's recommendations, on 3D-printed anatomical models. After the implant surgical procedure, CT of the 3D-printed models was performed to compare the actual and simulated implant placements. All procedures in the study were performed in accordance with the Declaration of Helsinki.

RESULTS

In total, two implants were placed in a 3D-printed anatomical model of a female patient who required implant rehabilitation for dental agenesis at the second mandibular premolar positions (#35 and #45). Superimposition of the actual and simulated implants showed high concordance between them.

CONCLUSION

AR in education offers crucial surgical information for novice surgeons in real time. However, the benefits provided by AR in clinical and educational implantology must be demonstrated in other studies involving a larger number of patients, surgeons and apprentices.

Assessment of a virtual prosthetic case planning environment for dental education - A multicentric analysis

OBJECTIVES

The aim of the present study was the multicentric assessment of the virtual prosthetic case planning environment (VCPE), which relocates patient planning into the virtual space in dental education.

MATERIALS AND METHODS

The VCPE is separated into two rooms: a virtual entry area where the user can choose between 10 different prosthetic case plans of ascending complexity, and a virtual patient case planning room. In spring term 2022, the use of virtual case planning was voluntarily assessed in four different German dental schools (DSs) from the perspective of both lecturers and students. The assessment was performed afterwards using a questionnaire. Data were analysed using Kolmogorov-Smirnov test, exploratory data analysis, Fisher-Freeman-Halton test, and exact Fisher test. Reliability was assessed with Cronbach Alpha test (α < 0.05).

RESULTS

A total of 59 lecturers and 63 students were included. There were 38.5% male, 60.7% female, and 0.8% diverse participants. The mean age of the lecturers was 36.2 ± 9.0 years and of the students 24.3 ± 3.0 years. The VCPE was assessed as good, yet the evaluations between either the DSs or between the lecturers and students were significantly different.

CONCLUSIONS

Even though for some assessment criteria significantly different results between the four DS were observed, the majority of participants evaluated the VCPE positively and recommended them for teaching. The virtual reality as a teaching method for teaching prosthetic case planning for the further preparation of the students for the later professional life can be considered as helpful.

Enhancing learning experiences in pre-clinical restorative dentistry: the impact of virtual reality haptic simulators

BACKGROUND

Utilization of Virtual Reality haptic simulation (VRHS) to aid in the training of various pre-clinical skills is of recent interest. The aim of this study was to evaluate the impact of VRHS in restorative dentistry on the learning experiences and perceptions of dental students.

METHODS

An interventional study design was utilized to recruit third year students. All participants provided informed consents and were randomly divided into two groups. Group 1: Initially performed a Class I cavity preparation with the VRHS, followed by the same exercise using the phantom head/ acrylic typodont teeth in a conventional simulation environment (CSE). Group 2: Initially performed Class I preparations in a CSE, followed by the same exercise using VRHS. Both groups performed the exercises on a lower right first molar. To understand students' perception, an online questionnaire was circulated. Data analysis involved Chi-square tests, independent t-tests and Mann-Whitney U-tests using the R statistical environment package.

RESULTS

A total of 23 dental students participated in this study. Although student's perceptions were similar in both groups, a strong agreement that VRHS training might be used to supplement standard pre-clinical training was noted. Advancements to the VRHS hardware and software are required to bridge the gap and provide a smooth transition to clinics.

CONCLUSION

Novice dental students generally perceived VRHS as a useful tool for enhancing their manual dexterity. Dental institutions should endorse virtual reality technology with caution, ensuring a planned integration into the curriculum to optimize benefit. Feedback is pivotal to effective learning in simulation-based education, and the triangulation of feedback could serve as a powerful aid to maximize the learning experience.

Current status and future prospects of stomatology research

Research in stomatology (dental medicine) continues to expand globally and is oriented towards solving clinical issues, focusing on clarifying the clinical relevance and potential mechanisms of oral‍-‍systemic connections via clinical epidemiology, oral microecological characterization, and the establishment of animal models. Interdisciplinary integration of materials science and tissue engineering with stomatology is expected to lead to the creation of innovative materials and technologies to better resolve the most prevalent and challenging clinical issues such as peri-implantitis, soft and hard tissue defects, and dentin hypersensitivity. With the rapid development of artificial intelligence (AI), 5th generation mobile communication technology (5G), and big data applications, "intelligent stomatology" is emerging to build models for better clinical diagnosis and management, accelerate the reform of education, and support the growth and advancement of scientific research. Here, we summarized the current research status, and listed the future prospects and limitations of these three aspects, aiming to provide a basis for more accurate etiological exploration, novel treatment methods, and abundant big data analysis in stomatology to promote the translation of research achievements into practical applications for both clinicians and the public.

A Custom-Made Surgical Guide for Accurate Enucleation of Nasopalatine Duct Cysts: A Technical Note and Case Report

Nasopalatine cysts are common nonodontogenic cysts that occur in the maxilla. During the nucleation of large cysts extending to the floor of the nasal cavity, care must be taken to avoid damage to the nasal mucosa. In the present report, an innovative custom-made surgical guide made by a Three-dimensional printer is introduced for accurate enucleation surgery. The patient's cone-beam computerized tomography and dental model scan data were obtained, and a tooth-supported type of surgical guide was designed containing a circular plate structure showing the size of the cystic region, an indicator that showed the position of the bottom of the cyst, and a sliding stopper that was used to accurately indicate the position of the deepest cyst wall. The surgical tool enabled us to indicate the accurate size, location of the cysts, and approach direction. Although effective and accurate navigation systems have become increasingly available, the cost-effective and accurate computer-aided design/computer-aided manufacturing surgical guide system introduced in the present report could support the safe enucleation of large nasopalatine duct cysts.

Artificial Intelligence and Augmented Reality for Guided Implant Surgery Planning: a Proof of Concept

PURPOSE

To present a novel protocol for authentic three-dimensional (3D) planning of dental implants, using artificial intelligence (AI) and augmented reality (AR).

METHODS

The novel protocol consists of (1) 3D data acquisition, with an intraoral scanner (IOS) and cone-beam computed tomography (CBCT); (2) application of AI for CBCT segmentation to obtain standard tessellation language (STL) models and automatic alignment with IOS models; (3) loading of selected STL models within the AR system and surgical planning with holograms; (4) surgical guide design with open-source computer-assisted-design (CAD) software; and (5) surgery on the patient.

RESULTS

This novel protocol is effective and time-efficient when used for planning simple cases of static guided implant surgery in the partially edentulous patient. The clinician can plan the implants in an authentic 3D environment, without using any radiological guided surgery software. The precision of implant placement looks clinically acceptable, with minor deviations.

CONCLUSIONS

AI and AR technologies can be successfully used for planning guided implant surgery for authentic 3D planning that may replace conventional guided surgery software. However, further clinical studies are needed to validate this protocol.

STATEMENT OF CLINICAL RELEVANCE

The combined use of AI and AR may change the perspectives of modern guided implant surgery for authentic 3D planning that may replace conventional guided surgery software.

Evaluation of AR visualization approaches for catheter insertion into the ventricle cavity

Augmented reality (AR) has shown potential in computer-aided surgery. It allows for the visualization of hidden anatomical structures as well as assists in navigating and locating surgical instruments at the surgical site. Various modalities (devices and/or visualizations) have been used in the literature, but few studies investigated the adequacy/superiority of one modality over the other. For instance, the use of optical see-through (OST) HMDs has not always been scientifically justified. Our goal is to compare various visualization modalities for catheter insertion in external ventricular drain and ventricular shunt procedures. We investigate two AR approaches: (1) 2D approaches consisting of a smartphone and a 2D window visualized through an OST (Microsoft HoloLens 2), and (2) 3D approaches consisting of a fully aligned patient model and a model that is adjacent to the patient and is rotationally aligned using an OST. 32 participants joined this study. For each visualization approach, participants were asked to perform five insertions after which they filled NASA-TLX and SUS forms. Moreover, the position and orientation of the needle with respect to the planning during the insertion task were collected. The results show that participants achieved a better insertion performance significantly under 3D visualizations, and the NASA-TLX and SUS forms reflected the preference of participants for these approaches compared to 2D approaches.

User's image perception improved strategy and application of augmented reality systems in smart medical care: A review

BACKGROUND

Augmented reality (AR) is a new human-computer interaction technology that combines virtual reality, computer vision, and computer networks. With the rapid advancement of the medical field towards intelligence and data visualisation, AR systems are becoming increasingly popular in the medical field because they can provide doctors with clear enough medical images and accurate image navigation in practical applications. However, it has been discovered that different display types of AR systems have different effects on doctors' perception of the image after virtual-real fusion during the actual medical application. If doctors cannot correctly perceive the image, they may be unable to correctly match the virtual information with the real world, which will have a significant impact on their ability to recognise complex structures.

METHODS

This paper uses Citespace, a literature analysis tool, to visualise and analyse the research hotspots when AR systems are used in the medical field.

RESULTS

A visual analysis of the 1163 articles retrieved from the Web of Science Core Collection database reveals that display technology and visualisation technology are the key research directions of AR systems at the moment.

CONCLUSION

This paper categorises AR systems based on their display principles, reviews current image perception optimisation schemes for various types of systems, and analyses and compares different display types of AR systems based on their practical applications in the field of smart medical care so that doctors can select the appropriate display types based on different application scenarios. Finally, the future development direction of AR display technology is anticipated in order for AR technology to be more effectively applied in the field of smart medical care. The advancement of display technology for AR systems is critical for their use in the medical field, and the advantages and disadvantages of various display types should be considered in different application scenarios to select the best AR system.

Future of Orthodontics-A Systematic Review and Meta-Analysis on the Emerging Trends in This Field

Technology is rapidly evolving in the modern world, and the accompanying developments due to its influence are shaping each and every aspect of our life, with the field of orthodontics being no exception. This systematic review and meta-analysis aimed to examine such trends in orthodontics and hypothesize which ones would emerge and continue in the near future. After a thorough search of online journals using keywords such as "3D printing," "Aligners," "Artificial intelligence," "Future trends," "Orthodontics," and "Teleorthodontics" across databases of PubMed-MEDLINE, Web of Science, Cochrane, and Scopus, a total of 634 papers were initially recovered. Technological advancements in 3D printing, Computer-aided design and Computer-aided manufacturing (CAD/CAM), biopolymers and Teleorthodontics were the most important categories of development seen across the 17 studies that we selected for our review. All the investigations selected for this systematic review depicted aspects of orthodontics that were influenced by rapid technological changes and could potentially become mainstream in the coming times. However, caution was sought to be observed in the usage/adoption of some of these trends, with social media usage amongst both patients as well as orthodontists being a prime example of this.

Mobile virtual tooth morphology teaching environment for preclinical dental students

OBJECTIVES

Extended reality as an additional digital learning concept comprises virtual reality (VR), augmented reality, and mixed reality. In particular, VR allows an interaction in the virtual world. The aim of this study was to evaluate the students' attitude toward a mobile VR application for teaching tooth morphologies.

METHODS

Eighty-two first year dental students were enrolled. After using the VR learning environment with mobile VR glasses at home for 1 week, the students were asked to fill in a questionnaire with 21 questions regarding intuitive handling, and supplemental learning information in comparison to the use of conventional textbooks. Nine questions provided predefined answer options, another nine had the form of a visual analog scale (VAS, range 0%-highly negative to 100%-highly positive), and three allowed free text answers. The data were checked for normal distribution (Kolmogorov-Smirnov test) and was analyzed descriptively.

RESULTS

Forty-four percent of the students rated their perception of understanding of dental morphologies much better with VR than with conventional learning. The potential of the VR learning environment for further dental topics was assessed with a median VAS score of 75.8%. Its intuitive handling was evaluated with a median VAS score of 67.1%. The haptic, visual, and auditory supplemental learning information was consistently rated positively with VAS scores of 73.9%, 80.0%, and 71.6%, respectively. Overall, a majority of the students (85.5%) recommended the VR learning environment for dental morphology.

CONCLUSIONS

The VR dental learning environment allows dental students an additional learning opportunity of dental morphologies, recommended by more than 85% of students.

Application of HoloLens-based augmented reality and three-dimensional printed anatomical tooth reference models in dental education

Tooth anatomy is fundamental knowledge used in everyday dental practice to reconstruct the occlusal surface during cavity fillings. The main objective of this project was to evaluate the suitability of two types of anatomical tooth reference models used to support reconstruction of the occlusal anatomy of the teeth: (1) a three-dimensional (3D)-printed model and (2) a model displayed in augmented reality (AR) using Microsoft HoloLens. The secondary objective was to evaluate three aspects impacting the outcome: clinical experience, comfort of work, and other variables. The tertiary objective was to evaluate the usefulness of AR in dental education. Anatomical models of crowns of three different molars were made using cone beam computed tomography image segmentation, printed with a stereolithographic 3D-printer, and then displayed in the HoloLens. Each participant reconstructed the occlusal anatomy of three teeth. One without any reference materials and two with an anatomical reference model, either 3D-printed or holographic. The reconstruction work was followed by the completion of an evaluation questionnaire. The maximum Hausdorff distances (Hmax) between the superimposed images of the specimens after the procedures and the anatomical models were then calculated. The results showed that the most accurate but slowest reconstruction was achieved with the use of 3D-printed reference models and that the results were not affected by other aspects considered. For this method, the Hmax was observed to be 630 μm (p = 0.004). It was concluded that while AR models can be helpful in dental anatomy education, they are not suitable replacements for physical models.

Case Report: Application of Mixed Reality Combined With A Surgical Template for Precise Periapical Surgery

Objective

The etiology of apical diseases is diverse, and most are due to incomplete root canal therapy. The common clinical manifestations include gingival abscess, fistula and bone destruction. The currently existing limitation of procedures is that surgeons cannot visually evaluate the surgical areas. We sought to combine mixed reality (MR) technology with a 3-dimensional (3D) printed surgical template to achieve visualization in apical surgery. Notably, no reports have described this application.

Methods

We created visual 3D (V3D) files and transferred them into the HoloLens system. We explained the surgical therapy plan to the patient using a mixed reality head-mounted display (MR-HMD). Then, the 3D information was preliminarily matched with the operative area, and the optimal surgical approach was determined by combining this information with 3D surgical guide plate technology.

Results

We successfully developed a suitable surgical workflow and confirmed the optimal surgical approach from the buccal side. We completely exposed the apical lesion and removed the inflammatory granulation tissue.

Conclusion

We are the first group to use the MR technique in apical surgery. We integrated the MR technique with a 3D surgical template to successfully accomplish the surgery. Desirable outcomes using minimally invasive therapy could be achieved with the MR technique.

Augmented Reality and Virtual Reality in Dentistry: Highlights from the Current Research

Many modern advancements have taken place in dentistry that have exponentially impacted the progress and practice of dentistry. Augmented reality (AR) and virtual reality (VR) are becoming the trend in the practice of modern dentistry because of their impact on changing the patient’s experience. The use of AR and VR has been beneficial in different fields of science, but their use in dentistry is yet to be thoroughly explored, and conventional ways of dentistry are still practiced at large. Over the past few years, dental treatment has been significantly reshaped by technological advancements. In dentistry, the use of AR and VR systems has not become widespread, but their different uses should be explored. Therefore, the aim of this review was to provide an update on the contemporary knowledge, to report on the ongoing progress of AR and VR in various fields of dental medicine and education, and to identify the further research required to achieve their translation into clinical practice. A literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for articles in peer-reviewed English-language journals published in the last 10 years up to 31 March 2021, with the help of specific keywords related to AR and VR in various dental fields. Of the total of 101 articles found in the literature search, 68 abstracts were considered suitable and further evaluated, and consequently, 33 full-texts were identified. Finally, a total of 13 full-texts were excluded from further analysis, resulting in 20 articles for final inclusion. The overall number of studies included in this review was low; thus, at this point in time, scientifically-proven recommendations could not be stated. AR and VR have been found to be beneficial tools for clinical practice and for enhancing the learning experiences of students during their pre-clinical education and training sessions. Clinicians can use VR technology to show their patients the expected outcomes before the undergo dental procedures. Additionally, AR and VR can be implemented to overcome dental phobia, which is commonly experienced by pediatric patients. Future studies should focus on forming technological standards with high-quality data and developing scientifically-proven AR/VR gadgets for dental practice.

Augmented, Virtual and Mixed Reality in Dentistry: A Narrative Review on the Existing Platforms and Future Challenges

The recent advancements in digital technologies have led to exponential progress in dentistry. This narrative review aims to summarize the applications of Augmented Reality, Virtual Reality and Mixed Reality in dentistry and describes future challenges in digitalization, such as Artificial Intelligence and Robotics. Augmented Reality, Virtual Reality and Mixed Reality represent effective tools in the educational technology, as they can enhance students’ learning and clinical training. Augmented Reality and Virtual Reality and can also be useful aids during clinical practice. Augmented Reality can be used to add digital data to real life clinical data. Clinicians can apply Virtual Reality for a digital wax-up that provides a pre-visualization of the final post treatment result. In addition, both these technologies may also be employed to eradicate dental phobia in patients and further enhance patient’s education. Similarly, they can be used to enhance communication between the dentist, patient, and technician. Artificial Intelligence and Robotics can also improve clinical practice. Artificial Intelligence is currently developed to improve dental diagnosis and provide more precise prognoses of dental diseases, whereas Robotics may be used to assist in daily practice.

Communication tools and patient satisfaction: A scoping review

Objective

This scoping review aimed to present an overview of the literature on communication tools in esthetic dentistry. A variety of communication tools have been proposed to include patients in the shared decision‐making (SDM) workflow. Only little is known about implementing communication tools in dentistry and their impact on patient communication and patient satisfaction. A systematic literature search was performed in Medline, Embase, Cochrane, and World of Science to identify if communication tools have an impact on patient satisfaction.

Material and Methods

The search included studies from January 1, 2000 to March 3, 2020 published in English, focusing on patient communication tools and patient satisfaction in esthetic dentistry.

Results

Out of 6678 records, 53 full‐texts were examined. Ten studies were included. Data of the included studies were extracted systematically and subsequently analyzed. All studies found that patient communication utilizing specific communication tools positively impacted either patient satisfaction, patient‐dentist relationship, information retention, treatment acceptance, quality of care or treatment outcome.

Conclusions

Additional communication tools besides conventional verbal communication are able to enhance patient satisfaction, improve quality of care and establish a better patient‐dentist relationship. It seems essential to further develop standardized communication tools for SDM in dental medicine, which will allow the comparison of research on this topic.

Clinical significance

This scoping review shows the importance of patient involvement in the decision‐making process for improved patient satisfaction with esthetic dental treatments. With an increased implementation of communication tools, patient satisfaction and SDM may further improve in the future.

Virtual dental teaching and its effect on test success - A cross-over study

OBJECTIVES

The aim of this cross-over investigation was to analyze the effect of virtual teaching using virtual reality (VR) within a dental learning environment by preclinical students with or without dental professional experience on test performance.

METHODS

Preclinical students (N = 82) were randomly divided into two groups for cross-over testing of tooth morphology knowledge: (a) anterior VR-group (group 1) using the VR-glasses as an additional learning tool for the anterior tooth morphologies and (b) posterior VR-group (group 2) using it for the posterior tooth morphologies also in addition to conventional learning. All students used the VR-glasses for 1 week independent of time and location depending on group. The students had to recognize teeth (anterior or posterior within two separate tests after three [anterior test] and 6 weeks [posterior test] of practical course) and note the tooth number and characteristics in written form. Former dental experience (dental technician/assistance) was noted. Test results were analyzed to quantify the effect of virtual teaching on test scores. Data were analyzed with the Kolmogorov-Smirnov and Mann-Whitney U test (p = 0.05).

RESULTS

By differentiating the two student groups (use of VR glasses for anterior/posterior teeth) within the dental experience group, significantly better test results (p = 0.040) were shown for group 1 in the total posterior teeth test score. Furthermore, no other significant differences, but a possible tendency, in the test results and thus no effect of the use of the VR glasses on both VR groups could be analyzed (p ≥ 0.051).

CONCLUSIONS

Using the VR tooth learning environment predominantly did not lead to a significant improvement of test results. Anterior teeth test scores predominantly showed significantly better results than posterior teeth test scores.

Effectiveness of Virtual Reality and Interactive Simulators on Dental Education Outcomes: Systematic Review

In recent years, virtual reality and interactive digital simulations have been used in dental education to train dental students before interacting with real patients. Scientific evidence presented the application of virtual technology in dental education and some recent publications suggested that virtual and haptic technologies may have positive effects on dental education outcomes. The aim of this systematic review was to determine whether virtual technologies have positive effects on dental education outcomes and to explore the attitudes of dental students and educators toward these technologies. A thorough search was conducted in PubMed, Scopus, MEDLINE (via EBSCO), The Cochrane Library (via Wiley), Web of Science Core Collection (via Thomson Reuters), and Dentistry and Oral Science source (via EBSCO) using the keywords (student, dental) AND (education, dental) AND (virtual reality) OR (augmented reality) OR (haptics) OR (simulation) AND (dentistry) OR (dental medicine). The quality of the reported information was assessed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement for systematic reviews. A total of 73 publications were considered for this review. Fifty-two of the selected studies showed significant improvement in educational outcomes and virtual technologies were positively perceived by all the participants. Within the limitations of this review, virtual technology appears to improve education outcomes in dental students. Further studies with larger samples and longer term clinical trials are needed to substantiate this potential positive impact of various virtual technologies on dental education outcomes.

Virtual Reality (VR) Simulation and Augmented Reality (AR) Navigation in Orthognathic Surgery: A Case Report

VR and AR technology have gradually developed to the extent that they could help operators in the surgical field. In this study, we present a case of VR simulation for preoperative planning and AR navigation applied to orthognathic surgery. The average difference between the preplanned data and the post-operative results was 3.00 mm, on average, and the standard deviation was 1.44 mm. VR simulation could provide great advantages for 3D medical simulations, with accurate manipulation and immersiveness. AR navigation has great potential in medical application; its advantages include displaying real time augmented 3D models of patients. Moreover, it is easily applied in the surgical field, without complicated 3D simulations or 3D-printed surgical guides.

A proof-of-concept augmented reality system in oral and maxillofacial surgery

BACKGROUND

The advent of digital medical imaging, medical image analysis and computer vision has opened the surgeon horizons with the possibility to add virtual information to the real operative field. For oral and maxillofacial surgeons, overlaying anatomical structures to protect (such as teeth, sinus floors, inferior and superior alveolar nerves) or to remove (such as cysts, tumours, impacted teeth) presents a real clinical interest.

MATERIAL AND METHODS

Through this work, we propose a proof-of-concept markerless augmented reality system for oral and maxillofacial surgery, where a virtual scene is generated preoperatively and mixed with reality to reveal the location of hidden anatomical structures intraoperatively. We devised a computer software to process still video frames of the operating field and to display them on the operating room screens.

RESULTS

Firstly, we give a description of the proposed system, where virtuality aligns with reality without artificial markers. The dental occlusion plan analysis and cusps detection allow us to initialise the alignment process. Secondly, we validate the feasibility with an experimental approach on a 3D printed jaw phantom and an ex-vivo pig jaw. Thirdly, we evaluate the potential clinical benefit on a patient.

CONCLUSION

this proof-of-concept highlights the feasibility and the interest of augmented reality for hidden anatomical structures visualisation without artificial markers.

The Current Situation and Future Prospects of Simulators in Dental Education

The application of virtual reality has become increasingly extensive as this technology has developed. In dental education, virtual reality is mainly used to assist or replace traditional methods of teaching clinical skills in preclinical training for several subjects, such as endodontics, prosthodontics, periodontics, implantology, and dental surgery. The application of dental simulators in teaching can make up for the deficiency of traditional teaching methods and reduce the teaching burden, improving convenience for both teachers and students. However, because of the technology limitations of virtual reality and force feedback, dental simulators still have many hardware and software disadvantages that have prevented them from being an alternative to traditional dental simulators as a primary skill training method. In the future, when combined with big data, cloud computing, 5G, and deep learning technology, dental simulators will be able to give students individualized learning assistance, and their functions will be more diverse and suitable for preclinical training. The purpose of this review is to provide an overview of current dental simulators on related technologies, advantages and disadvantages, methods of evaluating effectiveness, and future directions for development.

Curriculum setting and students' feedback of pre-clinical training in different dental schools in China-A national-wide survey

INTRODUCTION

Adequate time and effective training facilities are essential for undergraduate dental students participating in pre-clinical dental practice to ensure them providing safe treatment for patients in the future. The study aimed to explore the current status of pre-clinical dental training in China in relation to the curriculum setting and students' feedback of pre-clinical training in different dental schools and thus provide information for further standardise curricula.

MATERIALS AND METHOD

An online questionnaire was distributed electronically to undergraduates in 44 Chinese dental schools of different levels according to China Discipline Ranking (CDR). The questionnaire collected information in relation to the training hour and student to facility ratio of four main dental courses (cariology and endodontics, periodontology, prosthodontics and oral surgery), as well as the application and effect of virtual reality (VR) simulator in pre-clinical dental practice in different schools. Students' feedback was also collected.

RESULTS

A total of 565 valid questionnaires were recruited. Results of this cross-sectional survey show that training hour of periodontology course was the lowest, and oral surgery course showed most prominent shortage of facilities. The application of VR simulator amongst schools is uneven. Students from A and A+ level schools showed higher satisfaction with their pre-clinical courses and reported a more positive attitude towards the use of VR simulator than other students. (p < .05).

CONCLUSION

Pre-clinical dental training in China remained imperfect in insufficient training time, training facility and students did not have access to standard pre-clinical training and quality assurance. VR technique has potential values in pre-clinical dental practice in China.

Disruptive Innovation in Dentistry: What It Is and What Could Be Next

Dentistry is a technically oriented profession, and the health care sector is significantly influenced by the ubiquitous trend of digitalization. Some of these digital developments have the potential to result in disruptive changes for dental practice, while others may turn out to be just a pipedream. This Discovery! essay focuses on innovations built on artificial intelligence (AI) as the center-technology influencing 1) dental eHealth data management, 2) clinical and technical health care applications, and 3) services and operations. AI systems enable personalized dental medicine workflows by analyzing all eHealth data gathered from an individual patient. Besides dental-specific data, this also includes genomic, proteomic, and metabolomic information and therefore facilitates optimized and personalized treatment strategies and risk management. Based on the power of AI, the triangular frame of "data"/"health care"/"service" is supplemented by technological advancements in the field of social media, Internet of things, augmented and virtual reality, rapid prototyping, and intraoral optical scanning as well as teledentistry. Innovation continues to be critical to tackle dental problems until its routine implementation based on sound scientific evidence. Novel technologies must be viewed critically in relation to the cost-benefit ratio and the ethical implications of a misleading diagnosis or treatment produced by AI algorithms. Highly sensitive eHealth data must be handled responsibly to enable the immense benefits of these technologies to be realized for society. The focus on patient-centered research and the development of personalized dental medicine have the potential to improve individual and public health, as well as clarify the interconnectivity of disease in a more cost-effective way.

A review on the applications of virtual reality, augmented reality and mixed reality in surgical simulation: an extension to different kinds of surgery

Background: Research proves that the apprenticeship model, which is the gold standard for training surgical residents, is obsolete. For that reason, there is a continuing effort toward the development of high-fidelity surgical simulators to replace the apprenticeship model. Applying Virtual Reality Augmented Reality (AR) and Mixed Reality (MR) in surgical simulators increases the fidelity, level of immersion and overall experience of these simulators.Areas covered: The objective of this review is to provide a comprehensive overview of the application of VR, AR and MR for distinct surgical disciplines, including maxillofacial surgery and neurosurgery. The current developments in these areas, as well as potential future directions, are discussed.Expert opinion: The key components for incorporating VR into surgical simulators are visual and haptic rendering. These components ensure that the user is completely immersed in the virtual environment and can interact in the same way as in the physical world. The key components for the application of AR and MR into surgical simulators include the tracking system as well as the visual rendering. The advantages of these surgical simulators are the ability to perform user evaluations and increase the training frequency of surgical residents.

Development of flash cards to teach about lesions in the jaws and maxillary sinuses

OBJECTIVE

We sought to evaluate a set of flash cards to teach about lesions of the jaws and maxillary sinuses.

METHODS

We placed illustrations of 30 diseases of the jaws and maxillary sinuses on the front of the cards (7 cm × 5 cm). On the backs of the cards, a description of the radiological findings and the corresponding QR code for each disease were printed. Each QR code was linked to a website where actual X-ray images of the lesion could be viewed. Students and radiologists in training could easily access the website by scanning the QR code with a handheld device. The evaluation of the system by students was quite favorable and its utilization rate was high. After a 6-month trial, we conducted a questionnaire. The subjects were 94 fourth-year students at our college, and the questionnaire was anonymous.

RESULTS

The evaluation of the system by students was quite favorable and its utilization rate was high.

CONCLUSIONS

The learning content of our learning cards with QR codes was well received by students and was highly useful.

Recent Trends and Future Direction of Dental Research in the Digital Era

The digital transformation in dental medicine, based on electronic health data information, is recognized as one of the major game-changers of the 21st century to tackle present and upcoming challenges in dental and oral healthcare. This opinion letter focuses on the estimated top five trends and innovations of this new digital era, with potential to decisively influence the direction of dental research: (1) rapid prototyping (RP), (2) augmented and virtual reality (AR/VR), (3) artificial intelligence (AI) and machine learning (ML), (4) personalized (dental) medicine, and (5) tele-healthcare. Digital dentistry requires managing expectations pragmatically and ensuring transparency for all stakeholders: patients, healthcare providers, university and research institutions, the medtech industry, insurance, public media, and state policy. It should not be claimed or implied that digital smart data technologies will replace humans providing dental expertise and the capacity for patient empathy. The dental team that controls digital applications remains the key and will continue to play the central role in treating patients. In this context, the latest trend word is created: augmented intelligence, e.g., the meaningful combination of digital applications paired with human qualities and abilities in order to achieve improved dental and oral healthcare, ensuring quality of life.

The application of virtual reality and augmented reality in Oral & Maxillofacial Surgery

Background

Virtual reality is the science of creating a virtual environment for the assessment of various anatomical regions of the body for the diagnosis, planning and surgical training. Augmented reality is the superimposition of a 3D real environment specific to individual patient onto the surgical filed using semi-transparent glasses to augment the virtual scene.. The aim of this study is to provide an over view of the literature on the application of virtual and augmented reality in oral & maxillofacial surgery.

Methods

We reviewed the literature and the existing database using Ovid MEDLINE search, Cochran Library and PubMed. All the studies in the English literature in the last 10 years, from 2009 to 2019 were included.

Results

We identified 101 articles related the broad application of virtual reality in oral & maxillofacial surgery. These included the following: Eight systematic reviews, 4 expert reviews, 9 case reports, 5 retrospective surveys, 2 historical perspectives, 13 manuscripts on virtual education and training, 5 on haptic technology, 4 on augmented reality, 10 on image fusion, 41 articles on the prediction planning for orthognathic surgery and maxillofacial reconstruction. Dental implantology and orthognathic surgery are the most frequent applications of virtual reality and augmented reality. Virtual planning improved the accuracy of inserting dental implants using either a statistic guidance or dynamic navigation. In orthognathic surgery, prediction planning and intraoperative navigation are the main applications of virtual reality. Virtual reality has been utilised to improve the delivery of education and the quality of training in oral & maxillofacial surgery by creating a virtual environment of the surgical procedure. Haptic feedback provided an additional immersive reality to improve manual dexterity and improve clinical training.

Conclusion

Virtual and augmented reality have contributed to the planning of maxillofacial procedures and surgery training. Few articles highlighted the importance of this technology in improving the quality of patients’ care. There are limited prospective randomized studies comparing the impact of virtual reality with the standard methods in delivering oral surgery education.

Innovative Trends in Implant Dentistry Training and Education: A Narrative Review

BACKGROUND

The field of implant dentistry education is rapidly evolving as new technologies permit innovative methods to teach the fundamentals of implant dentistry.

METHODS

Literature from the fields of active learning, blended learning, augmented reality, artificial intelligence, haptics, and mixed reality were reviewed and combined with the experience and opinions of expert authors. Both positive and negative aspects of the learning methods are presented.

RESULTS AND CONCLUSION

The fundamental objectives of teaching and learning remain unchanged, yet the opportunities to reach larger audiences and integrate their learning into active experiences are evolving due to the introduction of new teaching and learning methodologies. The ability to reach a global audience has never been more apparent. Nevertheless, as much as new technology can be alluring, each new method comes with unique limitations.

Predicting the Debonding of CAD/CAM Composite Resin Crowns with AI

A preventive measure for debonding has not been established and is highly desirable to improve the survival rate of computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin (CR) crowns. The aim of this study was to assess the usefulness of deep learning with a convolution neural network (CNN) method to predict the debonding probability of CAD/CAM CR crowns from 2-dimensional images captured from 3-dimensional (3D) stereolithography models of a die scanned by a 3D oral scanner. All cases of CAD/CAM CR crowns were manufactured from April 2014 to November 2015 at the Division of Prosthodontics, Osaka University Dental Hospital (Ethical Review Board at Osaka University, approval H27-E11). The data set consisted of a total of 24 cases: 12 trouble-free and 12 debonding as known labels. A total of 8,640 images were randomly divided into 6,480 training and validation images and 2,160 test images. Deep learning with a CNN method was conducted to develop a learning model to predict the debonding probability. The prediction accuracy, precision, recall, F-measure, receiver operating characteristic, and area under the curve of the learning model were assessed for the test images. Also, the mean calculation time was measured during the prediction for the test images. The prediction accuracy, precision, recall, and F-measure values of deep learning with a CNN method for the prediction of the debonding probability were 98.5%, 97.0%, 100%, and 0.985, respectively. The mean calculation time was 2 ms/step for 2,160 test images. The area under the curve was 0.998. Artificial intelligence (AI) technology-that is, the deep learning with a CNN method established in this study-demonstrated considerably good performance in terms of predicting the debonding probability of a CAD/CAM CR crown with 3D stereolithography models of a die scanned from patients.

Comparison of Two Innovative Strategies Using Augmented Reality for Communication in Aesthetic Dentistry: A Pilot Study

During dental prosthetic rehabilitation, communication and conception are achieved using rigorous methodologies such as smile design protocols. The aim of the present pilot study was to compare two innovative strategies that used augmented reality for communication in dentistry. These strategies enable the user to instantly try a virtual smile proposition by taking a set of pictures from different points of view or by using the iPad as an enhanced mirror. Sixth-year dental students (n=18, women = 13, men = 5, mean age = 23.8) were included in this pilot study and were asked to answer a 5-question questionnaire studying the user experience using a visual analog scale (VAS). Answers were converted into a numerical result ranging from 0 to 100 for statistical analysis. Participants were not able to report a difference between the two strategies in terms of handling of the device (p=0.45), quality of the reconstruction (p=0.73), and fluidity of the software (p=0.67). Even if the participants' experience with the enhanced mirror was more often reported as immersive and more likely to be integrated in a daily dental office practice, no significant increase was reported (p=0.15 and p=0.07). Further investigations are required to evaluate time and cost savings in daily practice. Software accuracy is also a major point to investigate in order to go further in clinical applications.

Development and Assessment of a Three-Dimensional Tooth Morphology Quiz for Dental Students

Tooth morphology has a pivotal role in the dental curriculum and provides one of the important foundations of clinical practice. To supplement tooth morphology teaching a three-dimensional (3D) quiz application (app) was developed. The 3D resource enables students to study tooth morphology actively by selecting teeth from an interactive quiz, modify their viewpoint and level of zoom. Additionally, students are able to rotate the tooth to obtain a 3D spatial understanding of the different surfaces of the tooth. A cross-over study was designed to allow comparison of students' results after studying with the new application or traditionally with extracted/model teeth. Data show that the app provides an efficient learning tool and that students' scores improve with usage (18% increase over three weeks, P < 0.001). Data also show that student assessment scores were correlated with scores obtained while using the app but were not influenced by the teaching modality initially accessed (r²  = 0.175, P < 0.01). Comparison of the 2016 and 2017 class performance shows that the class that had access to the app performed significantly better on their final tooth morphology assessment (68.0% ±15.0 vs. 75.3% ±13.4, P < 0.01). Furthermore, students reported that the 3D application was intuitive, provided useful feedback, presented the key features of the teeth, and assisted in learning tooth morphology. The 3D tooth morphology app thus provides students with a useful adjunct teaching tool for learning dental anatomy. Anat Sci Educ 00: 000-000. © 2018 American Association of Anatomists.

Errors according to the number of registered markers used in navigation-assisted surgery of the mandible

Background

The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of the navigation system for the mandible.

Methods

The TREs were measured in five different experiments, varying only in the number of registration reference markers, which ranged from three to seven. To measure the TREs according to the number of registration reference markers, two experimental navigation devices were used: 1) Cbyon navigation surgery equipment 2) Polaris optical tracker. Both experiments were conducted to obtain the TREs at the anatomical locations of the mandible according to the number of registration markers during the navigation process. Statistical analysis was performed using the SPSS 23.0 software.

Results

At all anatomical locations, errors were 2 mm or less. Further, significant differences in the target errors measured by the Cbyon system were found according to the number of registration markers. Significant differences in the target errors measured by the Polaris optical tracker were found according to the registration markers at the posterior border only. In both groups, the target errors did not decrease as the number of registration markers increased.

Conclusions

This study demonstrates that an increase in the number of registration markers is not associated with a decrease in the TRE, and that a specific number of registration markers could reduce the TREs at each anatomical site. It is important to determine the minimum number of image registration markers at which the smallest TRE would be observed for different surgical sites.