Implant placement using mixed reality-based dynamic navigation: A proof of concept.

Traditional dental implantology relies on static templates or screen-based dynamic navigation to ensure precise fixture positioning within the alveolar bone. Prior research has shown that static guides often limit surgical visibility and irrigation access during the osteotomy process, which can lead to thermal injury. Screen-based systems require clinicians to divert their gaze from the operative field to a monitor, potentially disrupting hand-eye coordination and spatial awareness. Augmented reality and holographic overlays offer a potential solution by projecting digital planning data directly onto the patient's anatomy during the procedure. Existing literature lacks clinical validation for systems that merge these holographic projections with real-time tracking in a single tooth gap scenario. The current landscape of guided surgery necessitates a more intuitive interface that maintains the clinician's focus on the surgical site. This absence of evidence motivated the development and testing of a novel interface for guided implantology.

This investigation evaluated the clinical feasibility and precision of a novel holographic guidance system for single-unit dental restoration in a patient. Researchers sought to determine if mixed reality could streamline the workflow from digital planning to physical execution without compromising accuracy. The study aimed to quantify the spatial deviations between the planned implant coordinates and the actual post-operative position using specific metrics. Assessing the temporal efficiency of the entire surgical procedure from initial anesthesia to final wound closure remained a primary objective for the surgical team. The team focused on validating the safety profile of the ANNA system within a real-world clinical environment to ensure patient protection. Establishing a standardized protocol for integrating intraoral scans with volumetric imaging through holographic interfaces was central to the project's success. This proof-of-concept approach was designed to demonstrate the potential for mixed reality to replace traditional navigation methods.

The clinical protocol initiated with the acquisition of three-dimensional patient data using Intraoral Scanning (IOS) and Cone-Beam Computed Tomography (CBCT) to map the anatomy. Clinicians utilized specialized guided surgery software to define the ideal three-dimensional trajectory, depth, and diameter for the dental fixture based on the bone volume. The novel ANNA Mixed Reality-based Dynamic Navigation (MR-DN) system from MARS Dental, located in Haifa, Israel, facilitated the holography-guided osteotomy and placement. This hardware tracked surgical instruments in real-time while projecting the digital plan as a stable hologram over the surgical site for the clinician. Following the procedure, the team performed a rigorous accuracy verification by comparing the final implant position to the initial digital blueprint using post-operative data. Statistical analysis focused on planar distances at the entry point and the apex across three spatial dimensions to determine the error margin. The researchers monitored the total time elapsed from the start of anesthesia to the final suturing of the soft tissue.

The mixed reality-based dynamic navigation system achieved high surgical precision with a 3D entry point distance (En) deviation of only 0.417 mm from the plan. Surgical duration proved highly efficient, requiring only 30 minutes to complete the entire sequence from anesthesia administration to the final suturing. Measurements at the entry point revealed a planar distance error of 0.381 mm in the XY plane and 0.173 mm in the Z plane. The 3D apex deviation (An) remained remarkably low at 0.193 mm, indicating stable control during the deep portion of the osteotomy within the bone. Angular accuracy was maintained within a narrow margin, showing a mean difference of 1.852 degrees from the planned longitudinal axis of the implant. No intraoperative complications or system failures occurred during the holographic guidance phase, supporting the safety of the MR-DN approach for clinical use. These quantitative results indicate that the holographic overlay provides sufficient guidance to match the accuracy of established static surgical templates.

This proof-of-concept study confirms that holographic guidance represents a viable alternative to conventional static and dynamic surgical techniques for dental rehabilitation. The integration of mixed reality into the dental workflow enhances the perspective of guided surgery for single tooth gap rehabilitation in modern practice. These findings suggest that real-time holographic overlays can maintain high accuracy without the ergonomic drawbacks of external monitors or physical templates. Future research should involve larger patient cohorts to validate these preliminary results across diverse clinical scenarios and varying bone densities. The successful application of the ANNA system indicates a shift toward more intuitive digital interfaces in restorative dentistry and oral surgery. Refining the calibration and tracking algorithms may further reduce the sub-millimeter deviations observed in this initial clinical trial for single tooth gaps. The researchers conclude that mixed reality-based dynamic navigation can change the perspectives of guided dental implant surgery as a possible alternative to classic techniques.