Camera-Based Augmented Reality Navigation for Assisting the Extraction of Impacted Supernumerary Teeth

The surgical removal of deeply impacted supernumerary teeth is a demanding pediatric procedure due to their hidden positions and proximity to vital structures, such as tooth germs and nerves. Conventional freehand methods often rely on subjective mental reconstruction of 3D imaging, which can lead to excessive bone removal and iatrogenic injury. This study presents a standardized protocol that uses a camera-based 3D AR navigation system to assist in localizing impacted supernumerary teeth. A digital workflow was established by integrating preoperative cone-beam computed tomography (CBCT) data with intraoral scans to create a patient-specific virtual plan. During surgery, a high-resolution camera captures the operative field, and the virtual model of the impacted supernumerary tooth is overlaid on the live camera image displayed on the computer screen, providing a visual reference for assisted localization. The AR navigation interface allows surgeons to adjust the transparency of various tissue layers to enhance internal observation and fine-tune image registration via an adjustable localization confidence threshold. Furthermore, the system enables fixing the display once the most accurate alignment is achieved, ensuring visual stability during critical maneuvers. This protocol was demonstrated in a clinical case involving a patient with a deeply impacted supernumerary tooth. The preliminary outcome showed that the system provided intuitive spatial guidance for assisted localization of the impacted supernumerary tooth. The workflow proved clinically feasible, and no intraoperative complications, such as damage to adjacent roots, were observed. In conclusion, camera-based AR navigation may serve as a potential adjunctive approach to conventional techniques for the assisted extraction of impacted supernumerary teeth. By providing real-time visualization of internal structures and interactive control over registration and transparency, this protocol supports the clinical adoption of digital innovations in complex pediatric dental interventions.