Augmented Reality in Dentistry: Uses and Applications in the Digital Era

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Citation: Al-Khaled I, Al-Khaled A and Abutayyem H. Augmented reality in dentistry: uses and applications
in the digital era (2021) Edelweiss Appli Sci Tech 5: 25-32.
25
Research Article ISSN: 2576-8484
Augmented Reality in Dentistry: Uses and
Applications in the Digital Era
Israa Al-Khaled1*, Alaa Al-Khaled1 and Huda Abutayyem2
Affiliation
1RAK College of dental Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates
2Orthodontic Department, RAK College of dental Sciences, RAK Medical and Health Sciences University, Ras AL-Khimah, United Arab
Emirates
*Corresponding author: Israa Al-Khaled, RAK College of dental Sciences, RAK Medical and Health Sciences University,
Ras Al-Khaimah, United Arab Emirates, PO-Box: 11172, E-mail: Israa.alkhaled2@gmail.com
Citation: Al-Khaled I, Al-Khaled A and Abutayyem H. Augmented reality in dentistry: uses and applications in the digital era (2021)
Edelweiss Appli Sci Tech 5: 25-32.
Received: Mar 10, 2021
Accepted: Mar 23, 2021
Published: Mar 29, 2021
Copyright: © 2021 Al-Khaled I, et al., This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction: With all the advancements that technology has reached, Dentistry can't be left behind. In the past few years, researchers have
focused on emerging technologies like Virtual and Augmented Reality with clinical practice. Objectives: This literature review aims to provide
an update on the latest technological applications and development in augmented reality in the dental field. Methods: The PubMed database was
reviewed, and the studies that fulfilled the inclusion criteria in the last 20 years, from 2000 to 5 May 2020, were included. Results: The search
results revealed a total of 72 articles, 32 were excluded, while 40 articles were included. It’s been observed that augmented reality application is
still under testing, as certain drawbacks still tie the spread of this technology in the dental field. Multiple studies have resulted in a system that is
suitable for clinical use. Yet no routine clinical application has been reported. Conclusion: The research department has already covered more
advanced technologies like mixed reality. Therefore, a question arises, whether augmented realty will continue to grow independently or will
mixed reality dominate the field.
Keywords: Augmented reality, Dentistry, Dental technology, Clinical application, Technology, Dental practice.
Abbreviations: CAM-Computer Aided Manufacturing, CAD-Computer-Aided Design, RP-Rabid Prototyping, ML-Machine Learning, VR-Virtual
Reality, AR-Augmented Reality.
Introduction
With each passing day, technology evolves, improving prospects
in multiple fields in life. whether in the applied sciences fields,
education, military, sports, entertainment industry, medical field,
dental field or others [1,2]. Many digital production management
workflows have already been implemented into treatment
protocols, particularly in the fast-growing Computer-Aided
Design\Computer Aided Manufacturing (CAD\CAM), Rabid
Prototyping (RP), automated processing in radiological imagining
by the usage of Artificial Intelligence (AI) and Machine Learning
(ML), Virtual Reality (VR), and Augmented Reality (AR) [1].
Virtual Reality (VR) technology is a synthetic environment
composed of computer-generated images, audio, and videos where
the users are emerged inside the artificial environment and can’t
see the real world [1]. Consequently, Augmented Reality (AR) is
the technology that combines computer-generated images, audio,
and videos on a screen with real-life scenes [1,3]. Therefore, for
AR creation, computerized virtual components or elements are
needed. The AR technology allows the users to superimpose
virtual content in the real world; thus, it supplements reality with
virtual content as a mix, rather than a complete replacement [4].
Due to this distinctive feature, AR is much easier to be realized
and understood than VR [5].
For the creation of augmented reality systems, multiple
components are required to be present. First and fore most is a
camera, a sensor, or a scanning device; that will capture real-life
scenes and objects. A second component is a computer unit;
which can be described as the processing phase of the captured
images and movements, analyzing the position, tilt, acceleration,
and adding depth to the captured images; hence generating 3D
images. Thirdly, a display system to display virtual and 3D objects
in the real world. Lastly, a tracking device is needed to
accomplish the registration phase, which is a phase that is needed
to continuously track the user during the procedure to allow for
real-time visualization [6]. Registration techniques can be
categorized into two main groups: marker-free registration, such
as laser skin surface scanning, and marker-based registration, such
as anatomical landmarks, bone screws, and skin adhesive markers
[7,8]. The virtual objects can be viewed from multiple angles and
follow the patient and the operator’s movements by the usage of
tracking systems [6-9].
There are two techniques used for tracking. The first technique
uses the Fiducially Markers, which depend on the anatomical
landmarks obtained from the X-rays. The second technique uses
Surface Matching, which depends on position sensors placed on
the instrument used and on the patient. Tracking systems are used

Al-Khaled I, et al. Edelweiss Applied Science and Technology, 2021 PDF: 191, 5:1
Citation: Al-Khaled I, Al-Khaled A and Abutayyem H. Augmented reality in dentistry: uses and applications in
the digital era (2021) Edelweiss Appli Sci Tech 5: 25-32.
26
to track the patient, the instruments, and the operator's movement.
Then, transferring the collected data to the processing unit; allows
for almost real-time visualization. This process of registration and
re-registration (in case any of the elements being tracked moves)
takes time and depends upon the speed of the processing unit [9].
From a dental perspective, the pre-operative X-rays of the patient
resemble the previously taken images that will later be used to
obtain the 3D x-rays. Such x-rays can be obtained from 3D X-
rays, like Computed Tomography (CT), or from multiple 2D
images [10,11]. Four main types of 3D imaging systems have
been used to capture dental and ore-facial structures; Cone-Beam
Computed Tomography Systems (CBCT), Laser scanner,
Structured light scanner, and Sterophotogrammetry [12].
After the images were captured and analyzed, they are displayed
on the operating field (patient mouth or face) as superimposed
objects; to allow navigational support intra-operatively from the
previously obtained pre-operative X-rays directly on the patient.
This can be based on video-based display, see-through display,
and projection-based AR. The video-based display uses
endoscopic cameras or Head-Mounted Displays (HMD) to
superimpose virtual objects on a (stereo) video stream, thus
increasing the viewer’s understanding of depth, motion, and stereo
parallax. See-through display and projection-based AR uses
translucent silver mirrors, see-through devices, and projectors.
Those devices are placed between the operator and the patient; to
allow the projection of the virtual objects [6,13-16]. Multiple
researchers have proved the effectiveness of the AR simulators in
assisting dentists by showing and displaying virtual models in the
operating field. This directly contributed to the reduction in the
difficulty of hand-eye coordination [17].
AR has already been introduced in the dental research,
incorporating the dental implant, oral and maxillofacial surgery,
orthodontic, endodontic, prosthodontics, paedodontics, operative
dentistry, as well as dental education [1,4-6,17-26]. The reason
why this study aims to acknowledge the latest technological
development related to augmented reality uses and applications in
the dental field, also its future, and how can it be improved.
Materials and Methods
Duration: 6 months.
Study Design: Literature Review.
Inclusion Criteria: 2000-5 May 2020, database that was
searched: PubMed.
Exclusion Criteria: All the studies that were published in a
language other than English were excluded, as well as editorial,
letters to the editor, experimental studies on animals, short
communications, articles related to Cranial-Maxillofacial Surgery,
and articles that do not present an application or use of AR
systems in dentistry. Studies focusing on other technological
advancements that modify the normal visual environment like
mixed reality, hybrid reality, and virtual reality were also
excluded.
Data Collection Procedure: the search terms “Augmented
reality” and “Dentistry” were used to search the PubMed database
from the year 2000-2005 May 2020 for augmented reality uses in
dentistry. n=72 articles were found in which n=40 were included
and n=32 were excluded. Articles selection occurred in 2 stages,
title and abstract evaluation, which resulted in the exclusion of
n=19 articles leaving n=53 articles, followed by the full article
evaluation, which resulted in the exclusion of n=13 articles
leaving n=40 Figure 1. The list of included articles present in
Table 1. The included articles presented in Table 1 are arranged in
chronological order and start from 2005 as the previous articles
did not meet the inclusion criteria.
Figure 1: flowchart of the method of data collection.
Ethical Consideration: This literature review was approved by
RAK Medical and Health Sciences University ethical committee
and institutional review board.
Figure 2: Number of articles published per year under the search
term (Augmented reality) AND (Dentistry).
Figure 3: Pie-chart showing the amount of articles covered in this
review, according to the speciality.
It’s been observed that most articles were published in the last 5
years as n=48 articles from n=72 were published from 2016-5
May 2020 Figure 2. 55% of our included articles covered the AR
applications, as a navigational system, in surgery, which exceeds
the amount covered for other dental specialties Figure 3. The
applications found were summarized in Table 2 and were divided
according to the dental specialties. A detailed description of the
AR systems was covered in Table 3.

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Author
Year
Study Design
Sample
Human/
Field of
interest
Hardware (display) and Software (processing)
Phantom
Nijmeh AD
2005
Review
Review
Review
Surgery
Microscope, HMD
Mischkowski
RA
2006
Clinical trail
5
Humans
Surgery
LCD screen with digital camera and X-Scope
software.
Tran HH
2011
Experimental study on a
phantom and a feasibility
study on a volunteer
1 Phantom/ 1
Volunteer
Both
Surgery
Half silvered mirror and GPU based rendering
algorithm.
Zhu M
2011
Clinical trail
15
Humans
Surgery
ARToolKit software.
Aichert A
2012
Clinical trail
3
Humans
Orthodontics
Monocular AR system.
Bruellmann
DD
2013
Experimental in vitro
study
126 Human Teeth
Human teeth
in vitro
Endodontics
Intra-oral or microscopic camera and
Software implemented using C++, Qt.
Suenaga H
2013
Pilot study
1 Phantom/
1Volunteer
Both
Surgery
Half silvered mirror and multiple software.
Zinsera MJ
2013
Clinical trail
16
Humans
Surgery
IGVD with VGA camera and I-plan CMF
software.
Wang J
2014
Experimental study on a
phantom
1
Phantom
Surgery
Half silvered mirror and HALCON Library
software with algorithms implemented using
C++, Qt.
Badiali G
2014
Experimental study on a
phantom
1
Phantom
Surgery
HMD and Autodesk software.
Lin YK
2015
Experimental study on a
phantom
40 Osteotomy Sites
on 4 Maxilla and 4
Mandible Stereo
lithographic Models
Phantom
Surgery
HMD
Espejo-
Trung LC
2015
Qusitionnaire-based
Clinical trail
77
Resin Teeth
Educational
XCadCam scanner and a camera and
HITLabNZ software.
Suenaga H
2015
Pilot study
1 Phantom/
1Volunteer
Both
Surgery
Half silvered mirror and Multiple software.
Albuha Al-
Mussawi R
2016
Review
Review
Review
Review
Review
Zhu M
2017
Experimental study on a
phantom
20 Stereo
lithographic Models
Phantom
Surgery
Semi-transparent glass and AR Toolkit
software.
Won YJ
2017
Clinical trail
1
Human
Educational
Monitor and Multiple software.
Wang J
2017
Experimental study on a
phantom and a feasibility
study on a volunteer
1 Phantom/
1Volunteer
Both
Surgery
4K Camera and Self developed string codes.
Llena C
2018
Qusitionnaire-based
Study
41 Student Divided
into two groups
Models
Educational
Computers and mobiles and Aumentaty
Viewer software.
Huang TK
2018
Review
Review
Review
Review
Review
Murugesan
YP
2018
Experimental Study
6 Groups
Humans
Surgery
Translucent mirror and New rotation matrix
and translation victor (RMaTV) custom made
by the author.
Zhu M
2018
Clinical trail
93 patients, divided
into three
comparison groups.
Humans
Surgery
HMD and AR Toolkit with Autodesk 3ds
Max.
Kwon HB
2018
Review
Review
Review
Review
Review
Jiang W
2018
Clinical trail
12 RP Mandibular
Models
Models
Surgery
See-through device and custom made by the
author.
Basnet BR
2018
Experimental Study
10 Groups
Humans
Surgery
Translucent mirror and Custom made
software by the author.
Goodacre CJ
2018
Perspective Study
Not presented
Not presented
Educational
Not presented
Ma L
2019
Experimental study on a
phantom and a feasibility
study on a volunteer
5 Phantom/ 1
Volunteer
Both
Surgery
Half silvered mirror.
Bosc R
2019
Review
Review
Review
Surgery
Review
Mladenovic
R
2019
Prospective Study
41 Student Divided
into two groups
Models
Educational
HMD and Dental Simulator mobile app.
Touati R
2019
Questionnaire-based Pilot
Study
18 Student
Humans
Prosthodontics
iPad or iPhone and Ivo Smile app.
Wang J
2019
Experimental study on a
phantom and a feasibility
study on a volunteer
1 Phantom/
1Volunteer
Both
Surgery
Custom made stereo-Camera and Self
developed 3D stereo-matching algorithm.
Joda T
2019
Review
Review
Review
Review
Review

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the digital era (2021) Edelweiss Appli Sci Tech 5: 25-32.
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Pietruski P
2019
Experimental study on a
phantom.
126 osteotomies
were performed on
21 identical
mandible models
Phantom
Surgery
HMD and Multiple software modified by the
authors.
Farronato M
2019
Review
Review
Review
Review
Review
Pellegrino G
2019
Clinical trail
2
Humans
Surgery
HMD.
Kim-Berman
H
2019
Questionnaire-based
Experimental Study
93 Student
Not presented
Educational
Mobile and Costume made by the author.
Ayoub A
2019
Review
Review
Review
Surgery
Review
Zhou Y
2019
Pilot Study
Extracted human
teeth installed on
model
Not presented
Operative
HMD.
Amantini S
2020
Questionnaire-based
prospective Study
Not presented
Not presented
Educational
Monitor and Multiple software has been used.
Mladenovic
R
2020
Prospective Study
21 Student
Humans
Educational
Mobile and Dental simulator mobile app.
Zafar S
2020
Questionnaire-based
Study
88 Student
Humans
Educational
HMD and HoloHuman software.
Table 1: The list of included articles, with study design, sample, field of interest, hardware used for display, and software used for processing.
Dental Specialty
Application of AR
Surgery
- Outlining lesions
- Zygotic Reconstruction.
- LeFort 1 Osteotomy bi-maxillary orthognathic surgery.
- Implant placement.
- Mandibular Angle Oblique Split Osteotomy (MASO).
- Projecting and Locating of Inferior Alveolar Nerve (IAN).
- Projecting and locating both arches with the teeth (crowns and roots).
- Projecting and locating the skull in relation to the maxilla.
- Projecting and locating the carotid artery.
Orthodontics
Bracket placement guide.
Endodontic
Root Canal Detection.
Prosthodontics
Facial Recognition for smile design.
Operative
Dental Decay Monitoring.
Paedodontics
Game Serious to motivate children for oral hygiene practice.
Educational
- Virtual Teeth identification test for dental anatomy course.
- OSCE Simulation.
- In anatomy courses.
- Administration of Inferior Alveolar Nerve Block (IANB) Anesthesia.
- Administration of Anterior Superior Alveolar nerve block (ASA).
- Preparation of Class I and Class II Cavities
- Preparation of gold only restoration.
Table 2: The application of AR in dentistry.
Components of AR system
Pre-operative patient data
- CT.
- PET scan.
- MRI.
- Digital Volume Tomography (DVT).
- Intra-oral or microscopic camera.
- CBCT.
- 3D Cephalometric.
- Optical Coherence Tomography (OCT), and infrared Scanning
Fiber Endoscope (SFE).
Software used
- X-Scope.
- GPU based rendering algorithm.
- AR Toolkit.
- Software implemented using C++, Qt.
- 3D Slicer.
- I-plan CMF software.
- HALCON Library software.
- Autodesk.
- HITLabNZ software.
- Open GL.
- Aumentaty Viewer software.
- New Rotation Matrix and Translation Victor (RMaTV).
- Holloman software.

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Display technique
- Microscope.
- HMD.
- LCD screen with digital camera.
- Half silvered mirror.
- Projector based display.
- Monocular AR system.
- Image-guided Visualization Display (IGVD) with video graphics
array (VGA) camera.
- Semi-transparent glass.
- 4 K Cameras.
- IPad or iPhone.
- Monitor.
Tracking technique
- Occlusal splint with fiducially marker.
- Surface matching.
- Polaris Spectra optical tracking system.
- Virtual planes.
- Customized stereo-camera with fiducially marker.
- Processing of video frames grabbed by the cameras.
- 4 K Cameras.
- Optical image tracking technique.
- Kinect Xbox 360 sensor (Microsoft Corp.)
Table 3: Detailed description of AR systems in the included literature.
Discussion
In this review, multiple systems and methods have been covered
for the implication of AR in clinical practices. The reason
behind this is that no standard method for AR technology
application in clinical practice has been yet proposed [4,14].
This encouraged the researchers to modify the previously used
systems to create new systems that would provide better
outcomes [13,15,19,24,27]. The results revealed that the amount
of literature covering the uses of AR as a navigational system in
surgeries exceeds the amount covered for other dental
specialties. This coincides with a review done by Ayoub A. et
al. in 2019, which had described it as the primary area of use
[12].
Many of the studies in this review have focused on improving
certain aspects that could consequently enhance the AR
systems. Such aspects would be accuracy, processing time,
image registration, depth perception, and occlusion handling
[13,15,19,24,28,29]. In comparison with manual procedures,
Implant AR-supported navigation systems have shown more
accurate results and less deviation. Also, it reduces iatrogenic
complications such as sinus perforations, fenestrations,
dehiscence’s, or mandibular nerve damage [19,20,30]. Although
good results have been proven in multiple studies, Pellegrino G.
et al. had a negative result in using the AR system for placement
of two implants, as angular deviations for the first and second
implants were respectively 3.05° and 2.19°. Thus further testing
and researches are needed [31].
2D and 3D Computer-assisted navigational systems have been
of great value to surgeons in the preceding years. In particular,
the field of OMF surgery, where surgeons are faced with
complex anatomy, the narrow spatial relationship of vital
structures, and high esthetic demands. One of the major
improvements was image-guided navigation that uses the pre-
operatively acquired scans to enable intra-operative guidance.
Nevertheless, certain flows and challenges were accompanied
by the use of these devices [20,32]. These include a lack of
image depth in the virtually displayed images, the need for
hand-eye Transformation, indirect recognition of the patient’s
anatomy from the two-dimensional images, and inaccurate
Registration in indirect visualization of three-dimensional
images, as the small surface details may be smoothened out
[6,13]. Accordingly, a constant comparison between the surgical
field and the displayed image is required, conveying the need to
look away from the operating field to see the displaying screen
[6,13].
The usage of the augmented reality technology as a navigational
tool could decrease the mean positional errors to 0.7 mm [6]. A
study in 2018, done by Zhu M. et al., compared the usage of the
AR system, Individualized Templates (IT), and free-hand
technique in a Mandibular Angle Osteotomy (MAO) [33]. The
study sample was divided into three groups; 31 patients were in
the AR group, 28 patients in the IT group, and 34 patients in the
free-hand group.
The study results showed that AR needed more time than the
free-hand technique in the pre-operative phase, but in regards to
the procedure time, the AR system proved to be less. The AR
system showed an advantage over the IT system as the AR
system pre-surgical option can be altered anytime. Furthermore,
the surgeons performing the procedure favored the use of the
AR system on the IT technique, as it provided more
understanding of the operative field and provided better viewing
[33]. A study was done in 2019 by Pietruski P. et al [34].
compared the usage of cutting guides created by CAD/CAM
and two AR systems, based on simple (SAR) and a Navigated
(NAR) Augmented Reality technology, for a mandibular
osteotomy procedure, concerning the accuracy of the systems.
After performing 21 osteotomies on the identically fabricated
mandibles (Seven for each method). The result indicated a more
accurate procedure when using surgical guides. CAD/CAM
printed guides are gaining a lot of popularity nowadays.
Although it has been proven more accurate than AR, this
technique is limited by certain drawbacks that permit the
widespread use of this technology. A time-consuming process,
as the guide needs to be printed, which limits its use for trauma
and cancer patients. It is also a costly technique. The main
drawback is that the guide needs to be placed directly on a bony
landmark, which means that greater irritation and extensive
dissection of soft tissue are required. AR technologies have the
potential to decrease these limitations in the future [34].
The relevant advances in the AR systems and techniques opened
the door for the uses of AR in other dental specialties [33].
According to Dr. Charles J. Good acre, an educator at Loma

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Linda University School of Dentistry (Loma Linda, CA), there
are four key factors to enhance dental education; spatial ability,
interactivity, critical thinking, and clinical correlations with the
integration of multiple dental disciplines. He described how 3D
software (eHuman (https://ehuman.com/)) could help in
enhancing dental education and the advantages it gives to the
students [35]. Preclinical classes help dental students in
improving fine motor abilities, mastery of new tools, as well as,
provide an understanding of therapeutics, biomaterials, and
techniques before patient treatment where the convergence of
these disciplines takes place [36].
Figure 4: (a) Teeth model overlay with critical structures to
visualize the hidden tooth roots. (b) Augmented display of the
surgical instrument with the overlaid drill path. (c) Three-
dimensional images of molars including a growing wisdom
tooth were overlaid on a lower jaw model. (d) Augmented
display of the surgical instrument indicating the drill path.
According to the literature, AR has proved to increase those
skills needed for this convergence, as it is strongly related to
spatial vision, since it increases both the surgeon’s visual
awareness in high-risk surgeries and increases the surgeon's
intuitive grasp of the operating field [4,11,37]. Also, it decreases
the iatrogenic complications of the treatment performed like the
injuries of the surrounding anatomical structures Figure 4,
proved effectiveness by assisting the oral surgeons to better
visualize the operating fields that are not directly observed,
aiding in the reduction of surgical time and morbidity, which
may result in a reduced overall treatment coast, and help address
the challenges that may confront the surgeon during a procedure
[4,11,19,24,31,34]. Furthermore, it helps in decreasing the
amount of X–rays the patient is required to have [8].
In contrast to the previously mentioned benefits, AR does have
certain drawbacks. In OMF surgeries, the implementation of AR
decreased because of the sophistication of such surgeries and
the longer time required for the implementation of such devices.
Additionally, the technical application and the limited accuracy
have been proposing a difficulty [14]. Without forgetting to
mention, that the system needs expensive necessary equipment,
as the expenses of AR systems are still high [4,15,25]. This is
why this technology demands both economic and
methodological rationalization [4,33,38]. Those drawbacks not
only apply to OMFS, but also the routine dental application of
AR. A study by Won Y. in 2017 covered the usage of a simple
AR system for assisting in the IAN block administration [14].
The study suggested a simple method of implementation of AR
in dental practice without the need for a sophisticated system, as
they attempted to create an AR on a screen monitor. It also
suggested that the utilization of this technique could prove
beneficial in orthodontics or prosthodontics, with certain
enhancements made Figure 5. Zhou Y. et al [14]. published a
study in 2019, also proposed the use of an HMD with a low-cost
2D imaging modality like SFE in the early detection of dental
caries [17]. Such simple AR systems could enable the usage of
AR in routine dental clinical practice in the future [14,17].
Figure 5: performing of an inferior alveolar nerve block
procedure using a simple augmented reality method, in which
the superimposed images are used as references to locate the
mandibular foramen in an intraoral view during the injection of
local anesthetics.
Unfortunately, the use of HMD devices may cause vertigo,
nausea, blurred vision, eyestrain, and headaches. That is why a
proper examination of the potential occurrence of these
elements is important before the first use [26,34]. The reason
behind those side effects may be because of the mismatch
between the visual and vestibular systems. Conversely, avoiding
these side effects may be possible by adjusting the headset,
moving the eyes at an adequate speed, circumventing any abrupt
bodily movements while using it, and having rest for a while
after using the device [26]. These side effects might be the
reason why most of the authors are indicating the usage of non-
wearable display camera systems [39]. In this review, we also
reached to the same conclusion. This was also supported by Zhu
M. et al. in 2011 [7]. Yet, according to Espejo-Trung LC et al.,
using such systems may reduce the augmenting perception of
the operator [39].
Moreover, Wang J. et al. proposed a video see-throw AR system
to address the methodological and implementation issues that
other systems resulted in [40]. The study suggested the usage of
a simple video camera that can register and project the virtual
objects on the camera itself, which resolves the issue concerning
the space occupied by the external tracking and display system.
Thus, reducing the need for extra space and the time needed to
adjust them. Putting in mind that almost all modern operating
rooms already utilize the use of an optical camera that allows
for AR technology applications Figure 6 [28]. Another
limitation is that AR cannot be used for emergency treatments,
as it requires proper pre-operative investigations [33]. Certain
studies had a prolonged time and delay due to the registration
phase and other technical problems [25,32].
Figure 6: (a) Picture of the surgeon wearing a video camera. (b)
Teeth tracking and (c) video see-through augmented reality
validated on clinical data. The model of the carotid artery of the
patient is overlaid.

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Due to the continuous development in the field, new systems
became available for use and eased the way to a solution for this
obstacle. Suenaga H. et al. published a study in 2015 that
introduced a new system. Instead of taking an hour for the
registration phase, it takes less than 30 seconds for the
completion of it [11]. Wang J. et al. also had similar results
[24]. In like manner, Ma L. et al. in 2019 proposed a system that
can register the Occlusal splint outside the patient mouth, thus
reducing the intra-operative time [30].
For further enhancements of the previous points, Basnet B. R. et
al. in 2018 shed the light on further issues in regards to the
processing phase, including noise in real-time images, image
registration, high processing time, and poor occlusion handling
[29]. The study also proposed a solution to handle those
limitations by introducing a new system aimed to increase the
navigational accuracy by removal of occlusion and noise in real-
time navigation. This was accomplished by the use of a
weighting-based de-noising filter and depth mapping-based
occlusion removal to exclude occluded objects (Blood, surgical
tools, and the surgeon's body) [10,29]. In this context, legal
regulations must be clearly defined with a clear standard for the
directive of patient data [3].
The fastest way for the brain to capture content is through
images and visual experience. The concept of human
understanding of reality is confined with the three dimensions of
space, as the human brain functions on the principles of images
and associations, which in return supports the AR concept, thus,
yields the promise for further adaptations [41].
Conclusion
This review article covered the AR history, its systems, clinical
applications, and the advancements in the AR field from 2000
till 5 May 2020. The publications indicate that AR application is
still under testing, as certain drawbacks do tie the spread of this
technology in the dental field. Multiple studies have resulted in
a system that is suitable for clinical use, yet no routine clinical
application has been reported. Improving the speed and
accuracy of the processing unit should be the focus of future
studies. The results revealed that AR was not used in all dental
specialties as the applications found only covered oral surgery,
orthodontics, endodontic, prosthodontics, operative,
pedodontitics, and dental education As technological
advancements resemble a continuous cycle, mixed reality is a
new promising technology that combines both VR and AR. The
research department has already covered this technology;
therefore, a question arises, whether AR will continue to grow
independently or will mixed reality dominate the field.
Acknowledgements
We would like to thank all the individuals who contributed to
the success of this research. We would like to direct a special
thanks to all the faculty, supervisors, and ethical committee in
the RAKCODS and RAKMHSU.
References
1. Huang TK, Yang CH, Hsieh YH, Wang JC and Hung CC.
Augmented reality (AR) and virtual reality (VR) applied in
dentistry (2018) Kaohsiung J of Med Scie 34: 243-248.
https://doi.org/10.1016/j.kjms.2018.01.009
2. Phuyal S, Bista D and Bista R. Challenges, opportunities and
future directions of smart manufacturing: a state of art review
(2020) Sustain Futur 2
https://doi.org/10.1016/j.sftr.2020.100023
3. Joda T, Gallucci GO, Wismeijer D and Zitzmann NU.
Augmented and virtual reality in dental medicine: a
systematic review (2019) Comput Biol Med 108: 93-100
https://doi.org/10.1016/j.compbiomed.2019.03.012
4. Badiali G, Ferrari V, Cutolo F, Freschi C and Caramella D, et
al. Augmented reality as an aid in maxillofacial surgery:
Validation of a wearable system allowing maxillary
repositioning (2014) J Cranio-Maxillofacial Surg 42: 1970-
1976 http://dx.doi.org/10.1016/j.jcms.2014.09.001
5. Mladenovic R, Dakovic D, Pereira L, Matvijenko V and
Mladenovic K. Effect of augmented reality simulation on
administration of local anesthesia in pediatric patients (2020)
Eur J Dent Educ
6. Suenaga H, Hoang Tran H, Liao H, Masamune K and Dohi
T, et al. Real-time in situ three-dimensional integral
videography and surgical navigation using augmented reality:
a pilot study (2013) Int J Oral Sci 5: 98-102
http://www.nature.com/articles/ijos201326
7. Zhu M, Chai G, Zhang Y, Ma X and Gan J. Registration
strategy using occlusal splint based on augmented reality for
mandibular angle oblique split osteotomy (2011) J Craniofac
Surg 22: 1806-1809
https://doi.org/10.1097/scs.0b013e31822e8064
8. Zhu M, Liu F, Chai G, Pan JJ and Jiang T, et al. A novel
augmented reality system for displaying inferior alveolar
nerve bundles in maxillofacial surgery (2017) Sci Rep 7
https://doi.org/10.1038/srep42365
9. Nijmeh AD, Goodger NM, Hawkes D, Edwards PJ and
McGurk M. Image-guided navigation in oral and
maxillofacial surgery (2005) Br J Oral Maxillofac Surg
43:294-302 https://doi.org/10.1016/j.bjoms.2004.11.018
10. Farronato M, Maspero C, Lanteri V, Fama A and Ferrati F, et
al. Current state of the art in the use of augmented reality in
dentistry: A systematic review of the literature (2019) BMC
Oral Health 19 https://doi.org/10.1186/s12903-019-0808-3
11. Suenaga H, Tran HH, Liao H, Masamune K and Dohi T, et
al. Vision-based markerless registration using stereo vision
and an augmented reality surgical navigation system: a pilot
study (2015) BMC Med Imaging 15
https://doi.org/10.1186/s12880-015-0089-5
12. Ayoub A and Pulijala Y. The application of virtual reality
and augmented reality in Oral and Maxillofacial Surgery
(2019) BMC Oral Health 8 https://doi.org/10.1186/s12903-
019-0937-8
13. Tran HH, Suenaga H, Kuwana K, Masamune K and Dohi T,
et al. Augmented reality system for oral surgery using 3D
auto stereoscopic visualization (2011) Lect Notes Comput
Sci 81-88 https://doi.org/10.1007/978-3-642-23623-5_11
14. Won Y-J and Kang S-H. Application of augmented reality
for inferior alveolar nerve block anesthesia: A technical note
(2017) J Dent Anesth Pain Med 17: 129-134
https://doi.org/10.17245/jdapm.2017.17.2.129
15. Murugesan YP, Alsadoon A, Manoranjan P and Prasad PWC.
A novel rotational matrix and translation vector algorithm:
geometric accuracy for augmented reality in oral and
maxillofacial surgeries (2018) Int J Med Robot Comput
Assist Surg 14: 1-14 https://doi.org/10.1002/rcs.1889
16. Bosc R, Fitoussi A, Hersant B, Dao TH and Meningaud JP.
Intraoperative augmented reality with heads-up displays in
maxillofacial surgery: a systematic review of the literature
and a classification of relevant technologies (2019) Int J Oral
Maxillofac Surg 48: 132-139.
https://doi.org/10.1016/j.ijom.2018.09.010
17. Zhou Y, Yoo P, Feng Y, Sankar A and Sadr A, et al.
Towards AR-assisted visualisation and guidance for imaging
of dental decay (2019) Healthcare Tech Letters 6: 243-248
https://doi.org/10.1049/htl.2019.0082

Al-Khaled I, et al. Edelweiss Applied Science and Technology, 2021 PDF: 191, 5:1
Citation: Al-Khaled I, Al-Khaled A and Abutayyem H. Augmented reality in dentistry: uses and applications in
the digital era (2021) Edelweiss Appli Sci Tech 5: 25-32.
32
18. Kwon HB, Park YS and Han JS. Augmented reality in
dentistry: a current perspective (2018) Acta Odontol Scand
76: 497-503 https://doi.org/10.1080/00016357.2018.1441437
19. Jiang W, Ma L, Zhang B, Fan Y and Qu X, et al. Evaluation
of the 3d augmented reality-guided intraoperative positioning
of dental implants in edentulous mandibular models (2018)
Int J Oral Maxillofac Implants 33: 1219-1228
20. Lin YK, Yau HT, Wang IC, Zheng C and Chung KH. A
novel dental implant guided surgery based on integration of
surgical template and augmented reality (2015) Clin Implant
Dent Relat Res 17: 543-553
https://doi.org/10.1111/cid.12119
21. Aichert A, Wein W, Ladikos A, Reichl T and Navab N.
Image-based tracking of the teeth for orthodontic augmented
reality (2012) Lect Notes Comput Sci 601-608
https://doi.org/10.1007/978-3-642-33418-4_74
22. Bruellmann DD, Tjaden H, Schwanecke U and Barth P. An
optimized video system for augmented reality in endodontics:
A feasibility study (2013) Clin Oral Investig 17: 441-448
https://doi.org/10.1007/s00784-012-0718-0
23. Touati R, Richert R, Millet C, Farges J-C and Sailer I, et al.
Comparison of two innovative strategies using augmented
reality for communication in aesthetic dentistry: a pilot study
(2019) J Health c Eng 1-6
https://doi.org/10.1155/2019/7019046
24. Wang J, Suenaga H, Hoshi K, Yang L and Kobayashi E.
Augmented reality navigation with automatic marker-free
image registration using 3-d image overlay for dental surgery
(2014) Biomed Eng 61: 1295-1304
https://doi.org/10.1109/tbme.2014.2301191
25. Zinser MJ, Mischkowski RA, Dreiseidler T, Thamm OC and
Rothamel D, et al. Computer-assisted orthognathic surgery:
waferless maxillary positioning, versatility, and accuracy of
an image-guided visualisation display (2013) Br J Oral
Maxillofac Surg 51: 827-833
http://dx.doi.org/10.1016/j.bjoms.2013.06.014
26. Zafar S and Zachar JJ. Evaluation of holohuman augmented
reality application as a novel educational tool in dentistry
(2020) Eur J Dent Educ 24: 259-265
https://onlinelibrary.wiley.com/doi/abs/10.1111/eje.12492
27. Wang J, Shen Y and Yang S. A practical marker-less image
registration method for augmented reality oral and
maxillofacial surgery (2019) Int J Comput Assist Radiol Surg
14: 763-773 https://doi.org/10.1007/s11548-019-01921-5
28. Wang J, Suenaga H, Yang L, Kobayashi E and Sakuma I.
Video see-through augmented reality for oral and
maxillofacial surgery (2016) Int J med robotics and comp ass
surgery 13: 211-215 https://doi.org/10.1002/rcs.1754
29. Basnet BR, Alsadoon A, Withana C, Deva A and Paul M. A
novel noise filtered and occlusion removal: navigational
accuracy in augmented reality-based constructive jaw surgery
(2018) Oral Maxillofac Surg 22: 385-401
https://doi.org/10.1007/s10006-018-0719-5
30. Ma L, Jiang W, Zhang B, Qu X and Ning G, et al.
Augmented reality surgical navigation with accurate cbct-
patient registration for dental implant placement (2019) Med
Biol Eng Comput 57: 47-57 https://doi.org/10.1007/s11517-
018-1861-9
31. Pellegrino G, Mangano C, Mangano R, Ferri A and Taraschi
V, et al. Augmented reality for dental implantology: a pilot
clinical report of two cases (2019) BMC Oral Health 19
https://doi.org/10.1186/s12903-019-0853-y
32. Mischkowski RA, Zinser MJ, Kübler AC, Krug B and Seifert
U, et al. Application of an augmented reality tool for
maxillary positioning in orthognathic surgery - A feasibility
study (2006) J Cranio-Maxillofacial Surg 34: 478-483
https://doi.org/10.1016/j.jcms.2006.07.862
33. Zhu M, Liu F, Zhou C, Lin L and Zhang Y, et al. Does
intraoperative navigation improve the accuracy of
mandibular angle osteotomy: comparison between
augmented reality navigation, individualised templates and
free-hand techniques (2018) J Plast Reconstr Aesthetic Surg
71: 1188-1195 https://doi.org/10.1016/j.bjps.2018.03.018
34. Pietruski P, Majak M, Światek-Najwer E, Żuk M and Popek
M, et al. Supporting mandibular resection with intraoperative
navigation utilizing augmented reality technology-a proof of
concept study (2019) J Cranio-Maxillofacial Surg47: 854-
859 https://doi.org/10.1016/j.jcms.2019.03.004
35. Goodacre CJ. Digital learning resources for prosthodontic
education:the perspectives of a long-term dental educator
regarding 4 key factors (2018) J Prosthodont 27: 791-797
https://doi.org/10.1111/jopr.12987
36. Kim-Berman H, Karl E, Sherbel J, Sytek L and Ramaswamy
V. Validity and user experience in an augmented reality
virtual tooth identification test (2019) J Dent Educ 83: 1345-
1352 https://doi.org/10.21815/jde.019.139
37. Llena C, Folguera S, Forner L and Rodríguez-Lozano FJ.
Implementation of augmented reality in operative dentistry
learning (2018) Eur J Dent Educ 22: 122-130
https://doi.org/10.1111/eje.12269
38. Albuha Al-Mussawi RM and Farid F. Computer-based
technologies in dentistry: types and applications (2016) J
Dent (Tehran) 13: 215-222
http://www.ncbi.nlm.nih.gov/pubmed/28392819
39. Espejo-Trung LC, Elian SN and Luz MAADC. Development
and application of a new learning object for teaching
operative dentistry using augmented reality (2015) J of dental
edu79: 1356-1362
https://pubmed.ncbi.nlm.nih.gov/26522642/
40. Wolz MM. Language barriers: challenges to quality
healthcare (2015) Int J Dermatol 54: 248-250
http://doi.wiley.com/10.1111/ijd.12663
41. Mladenovic R, Pereira LAP, Mladenovic K, Videnovic N and
Bukumiric Z, et al. Effectiveness of augmented reality
mobile simulator in teaching local anesthesia of inferior
alveolar nerve block (2019) J Dent Educ 83: 423-428
https://doi.org/10.21815/jde.019.050