Artificial intelligence and augmented reality in implant planning

Until recently, however, this information was difficult to segment and assemble, and this limited the patient virtualisation process. Obtaining the virtual patient was difficult and costly, needing time and effort, since segmentation and alignment were essentially manual, and operator-dependent.

Today, thanks to artificial intelligence (AI), it is possible to use cloud-based software capable of returning to the clinician, in a few minutes and at very low cost, the entire set of 3D files of the patient (derived from intra-oral, face and CBCT scanning). These files, in STL format, are perfectly aligned and segmented, eliminating any possible error by the operator. Each tooth, for example, is the result of the perfect fusion, segmentation and alignment of CBCT (root) and intra-oral (crown) scans. The segmentation and alignment are automated, being the result of a learning process (machine learning) which represents the basis of AI.

It is a real revolution that has opened the door to changes in all fields of dentistry: from the possibility, for example, of planning a 3D orthodontic set-up that is truly safe for the bone to the planning of prosthetic complex cases. In implantology, AI-assisted software such as Virtual Patient Creator (Relu) allows us to enhance our diagnostic and planning skills. In particular, the use of 3D files in STL format processed by Virtual Patient Creator (Figs. 1 & 2), combined with modern virtual reality and augmented reality (AR) systems, creates new possibilities. In fact, it is possible to upload all files derived from AI-assisted software directly into apps specifically designed for AR, such as HoloDentist (FifthIngenium). Thanks to these apps, wearing an AR device such as HoloLens 2 (Microsoft), the dentist can view the holographic 3D models of the patient and use them to make a correct diagnosis and for communication with the dental laboratory, colleagues or patients in order to illustrate to them the selected treatment plan.

The use of AI and AR technologies transforms the manner of not only diagnosis and communication but also of implant planning. On the basis of the set of files segmented and aligned via AI, the surgeon wearing AR glasses such as HoloLens 2 or Magic Leap 2 (Magic Leap) can plan the positioning of one or more implants in the correct 3D position, inclination and depth, using holograms. Basically, it is no longer necessary to use software dedicated to guided implant surgery: the surgeon drags and drops the desired fixture from a 3D library provided by the HoloDentist app and positions it within the holographic model of the bone. The surgeon can also enlarge the holographic models to such an extent that they have the same dimensions as the operator, and the same applies for the hologram of the implant.

Finally, by navigating inside these models, the surgeon can tilt, rotate and otherwise move the implant within the bone hologram. This process is also guided by other masks and holograms, which can be on or off during 3D planning, for example that of the teeth and soft tissue or that of the prosthetic wax-up. This is authentic 3D planning, without the need for any guided implant surgery software or conventional 2D radiographic sections. This allows planning in a fast, intuitive and fun way, drastically reducing costs. The spatial position of the implant thus designed is saved and exported, together with the other files, for the design of the surgical guide, in open-source software. The next future development will be the import of this planning into a dynamic implant navigation system.