What Is Augmented Reality Restorative Dentistry?

Augmented reality has numerous applications in healthcare. But what does it have to do with dentistry, and how can it help? We look at how and speak to a couple of clinicians excited about its possibilities for treatment planning and patient outcomes.

Motivational speaker and dental entrepreneur Ankur Gupta, DDS, says that augmented reality is the new frontier for dental technology. He sees technology as driving where everything in the science is going.

"We need to realize, as providers, we're just a bunch of humans who are flawed and imperfect. As a result, we miss stuff and do stupid things, especially when we didn't get that much sleep the night before," Dr Gupta says. "By using augmented reality, all those potential subjectivities become objective."

Augmented reality is the addition of virtual modifications to the actual environment. Medical healthcare applications include surgical ones, like neurosurgery, laparoscopic surgery, and plastic surgery. However, augmented reality technology also has uses for medical education and training.¹

Dentistry leverages augmented reality technology, too. Clinicians use the technology for oral and maxillofacial surgery, implant placement, and orthognathic surgery. It also has relevancies for endodontics and orthodontics.² In addition, augmented reality aids in dental education, providing an objective way to evaluate student work and give direct feedback.³

An essential component of this process is 3D imaging, like CT scans. Once the software has the 3D x-rays, the operator can manipulate the images to make the superimposed virtual objects. Then, the object becomes an .stl file, which can visualize directly on the patient.⁴

One benefit of using augmented reality technology is solving a significant issue in digital dentistry: avoiding data loss and time in the third stage of digital scanning. The authors of 2019 research published in 2019 BMC Oral Health assert that by facilitating direct visualization, augmented reality technology avoids the last transfer of data that is common in scanning procedures, which provides significant advantages in digital techniques.⁴

Over the next 2 years, the technology continued to improve. In 2021, other researchers explored markerless tracking methods using the patient's facial profile. The Journal of Personalized Medicine gives a detailed account of a few cases enhanced by augmented reality technology in 2021. Using the Microsoft^® HoloLens 2, the researchers applied its functionality to guide maxillary osteotomies. While working, the surgeon could see on the smart glasses the virtual surgical planning superimposed on the patient's actual anatomy. Not only were there no complications but the surgery was also in line with the surgical time associated with similar cases. The researchers determined that the technology was a viable alternative to CAD/CAM cutting guides from a cost/benefit balance, safety, and precision. Moreover, the holographic imaging technology enabled surgeons to wear head-mounted displays to interact with the superimpositions in real time.⁵

Augmented reality software also aids esthetic dentistry, particularly for full-mouth rehabilitations. The software allows patients to see a real-time smile projection, enabling improved communication with patients and the dental laboratory. One of the most significant changes is that the patient can participate in the planning when clinicians use augmented reality software. By contrast, without augmented reality software, the patient picks from completed cases the lab and the restorative dentist put together without the patient's input.²

For example, patients usually submit photos, videos, and imaging in the first appointment in the past. Then, the restorative dentist and the lab technician will use the images to develop a couple of options for the patient to choose from at the next appointment. By contrast, augmented reality technology's ability to project possible designs for the anterior teeth allows the first appointment to have fewer photo and video sessions and more time to talk about what should be the goal of the restoration.²

Moreover, augmented reality technology can match the agreed-upon smile design to the digital impression to facilitate a digital wax-up. The linked tool could also mean time savings for the lab.²

Getting Smarter with Smart AR Glasses

New practical applications are emerging all the time with augmented reality technology. For general dentists, the possibilities could be extraordinary.

Jeff Rohde, MS, DDS, is experimenting with augmented reality technology at his Santa Barbara, CA, private practice. He is testing the Nreal AR glasses in his dental practice (and for watching a movie on a plane, too). Using a video connection to his laptop or iPad, he can look through the projection to the patient and see the CT scan without moving his head.

Dr Rohde is also experimenting with connecting it to his CEREC. The main benefit he has realized so far is that having more information in front of his eyes eliminates having to go back to another screen or the computer to look up pertinent information about the case.

"So, while we're scanning, I can see the scan hovering in front of me as it builds out the digital impression right in the glasses," Dr Rohde says. "What I'd love to see eventually is a true overlay. For example, while scanning, I saw a colorization on some teeth as I completed the digital impression. Then, I could see an overlay of that, allowing me to know if there are any holes in the scan or data."

Dr Rohde thinks there are many ways augmented reality technology could help clinicians. For example, he would love to see drilling protocols for endo. There could be an overlaid look at the tooth and your current sequence. In addition, he could picture drilling protocols for an implant. And, of course, there is the movie watching.

"It's like the equivalent of like a 100-inch screen," Dr Rohde says.

Another future application Dr Rohde would love to see is using the software to design a tooth live. With the augmented reality technology overlay, Dr Rohde could plan the tooth on the software but see the design in the patient's mouth simultaneously. This functionality would fix little details like matching surrounding dentition length and rounded edges live. The patient could see the overlay of their smile, and if they liked it, Dr Rohde could manufacture the case afterward.

Dr Rohde says augmented technology exists, but dental-specific software isn't yet. At this point in his practice, the Nreal glasses are more like an extended display. However, because the images are through the glasses, what he sees is floating in front of him.

"The cool thing is you can still see beyond it," Dr Rohde says. "It's like stained glass. Even though you see the colors of the stained glass, you can look outdoors."

So, will augmented reality change everything? Maybe, but not yet. Much of the present literature at this early stage is encouraged by the enhancements of augmented reality functionality but isn't ready to throw out business as usual yet. As one study in Frontiers in Oncology concludes about its use in implant surgery, "Augmented reality is a valuable tool for intraoperative verification but needs further research to be considered an alternative guided method for implant surgery."⁵

Dr Gupta agrees that the technology has a way to go, but the potential is exciting, perhaps even disruptive.

"Augmented reality is the new reality of dentistry," Dr Gupta says.

References

1. Kwon HB, Park YS, Han JS. Augmented reality in dentistry: a current perspective. Acta Odontol Scand. 2018;76(7):497-503. doi:10.1080/00016357.2018.1441437
2. Touati, R., Fehmer, V., Ducret, M. et al. Augmented Reality in Esthetic Dentistry: a Case Report. Curr Oral Health Rep 8, 23–28 (2021). https://doi.org/10.1007/s40496-021-00293-7
3. Farronato, M., Maspero, C., Lanteri, V. et al. Current state of the art in the use of augmented reality in dentistry: a systematic review of the literature. BMC Oral Health 19, 135 (2019). https://doi.org/10.1186/s12903-019-0808-3
4. Ceccariglia F, Cercenelli L, Badiali G, Marcelli E, Tarsitano A. Application of Augmented Reality to Maxillary Resections: A Three-Dimensional Approach to Maxillofacial Oncologic Surgery. J Pers Med. 2022;12(12):2047. Published 2022 Dec 12. doi:10.3390/jpm12122047
5. Ochandiano S, García-Mato D, Gonzalez-Alvarez A, et al. Computer-Assisted Dental Implant Placement Following Free Flap Reconstruction: Virtual Planning, CAD/CAM Templates, Dynamic Navigation and Augmented Reality. Front Oncol. 2022;11:754943. Published 2022 Jan 28. doi:10.3389/fonc.2021.754943