Augmented reality versus three-dimensionally printed guides in Le Fort I osteotomy: a preclinical study

Advancements in medical image acquisition facilitate patient-specific virtual surgical planning and surgical navigation in maxillofacial interventions such as Le Fort I osteotomy. Augmented reality (AR) allows superimposition of patient data onto the surgical field for guidance. The aim of this study was to develop and assess an AR navigation system leveraging traditional navigation methods. The accuracy of a three-dimensionally (3D)-printed guide was compared with an AR system in a phantom study. Preplanned osteotomy lines were cut, and screw holes were drilled, simulating a Le Fort I osteotomy, and its accuracy was assessed by comparing pre- and postoperative computed tomography. Seven maxillofacial surgeons participated, each tasked with drilling 12 screws and performing two osteotomy cuts using either AR or the guide. There was no statistically significant difference in cutting accuracy between AR and the guide, with median errors of 0.71 and 0.72 mm, respectively. However, AR drilling accuracy (1.48 mm) was significantly worse than that of the guide (0.73 mm) and yielding a 75% success rate of AR-drilled holes suitable for patient-specific implant fixation. AR-based navigation using head-mounted displays does not yet achieve the clinical requirement for drilling, contrary to cutting, yet it appears to be a promising alternative to 3D-printed guides for Le Fort I osteotomy.