Poster 145: International Teleconsultation During Image-Guided Osseointegrated Implant Surgery Based on 3D Surgical Simulation

Abstract

The execution of preoperative simulation is especially important in osseointegrated implant surgery. Image-guided surgery systems have become standard in many medical disciplines. The problem is that the digital workflow is currently limited to 3D reconstruction of the individual anatomy from CT. To integrate teleconsultation visualization in the complete CAD/CAM digital workflow, we used developed new telenavigation client software based on open source between international countries. We have used CAD visualization in cases of atrophic jaw and microtia to plan superstructures with osseointegrated implants. After planning implant positions with virtual software (Artma Virtual Implant, Vienna, Austria), all data was duplicated to the telenavigation client software. The simulation was then integrated three components in one coordinate system; 3D reconstruction of the bone from CT, implant simulation and high-resolution basic surface from the laser scanner. A reference 3D sensor was attached to the surgical template and the dental drill was tracked in real time by the other 3D sensor on the hand piece. The position of the dental drill was visualized in real-time during surgery. Simultaneously, the data was broadcast via TCP/IP protocol to the Internet. The non-redundant information was transmitted to a remote computer connected to the Internet, whereby the bandwidth was extremely low. The navigation data was subsequently processed in any remote computers to generate 3D model of the anatomy, surgical instruments and basic surface in real time. The results were evaluated by actual visualization and movement on the computer display. We transmitted for the first time a implant surgery from Vienna to Keio University in Tokyo in September, 2005. The live connection between two countries was implemented via an IP-based videoconference with a bandwidth of 1 Mbit/sec. The specific data of the surgical instruments was transmitted via TCP/IP protocol with a bandwidth requirement of only 50 kBit/sec. The quality of 3D simulation of surgery on the remote computer at Keio University was independent of the bandwidth fluctuations of the IP-based videoconference. After that, we conversely navigated surgery held in Vienna and have also succeeded. We have indicated that it was feasible to integrate dental CAD/CAM surface models into intraoperative visualization of osseointegrated implant surgery. With telenavigation client software, any remote client computer connected to the Internet can render a high-resolution 3D visualization with minimum bandwidth requirement. Although it was used only to access a second institute, we strongly hope that this will be spread to distance learning via online curriculums.