Application of Real-time Augmented Reality-guided Osteotomy and Apex Location in Endodontic Microsurgery: A Surgical Simulation Study Based on 3D-printed Alveolar Bone Model

Yue Chen; Liu Liu; Shenghao Qiu; Chengsi Hu; Liu Wang; Yantong Li; Xinqiao Tan; Yuan Gao; Dingming Huang

doi:10.1016/j.joen.2023.05.011

Application of Real-time Augmented Reality-guided Osteotomy and Apex Location in Endodontic Microsurgery: A Surgical Simulation Study Based on 3D-printed Alveolar Bone Model

J Endod. 2023 Jul;49(7):880-888. doi: 10.1016/j.joen.2023.05.011. Epub 2023 May 19.

Authors

Yue Chen¹, Liu Liu², Shenghao Qiu², Chengsi Hu³, Liu Wang², Yantong Li¹, Xinqiao Tan¹, Yuan Gao⁴, Dingming Huang⁵

Affiliations

¹ State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
² State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
³ School of Information Engineering, Guangdong University of Technology, Guangzhou, China.
⁴ State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China. Electronic address: gaoyuan@scu.edu.cn.
⁵ State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China. Electronic address: dingminghuang@163.com.

PMID: 37211311
DOI: 10.1016/j.joen.2023.05.011

Abstract

Introduction: Augmented reality (AR) is a novel visualization technique in which pregenerated virtual 3D content is superimposed on surgical sites. This study aimed to validate the viability of AR-guided endodontic microsurgery (ARG) and compare the changes in objective and subjective outcomes of surgical simulation using ARG and freehand (FH) endodontic microsurgery on customized 3D-printed models.

Methods: We created and printed a customized 3D alveolar bone model with artificial periapical lesions (APLs) based on cone-beam computed tomography. Eight models with 96 APLs were equally divided into ARG and FH groups. We planned surgical trajectories on rescanned printed models. Four inexperienced residents (IRs) performed ARG and FH on the models and completed pre and intraoperative confidence questionnaires for the subjective outcome. Postoperative cone-beam computed tomography scans of the models were reconstructed and analyzed, and all procedures were timed. We used pairwise Wilcoxon rank sum tests to compare objective outcomes. Kruskal-Wallis tests and post hoc pairwise Wilcoxon rank sum tests were used to compare subjective outcomes.

Results: Compared to the FH group, the ARG group significantly reduced deviation of the volume of bone removal, root-end resection, and deviation of bevel angle, with improved confidence of the IRs (P < .05); it also significantly increased surgical time and volume of unremoved APL (P < .05).

Conclusions: We customized an APL model through 3D printing and developed and validated a low-cost AR application framework, based on free AR software, for endodontic microsurgery. ARG allowed IRs to perform more conservative and precise surgical procedures with enhanced confidence.

Keywords: 3D printing; apical surgery; augmented reality; cone-beam computed tomography; confidence change; endodontic microsurgery.

MeSH terms

Augmented Reality*
Computer Simulation
Cone-Beam Computed Tomography
Microsurgery* / methods
Osteotomy / methods
Printing, Three-Dimensional