Markerless augmented reality-guided mini-screw placement: A clinical case series

Abstract

Introduction:

Placing mini-screws between teeth can risk contacting or damaging dental roots and injuring adjacent nerves, blood vessels or maxillary sinus when local anatomy is not visualised precisely. The latest digital advances in orthodontics have enabled three-dimensional (3D) virtual protocol designing, allowing orthodontists to simulate the orthodontic treatments and collaboratively map out the surgical intervention before procedures. Computed tomography (CT)-based surgical guides are strongly recommended for patients with delicate and complex anatomical conditions.

Case presentations:

Three patients presented with concerns related to their occlusion and required precise orthodontic mini-screw insertion.

Clinical findings and investigations:

In all cases, augmented reality (AR)-guided systems were used to assist in the precise positioning of orthodontic mini-screws.

Interventions and outcomes:

Successful placement of the mini-screw without damage to the tooth root, confirmed by postoperative radiographs.

Relevance and impact:

The non-invasive AR-guided system can efficiently highlight the precise position of the tooth root. Hence, AR-assisted mini-screw positioning might potentially aid in avoiding root damage and reducing mini-screw failure rates. This technology offers significant benefits over traditional methods, including adaptability, real-time adjustments and cost efficiency, making it a promising tool for clinicians who place mini-screws.

Plain language summary

Using augmented reality to guide safe mini-screw placement in orthodontic treatment

Why was the treatment done? Orthodontists sometimes use small screws (called mini-screws) in the jaw to help move teeth during treatment. Placing these screws between teeth can be risky as the mini-screws may touch or damage tooth roots by accident.

What did the clinicians do? Orthodontists used a new technology, ‘markerless augmented reality (AR)’ to help guide where to place the screws safely. The AR system used normal dental scans and 3D X-rays to make a real-time, on-screen view of the patient’s teeth and roots during mini-screw placement. This let the clinicians see exactly where to place the mini-screw without needing a guide or special markers. The technique was used for three patients needing orthodontic treatment or jaw surgery.

What did the clinicians achieve? In all cases, the mini-screws were placed with no damage to nearby teeth or tissues. Patients had no pain, swelling or problems during at least 1 year of follow-up. Importantly, no extra X-rays were needed to check the screw placement. Existing scans, used for other reasons, were enough to see where the mini-screw was placed.

What do the findings mean? This method is more flexible than normal methods because it lets the clinician see things in real time and adjust the position of the mini-screw during placement. It also avoids the cost and time needed to make a surgical guide for each patient. This early experience shows that ‘markerless AR’ could make mini-screw placement safer, simpler and more efficient for patients and clinicians.