The Preliminary Application of Augmented Reality in Unilateral Orbitozygomatic Maxillary Complex Fractures Treatment:

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.

Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review

OBJECTIVES

Augmented reality (AR) and virtual reality (VR) are emerging technologies with wide potential applications in health care. We performed a scoping review of the current literature on the application of augmented and VR in the field of facial plastic and reconstructive surgery (FPRS).

DATA SOURCES

PubMed and Web of Science.

REVIEW METHODS

According to PRISMA guidelines, PubMed and Web of Science were used to perform a scoping review of literature regarding the utilization of AR and/or VR relevant to FPRS.

RESULTS

Fifty-eight articles spanning 1997-2023 met the criteria for review. Five overarching categories of AR and/or VR applications were identified across the articles: preoperative, intraoperative, training/education, feasibility, and technical. The following clinical areas were identified: burn, craniomaxillofacial surgery (CMF), face transplant, face lift, facial analysis, facial palsy, free flaps, head and neck surgery, injectables, locoregional flaps, mandible reconstruction, mandibuloplasty, microtia, skin cancer, oculoplastic surgery, rhinology, rhinoplasty, and trauma.

CONCLUSION

AR and VR have broad applications in FPRS. AR for surgical navigation may have the most emerging potential in CMF surgery and free flap harvest. VR is useful as distraction analgesia for patients and as an immersive training tool for surgeons. More data on these technologies' direct impact on objective clinical outcomes are still needed.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:2568-2577, 2024.

The use of virtual reality and augmented reality in oral and maxillofacial surgery: A narrative review

OBJECTIVE

The purpose of this article is to review the current uses of virtual reality (VR) and augmented reality (AR) in oral and maxillofacial surgery. We discuss the use of VR/AR in educational training, surgical planning, advances in hardware and software, and the implementation of VR/AR in this field.

STUDY DESIGN

A retrospective comprehensive review search of PubMed, Web of Science, Embase, and Cochrane Library was conducted. The search resulted in finding 313 English articles in the last 10 years.

RESULTS

A total of 38 articles were selected after a meticulous review of the aims, objectives, and methodology by 2 independent reviewers.

CONCLUSIONS

Virtual reality/AR technology offers significant potential in various aspects, including student education, resident evaluation, surgical planning, and overall surgical implementation. However, its widespread adoption in practice is hindered by factors such as the need for further research, cost concerns, unfamiliarity among current educators, and the necessity for technological improvement. Furthermore, residency programs hold a unique position to influence the future of oral and maxillofacial surgery. As VR/AR has demonstrated substantial benefits in resident education and other applications, residency programs have much to gain by integrating these emerging technologies into their curricula.

Augmented and Virtual Reality for Preoperative Trauma Planning, Focusing on Orbital Reconstructions: A Systematic Review

BACKGROUND

This systematic review summarizes recent literature on the use of extended reality, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), in preoperative planning for orbital fractures.

METHODS

A systematic search was conducted in PubMed, Embase, Web of Science and Cochrane on 6 April 2023. The included studies compared extended reality with conventional planning techniques, focusing on computer-aided surgical simulation based on Computed Tomography data, patient-specific implants (PSIs), fracture reconstruction of the orbital complex, and the use of extended reality. Outcomes analyzed were technical accuracy, planning time, operative time, complications, total cost, and educational benefits.

RESULTS

A total of 6381 articles were identified. Four articles discussed the educational use of VR, while one clinical prospective study examined AR for assisting orbital fracture management.

CONCLUSION

AR was demonstrated to ameliorate the accuracy and precision of the incision and enable the better identification of deep anatomical tissues in real time. Consequently, intraoperative imaging enhancement helps to guide the orientation of the orbital reconstruction plate and better visualize the precise positioning and fixation of the PSI of the fractured orbital walls. However, the technical accuracy of 2-3 mm should be considered. VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images.

Mandibular resection and defect reconstruction guided by a contour registration-based augmented reality system: A preclinical trial

The aim of this study was to verify the feasibility and accuracy of a contour registration-based augmented reality (AR) system in jaw surgery. An AR system was developed to display the interaction between virtual planning and images of the surgical site in real time. Several trials were performed with the guidance of the AR system and the surgical guide. The postoperative cone beam CT (CBCT) data were matched with the preoperatively planned data to evaluate the accuracy of the system by comparing the deviations in distance and angle. All procedures were performed successfully. In nine model trials, distance and angular deviations for the mandible, reconstructed fibula, and fixation screws were 1.62 ± 0.38 mm, 1.86 ± 0.43 mm, 1.67 ± 0.70 mm, and 3.68 ± 0.71°, 5.48 ± 2.06°, 7.50 ± 1.39°, respectively. In twelve animal trials, results of the AR system were compared with the surgical guide. Distance deviations for the bilateral condylar outer poles were 0.93 ± 0.63 mm and 0.81 ± 0.30 mm, respectively (p = 0.68). Distance deviations for the bilateral mandibular posterior angles were 2.01 ± 2.49 mm and 2.89 ± 1.83 mm, respectively (p = 0.50). Distance and angular deviations for the mandible were 1.41 ± 0.61 mm, 1.21 ± 0.18 mm (p = 0.45), and 6.81 ± 2.21°, 6.11 ± 2.93° (p = 0.65), respectively. Distance and angular deviations for the reconstructed tibiofibular bones were 0.88 ± 0.22 mm, 0.84 ± 0.18 mm (p = 0.70), and 6.47 ± 3.03°, 6.90 ± 4.01° (p = 0.84), respectively. This study proposed a contour registration-based AR system to assist surgeons in intuitively observing the surgical plan intraoperatively. The trial results indicated that this system had similar accuracy to the surgical guide.

Systematic review of techniques used to validate the registration of augmented-reality images using a head-mounted device to navigate surgery

Augmented-reality (AR) head-mounted devices (HMD) allow the wearer to have digital images superposed on to their field of vision. They are being used to superpose annotations on to the surgical field akin to a navigation system. This review examines published validation studies on HMD-AR systems, their reported protocols, and outcomes. The aim was to establish commonalities and an acceptable registration outcome. Multiple databases were systematically searched for relevant articles between January 2015 and January 2021. Studies that examined the registration of AR content using a HMD to guide surgery were eligible for inclusion. The country of origin, year of publication, medical specialty, HMD device, software, and method of registration, were recorded. A meta-analysis of the mean registration error was conducted. A total of 4784 papers were identified, of which 23 met the inclusion criteria. They included studies using HoloLens (Microsoft) (n = 22) and nVisor ST60 (NVIS Inc) (n = 1). Sixty-six per cent of studies were in hard tissue specialties. Eleven studies reported registration errors using pattern markers (mean (SD) 2.6 (1.8) mm), and four reported registration errors using surface markers (mean (SD) 3.8 (3.7) mm). Three studies reported registration errors using manual alignment (mean (SD) 2.2 (1.3) mm). The majority of studies in this review used in-house software with a variety of registration methods and reported errors. The mean registration error calculated in this study can be considered as a minimum acceptable standard. It should be taken into consideration when procedural applications are selected.

Accuracy of virtual planning and intraoperative navigation in zygomaticomaxillary complex fractures: A systematic review

OBJECTIVE

This systematic review aims to investigate the effect of virtual planning on the treatment of zygomaticomaxillary complex (ZMC) traumatology followed by intraoperative navigation. Furthermore, clinical outcomes following intraoperative navigation surgery or conventional surgery will be compared.

MATERIALS AND METHODS

A systematic literature search was conducted in PubMed, Embase, Web-of-Science, and Cochrane on January 1st, 2022. Inclusion criteria were articles using preoperative three-dimensional (3D) virtual planning combined with intraoperative navigation or comparing these 3D methods with conventional methods. Furthermore, at least one of the following outcomes needed to be included in the article: technical accuracy of the procedure, preoperative planning time, operative time, number of fixation points, patient satisfaction, complications, or total costs of the intervention.

RESULTS

Following the screening of 4478 articles, 17 were included. Five articles appeared to indicate a significantly better technical linear accuracy, one article reported better accuracy for rotation and two articles showed better accuracy in restoring orbital volume when using navigation. Nine articles investigated operative time with varying results. Seven articles calculated the additional costs, of which three concluded no extra cost while the others indicated high additional costs or questionable cost-effectiveness.

CONCLUSION

Virtual planning and intraoperative navigation technologies have the potential to assist maxillofacial trauma surgeons in reducing ZMC fractures significantly more accurately and restoring the facial contour in a less invasive manner at an acceptable cost.

REGISTRATION

The protocol for this systematic review (CRD42020216717) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).

The application of augmented reality in craniofacial bone fracture reduction: study protocol for a randomized controlled trial

Background

Augmented reality (AR) is a new technology that increases users’ perception of the real world. The purpose of this study is to evaluate the efficacy and safety of augmented reality navigation system in treatment with craniofacial fracture reduction.

Methods

This will be a single-center prospective randomized controlled trial. Twenty-two patients will be assigned to two groups of 11, and those with zygomaticomaxillary complex fractures will undergo preoperative three-dimensional CT modeling and have operational plans designed. The control team will use traditional optical navigation to perform the surgery, and the experimental team will use an AR navigation system. The primary outcome measures will be the accuracy of the key points of surgical area between the preoperational surgical plan and post-operation. The secondary outcome measures will be the blood loss, operation time, bone reduction time, hospital time, and complication rate. The findings obtained through this study are expected to evaluate efficacy and safety of the augmented reality navigation system in the treatment of zygomaticomaxillary complex fractures.

Discussion

This controlled trial of augmented reality navigation system in treatment with zygomaticomaxillary complex fracture reduction will clarify the efficacy and safety of this technology by measuring the accuracy of the key points of surgical area and blood loss, operation and bone reduction times, hospital stay duration, and complication rates. This is a single-center study, and the results are expected to promote the application of augmented reality in craniofacial fracture reduction to improve surgery accuracy and efficacy.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900022626. Registered on April 19, 2019.

The Combined Application of Augmented Reality and Guide Template Technology in the Treatment of Nasal Deformities

OBJECTIVE

The purpose of this study is to propose a surgical plan based on augmented reality (AR) and guide template technology for restoration of nasal deformities, and evaluate its feasibility and clinical efficacy.

METHODS

Patients were scanned with a FaceScan to obtain the three-dimensional (3D) facial model, and computed tomography was also performed to obtain the maxillofacial computed tomography images while wearing the artificial marker. The mirroring tool and database searching and matching technology were employed to restore the nasal deformities for a normal nose (preoperative planning model). The design of guide template for deciding the incision area was based on the preoperative planning model, which was also imported into the AR image guidance system named HuaxiAR1.0 for reconstruction of the nose contour. One week after the surgery, the postoperative 3D facial model was obtained. Then, the clinical efficacy was evaluated by comparing the difference between the preoperative planning and postoperative 3D facial model.

RESULTS

The patients obtained satisfactory nasal shapes after surgery. Comparison of the difference between the preoperative and postoperative 3D model revealed that the maximum error was ranging from 2.24 mm to 3.10 mm with the mean error from 0.54 mm to 0.65 mm.

CONCLUSION

The combined application of AR and guide template technology provides a new approach for the treatment of nasal deformities, and has a certain significance in realizing the precise repair of other craniofacial soft tissue deformities.

Augmented reality in craniomaxillofacial surgery: added value and proposed recommendations through a systematic review of the literature

This systematic review provides an overview of augmented reality (AR) and its benefits in craniomaxillofacial surgery in an attempt to answer the question: Is AR beneficial for craniomaxillofacial surgery? This review includes a description of the studies conducted, the systems used and their technical characteristics. The search was performed in four databases: PubMed, Cochrane Library, Embase, and Web of Science. All journal articles published during the past 11 years related to AR, mixed reality, craniomaxillofacial, and surgery were considered in this study. From a total of 7067 articles identified using AR- and surgery-related keywords, 39 articles were finally selected. Based on these articles, a classification of study types, surgery types, devices used, metrics reported, and benefits were collected. The findings of this review indicate that AR could provide various benefits, addressing the challenges of conventional navigation systems, such as hand-eye coordination and depth perception. However, three main concerns were raised while performing this study: (1) it is complicated to aggregate the metrics reported in the articles, (2) it is difficult to obtain statistical value from the current studies, and (3) user evaluation studies are lacking. This article concludes with recommendations for future studies by addressing the latter points.