Application of augmented reality navigation in oral surgery. A clinical trial.

Abstract

Background. Augmented reality (AR) is a potential alternative for surgical navigation, as it can provide visualisation of various anatomical structures of maxilla-facial region.We have developed a specific platform for 3D model management and intraoperative AR-navigation during surgical procedures. Objective. The aim of this study was to evaluate the surgeons’ perceptions and usability of AR- navigation for most common surgical procedures in oral surgery. Materials and Methods. We performed a phantom study to determine the accuracy of the AR system in the maxillofacial region. Registration errors are typical in image-guided surgery were measured: Fiducial Registration Error (FRE), Target Registration Error (TRE), and Fiducial Localization Error (FLE). Thereafter we conducted a clinical trial with several surgeons performing surgical procedures on jaws using AR-technology. AR- navigation usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from -3 to +3 for each scale). Results. Mean value of the Fiducial Registration Error was 0.9 mm with SD = 0.7 mm (95% CI 0.4–1.3 mm). Target Registration Error was 1.3 mm (SD= 0.5 mm, 95% CI 1.1–1.5 mm). Fiducial Localization Error was the most significant – 2.2mm (SD= 0.9, 95% CI 1.9–2.5 mm). The higher rankings in the UEQ were related to the novelty and excitement of using an AR-navigation in maxillofacial surgery. The pragmatic quality aspect explains the technical focus of perception to achieve goals in a product, system, or service design. Efficiency was expected to be slightly higher, but in our opinion this is due to the technical difficulties of the system for novel AR technology. Conclusion. Based on our results, accuracy of the AR system in the maxillofacial region and the user experience of the AR-navigation system for oral surgery is good enough.