Augmented reality vs CAD/CAM system in orthognathic surgery: development and accuracy evaluation

Area of Science:

• Surgical Navigation Technologies
• Maxillofacial Surgery
• Augmented Reality Applications

Background:

• Augmented reality (AR) is increasingly explored for surgical applications, especially in maxillofacial surgery.
• This study compares the accuracy of an AR-based navigation system with optical see-through (OST) headsets against traditional CAD/CAM guided methods for Le Fort I osteotomy.

Purpose of the Study:

• To evaluate the accuracy and reproducibility of an AR-based navigation system versus conventional CAD/CAM guides in Le Fort I osteotomy.
• To compare surgical deviations between virtual surgical planning (VSP) using OST-AR and CAD/CAM surgical guides.

Main Methods:

• Twenty identical stereolithographic skull models were used, divided into two groups (n=10 each).
• One group utilized an OST-based AR navigation system, while the other employed conventional CAD/CAM surgical guides.
• Accuracy was measured by deviations between planned and postoperative positions of seven cephalometric reference points.

Main Results:

• Conventional CAD/CAM guided surgery achieved mean deviations below the 2-mm clinical threshold (0.72 ± 0.38 mm).
• The OST-based AR navigation group had higher mean deviations (2.27 ± 1.24 mm), with only 40% meeting the 2-mm threshold.
• A statistically significant difference in accuracy was found between the OST and CAD/CAM groups (p < 0.005), though improvements were noted in the OST group, suggesting a learning curve.

Conclusions:

• While CAD/CAM guides currently offer superior accuracy for Le Fort I osteotomy, AR systems present potential advantages in real-time visualization, cost reduction, and decreased preoperative time.
• Current accuracy limitations of AR systems necessitate further technological refinement and enhanced operator training.
• Future research is required to confirm the clinical applicability and reliability of AR-guided orthognathic surgery.