Ayoub, A. and Pulijala, Y., 2019. The application of virtual reality and augmented reality in Oral & Maxillofacial Surgery. BMC Oral Health, 19, pp.1-8.
Introduction
The use of virtual reality (VR) in dentistry has many benefits including assessing anatomical regions, aiding in diagnosis, treatment planning and surgical treatment. The aim of VR is to utilise the cognitive, motor and mental functions of the operator in a standardized and safe manner. VR can be split into immersive and non-immersive VR. Immersive VR provides the additional element of incorporating the operator’s physical presence with 3D visualisation by using a wearable device that detects eye movements. Non-immersive VR encompasses a computer-generated experience.
Methods
Various systems used to capture dental, facial tissues (soft and hard) data for oral & maxillofacial surgery include cone-beam computed tomography (CBCT), Laser scanner, structured light scanner, and stereophotogrammetry. Existing literature from 2009 to 2019 relating to the application of VR in oral and maxillofacial surgery were analysed. 101 articles comprising of 8 systematic reviews, 4 expert reviews, 9 case reports, 5 retrospective surveys, 2 historical perspectives, 13 manuscripts on virtual education and training, 14 on haptic training and 41 articles on planning of orthognathic surgery were reviewed.
Results and discussion
Clinical application
Dental implantology and orthognathic surgery are currently the most common use of VR in dentistry. The preoperative CBCT assessment is used to determine implant size, position, direction and proximity to vital structures. This is then relayed in surgery via a static guide approach using computer-aided-design/computer-aided-manufacturing (CAD/CAM) to enable the insertion of the implant. Accuracy levels are high at an overall navigation error of 0.35mm. Some limitations of CBCT in the assessment stage include poor contrast of soft tissues and image artefacts such as streaking and distortion. To combat this, fusion of images using CBCT and intra-oral scans are used to ensure an accuracy of within 0.5mm in cases such as orthognathic surgery planning.
Surgical training
Self-assessment is one of the many benefits of the use of VR in surgical training. 21 dental surgeons performed a range of case studies using haptic-enabled digital analysis with results showing reduction in errors in cephalometric analysis and more feasible landmarking. Local anaesthesia administration is also a skill that can be practised using 3D hepatic dental injections as seen in figure 1 which shows a VR system for inferior alveolar nerve block injections.
Figure 1. Demonstration of hepatic technology for inferior alveolar nerve block injection
Conclusion
In summary, VR has facilitated in the advancements in oral and maxillofacial surgery. Currently, most randomized studies focus on technical skills of surgical trainees and there are insufficient studies to assess the impact of VR compared to standard methods of delivering education. It can be agreed that VR offers significant potential in surgical planning and cognitive development. Integration of VR and augmented reality holds substantial benefits to improving quality of patient care and supplementation into curriculum is valuable.
Research Summary Written By: Keerusha Nagaendran, University of Sheffield – BDS4