While the dental community has historically been at the front of the technology curve, few technologies have revolutionized the practice as profoundly as mixed reality (MR) dental implant navigation systems. Mixed reality utilizes the virtual and real elements of the environment together in a way that allows oral surgeons to plan, visualize and execute implant placement with accuracy greater than was previously believed feasible.
As the demand for dental implants grows on a global scale, patients and clinicians are demanding to decrease risk, reduce recovery, and deliver predictable outcomes. Though traditional implant placement has been effective, the rhetoric of effectiveness can become a slippery measurement dependent on surgical skill and subject to error.
On the contrary, mixed reality technologies work immediately to address and mitigate this gap through real time support and surgical precision in oral implantology.
Understanding Mixed Reality in Dentistry
Mixed reality (MR) deals where the physical space is merged with computer-generated 3D visualizations. MR differs from virtual reality (VR) where the surgeon sees their actual surgical environment in which one can add holographic components.
In a surgical scenario where MR is used for navigational support of dental implants, MR allows the dento-facial surgeon to first apply and manipulate advanced software program with the 3D imaging provided by CBCT scans and/or intra-oral scanners, and then display a holographic image of the plan in the surgeons line of sight.
By utilizing MR headsets, this also enables the dento-facial surgeon to see beyond soft tissue (i.e., gingiva) allowing them to visualize bone densities relative to the treatment plan, visualize the positional constraints and pathways for surrounding nerves, and ultimately position implants in a way more closely aligned with their plan.
This transfers MR capabilities beyond pre-surgical planning to real time revising surgical plan all real-time allowing every implant placement to proceed as precisely as possible according to the preoperative plan or with minimal deviations to the pre-surgical pathways.
The Importance of Precision in Dental Implant Surgery
The success rates of dental implants are impressively high, with literature reporting the rates at greater than 95 percent. However, to achieve this success, you must have 100 percent accuracy in placement – with regard to implant angulation, bone density, occlusion, and avoiding the vital structures.
All of which are critical factors for long-term success when it comes to stability and functionality. Even the slightest errors in any of these factors can result in serious complications, such as nerve damage, perforated sinuses, incorrect occlusion, or implant failure. Most of the traditional techniques are freehand techniques, which are still being used today, but not only are they freehand, these techniques first and foremost depend on the surgical knowledge of the experience of the surgeon.
While static surgical guides have their merits, they don’t allow for any error, so you can’t adjust to real-time anatomical variances during surgery. This is vastly different from mixed reality navigation which will give the surgeon a dynamic interactive blueprint of optimal positioning that will help to contend with reducing risk for the patient.
How Mixed Reality Navigation Systems Work
The first step of the MR integration process in dental implant surgery is data acquisition, which includes cone beam CT (CBCT) followed by intraoral digital scans that delineate the patient’s anatomy in three-dimensions. This information will ultimately be used to develop a surgical plan with a defined location, angulation, and depth for the desired implant.
Once the surgical plan is complete, the plan can be uploaded into a head-mounted MR device. During surgery, the surgeon will be able to see a holographic projection overlaid on the jawbone with the planned trajectory of the implant. At the start of surgery, the MR headset will provide holographic guidance embedded in the surgery for the surgeon to begin. The MR device can also provide real-time feedback during the surgery, allowing the clinician to operate with less uncertainty.
MR navigation is both engaged and interactive, allowing the surgeon to modify surgical aspects as necessary using a greater degree of accuracy than intervening x-rays. More significantly, unlike static (fixed) guides, the MR integration into the dental implant process maps the clinical judgment of the provider without regard to the accuracy of a tooth root or overall anatomy, buccal-lingual extent and distance of the planned implant to critical anatomy.
This is the most significant aspect of MR navigation, controlled precision through intraoperative guidance, as the surgical aspects of the entire process are engaged fully at all times and the surgeon can adjust throughout the process.
Benefits of Mixed Reality in Dental Implant Surgery
The enhancement of surgical accuracy is one of the clearest benefits of augmented reality technology. Increased ease of use and real-time holographic visualization minimizes human error and properly situates the implant in the best possible position which means better functional outcomes, better aesthetics, and increased longevity of the implant.
Patient safety is also improved since augmented reality allows the clinician to identify important critical structures, like a nerve or a sinus cavity, and decreases the likelihood of causing unintended damage. Convenience is also a benefit since procedures, when augmented reality is used, seem to occur faster, allowing dentists to maximize chairtime and minimize patient discomfort.
Lastly, augmented reality has real value outside the clinical setting, as a form of holographic visualization, augmented reality provides dentists with legitimate avenues for patient education. Dentists can utilize holographic/digital impressions to help detail their treatment plan in a way that is much more clear to patients to provide a comprehensive understanding of their proposed procedure and ultimately increase their acceptance rate.
Finally, augmented reality is an anticipated stream of advancement in educational models; augmented reality will allow dental students and residents to employ realistic simulation techniques before ever treating real patients, resulting in a higher comfort level and better outcome.
Challenges in Adoption
The incorporation of MR navigation systems into dentistry has many possible challenges, which has limited the acceptance of the technology. First, cost is a huge barrier, as the hardware, software, and training required to incorporate the technology take a large financial commitment.
Smaller practices might struggle to pay for these advanced systems, and those in areas with few resources may be unable to finance any MR systems. Second, there may be a learning curve to MR; surgeons must invest time to adapt to the new workflows and technologies, which could introduce delays to procedures initially.
The integration with existing imaging software and planning software can also create barriers; not every software is compatible with all other software. Finally, accessibility with MR is of concern because currently it is only accessible in certain advanced dental centers or specialty practices, which limits patient access. As technology improves and systems become less expensive, we expect barriers to accessibility to continue to diminish.
Traditional Methods versus Mixed Reality Navigation
The difference between traditional implant surgery and MR-based implant surgery is stark. Conventional methods depend substantially on the surgeon’s ability to deliver a good result (which depends heavily on the surgical skill) and often use two dimensional (2D) images for pre-operative planning; whereas MR allows for interactive three dimensional (3D) imaging that enhances both initial planning and execution.
Complications are inherently higher with pre-operative planning of conventional surgery since the surgeon has limited visibility to anatomical structures; MR allows for in depth pre-operative planning, delineation, and more precise mapping in very specific tasks. From the perspective of patients undergoing traditional procedures, transparent processes may be difficult to understand as explanations are generally based on models, diagrams, and 2D images.
MR allows the patient to see holographically detailed visual elements of their treatment, increasing the hospitality of the process. For learning purposes, students learning conventional methods require hands-on learning with patients or master’s fees while MR can simulate realistic scenarios of varying presentations prior to executing their skills on real live patients.
The Future of Mixed Reality in Oral Surgery
The outlook for mixed reality dental implant navigation systems is incredibly exciting. As artificial intelligence continues to converge with MR platforms, these systems will have the capabilities to predict outcomes and perform implant placement with optimal positioning and would also provide alerts to the user in real-time while undergoing surgery. Robotics will also have an increasingly important presence.
By integrating MR (mixed reality) into robotic aided systems, there will be greater accuracy and even consistency regarding implant placement. Remote surgery and tele-dentistry are further developments to look forward to. Having cloud-based MR platforms will allow highly-skilled surgeons to give tips or instructions on live procedures performed in remote or underprivileged locations so that everyone will have access to the same level of care.
Cost will also be important in increasing MR adoption. As demand increases and these technologies become more prevalent, MR will become as commonplace as digital radiography or CAD/CAM units in dental practices.
Impact on Patients and Dental Practices
Patients receiving MR guided implant surgery definitely experience a range of benefits: more safety, less time in treatment, less invasive treatment procedures, and less recovery time. The added peace of mind that comes with knowing that they are receiving treatment with enhanced technology further enhances their trust and satisfaction.
For dental practices, investing in MR guided implantology offers a competitive advantage. It improves clinical incidentials, enhances communication to patients, enhances practice reputation, enhances referral rates, etc. Practices that invest in MR technology early on are more likely to emerge as leaders in sophisticated implantology.
Conclusion
Mixed reality dental implant navigation systems are a significant new frontier in oral surgery. With its unique aspects of overlaid holographic display of information (MR-Holo or Mixed Reality) combined with direct execution in real-time (MR-Direct) surgeons can visualize the implant position and angle with great precision and execute with a high level of confidence and accuracy.
While these systems are still maturing and issues such as cost, training, and accessibility are still in play; the reality and the practical benefits of using MR-directed implant placement outweigh the negatives. As AI, robotics, and tele-dentistry continue to develop alongside MR systems, a bright future exists for precision-focused implant surgery.
For the patients, this means additional safety and comfort, a reduction in treatment time, and predictable outcomes. For the clinician, this sets a new standard for implantology – where completed procedural precision is now backed by a multitude of MR-supported evidence.