Intelligent Virtual Dental Implant Placement via 3D Segmentation Strategy

Virtual dental implant placement in cone-beam computed tomography (CBCT) is a prerequisite for digital implant surgery, carrying clinical significance. However, manual placement is a complex process that should meet clinical essential requirements of restoration orientation, bone adaptation, and anatomical safety. This complexity presents challenges in balancing multiple considerations comprehensively and automating the entire workflow efficiently. This study aims to achieve intelligent virtual dental implant placement through a 3-dimensional (3D) segmentation strategy. Focusing on the missing mandibular first molars, we developed a segmentation module based on nnU-Net to generate the virtual implant from the edentulous region of CBCT and employed an approximation module for mathematical optimization. The generated virtual implant was integrated with the original CBCT to meet clinical requirements. A total of 190 CBCT scans from 4 centers were collected for model development and testing. This tool segmented the virtual implant with a surface Dice coefficient (sDice) of 0.903 and 0.884 on internal and external testing sets. Compared to the ground truth, the average deviations of the implant platform, implant apex, and angle were 0.850 ± 0.554 mm, 1.442 ± 0.539 mm, and 4.927 ± 3.804° on the internal testing set and 0.822 ± 0.353 mm, 1.467 ± 0.560 mm, and 5.517 ± 2.850° on the external testing set, respectively. The 3D segmentation-based artificial intelligence tool demonstrated good performance in predicting both the dimension and position of the virtual implants, showing significant clinical application potential in implant planning.