Skip to main content
Intended for healthcare professionals
Restricted access
Research article
First published online April 9, 2026
Request permissions

Markerless augmented reality-guided mini-screw placement: A clinical case series

Hideyuki Suenaga https://orcid.org/0000-0003-0415-1597 [email protected], Ayuko Sakakibara, […], Ryo Maruoka, Asako Taniguchi, and Kazuto Hoshi+2View all authors and affiliations
OnlineFirst
https://doi.org/10.1177/14653125261434039

Abstract

Introduction:

Placing mini-screws between teeth can risk contacting or damaging dental roots and injuring adjacent nerves, blood vessels or maxillary sinus when local anatomy is not visualised precisely. The latest digital advances in orthodontics have enabled three-dimensional (3D) virtual protocol designing, allowing orthodontists to simulate the orthodontic treatments and collaboratively map out the surgical intervention before procedures. Computed tomography (CT)-based surgical guides are strongly recommended for patients with delicate and complex anatomical conditions.

Case presentations:

Three patients presented with concerns related to their occlusion and required precise orthodontic mini-screw insertion.

Clinical findings and investigations:

In all cases, augmented reality (AR)-guided systems were used to assist in the precise positioning of orthodontic mini-screws.

Interventions and outcomes:

Successful placement of the mini-screw without damage to the tooth root, confirmed by postoperative radiographs.

Relevance and impact:

The non-invasive AR-guided system can efficiently highlight the precise position of the tooth root. Hence, AR-assisted mini-screw positioning might potentially aid in avoiding root damage and reducing mini-screw failure rates. This technology offers significant benefits over traditional methods, including adaptability, real-time adjustments and cost efficiency, making it a promising tool for clinicians who place mini-screws.

Plain language summary

Using augmented reality to guide safe mini-screw placement in orthodontic treatment
Why was the study/treatment done? Orthodontists sometimes use small screws (called mini-screws) in the jaw to help move teeth during treatment. Placing these screws between teeth can be risky as the mini-screws may touch or damage tooth roots by accident. What did the researchers/clinicians do? Orthodontists used a new technology, ‘markerless augmented reality (AR)’ to help guide where to place the screws safely. The AR system used normal dental scans and 3D X-rays to make a real-time, on-screen view of the patient’s teeth and roots during mini-screw placement. This let the clinicians see exactly where to place the mini-screw without needing a guide or special markers. The technique was used for three patients needing orthodontic treatment or jaw surgery. What did the researchers find/clinicians achieve? In all cases, the mini-screws were placed with no damage to nearby teeth or tissues. Patients had no pain, swelling or problems during at least 1 year of follow-up. Importantly, no extra X-rays were needed to check the screw placement. Existing scans, used for other reasons, were enough to see where the mini-screw was placed. What do the findings mean?/What did the patient think? This method is more flexible than normal methods because it lets the clinician see things in real time and adjust the position of the mini-screw during placement. It also avoids the cost and time needed to make a surgical guide for each patient. This early experience shows that ‘markerless AR’ could make mini-screw placement safer, simpler and more efficient for patients and clinicians.

Get full access to this article

View all access and purchase options for this article.

Get Access

References

Bae MJ, Kim JY, Park JT, et al. (2013) Accuracy of miniscrew surgical guides assessed from cone-beam computed tomography and digital models. American Journal of Orthodontics and Dentofacial Orthopedics 143(6): 893–901. https://doi.org/10.1016/j.ajodo.2013.02.018
Google Scholar
Benmahdjoub M, van Walsum T, van Twisk P, et al. (2021) Augmented reality in craniomaxillofacial surgery: Added value and proposed recommendations through a systematic review of the literature. International Journal of Oral and Maxillofacial Surgery 50(7): 969–978. https://doi.org/10.1016/j.ijom.2020.11.015
Google Scholar
Birlo M, Edwards PJE, Clarkson M, et al. (2022) Utility of optical see-through head mounted displays in augmented reality-assisted surgery: A systematic review. Medical Image Analysis 77: 102361. https://doi.org/10.1016/j.media.2022.102361
Google Scholar
Bosc R, Fitoussi A, Hersant B, et al. (2019) Intraoperative augmented reality with heads-up displays in maxillofacial surgery: A systematic review of the literature and a classification of relevant technologies. International Journal of Oral and Maxillofacial Surgery 48(1): 132–139. https://doi.org/10.1016/j.ijom.2018.09.010
Google Scholar
Chegini S, Edwards E, McGurk M, et al. (2023) Systematic review of techniques used to validate the registration of augmented-reality images using a head-mounted device to navigate surgery. British Journal of Oral and Maxillofacial Surgery 61(1): 19–27. https://doi.org/10.1016/j.bjoms.2022.08.007
Google Scholar
Condino S, Carbone M, Piazza R, et al. (2020) Perceptual limits of optical see-through visors for augmented reality guidance of manual tasks. IEEE Transactions on Biomedical Engineering 67(2): 411–419. https://doi.org/10.1109/TBME.2019.2914517
Google Scholar
de Geer AF, Brouwer de, Koning SG, van Alphen MJA, et al. (2022) Registration methods for surgical navigation of the mandible: A systematic review. International Journal of Oral and Maxillofacial Surgery 51(10): 1318–1329. https://doi.org/10.1016/j.ijom.2022.01.017
Google Scholar
Doughty M, Ghugre NR, Wright GA (2022) Augmenting performance: A systematic review of optical see-through head-mounted displays in surgery. Journal of Imaging 8(7): 203. https://doi.org/10.3390/jimaging8070203
Google Scholar
Giudice AL, Rustico L, Longo M, et al. (2021) Complications reported with the use of orthodontic miniscrews: A systematic review. Korean Journal of Orthodontics 51(3): 199–216. https://doi.org/10.4041/kjod.2021.51.3.199
Google Scholar
Groenenberg A, Brouwers L, Bemelman M, et al. (2024) Feasibility and accuracy of a real-time depth-based markerless navigation method for hologram-guided surgery. BMC Digital Health 2: 11. https://doi.org/10.1186/s44247-024-00067-y
Google Scholar
Hsu MC, Lin CC, Hsu JT, et al. (2024) Effects of an augmented reality aided system on the placement precision of orthodontic miniscrews: A pilot study. Journal of Dental Sciences 19(1): 100–108. https://doi.org/10.1016/j.jds.2023.05.025
Google Scholar
Kawakami H, Suenaga H, Sakakibara A, et al. (2024) Computer-assisted surgery with markerless augmented reality for the surgical removal of mandibular odontogenic cysts: Report of two clinical cases. International Journal of Oral and Maxillofacial Surgery 53(4): 347–350. https://doi.org/10.1016/j.ijom.2023.10.002
Google Scholar
Kim SH, Choi YS, Hwang EH, et al. (2007) Surgical positioning of orthodontic mini-implants with guides fabricated on models replicated with cone-beam computed tomography. American Journal of Orthodontics and Dentofacial Orthopedics 131(4 Suppl.): S82–S89. https://doi.org/10.1016/j.ajodo.2006.01.027
Google Scholar
Kravitz ND, Kusnoto B (2007) Risks and complications of orthodontic miniscrews. American Journal of Orthodontics and Dentofacial Orthopedics 131(4 Suppl.): S43–S51. https://doi.org/10.1016/j.ajodo.2006.04.027
Google Scholar
Mihit Mihit FZ, Zubizarreta-Macho Á, Montiel-Company JM, et al. (2023) Systematic review and network meta-analysis of the accuracy of the orthodontic mini-implants placed in the inter-radicular space by image-guided-based techniques. BMC Oral Health 23: 383. https://doi.org/10.1186/s12903-023-03079-8
Google Scholar
Minopoulos GM, Memos VA, Stergiou KD, et al. (2023) A medical image visualization technique assisted with AI-based haptic feedback for robotic surgery and healthcare. Applied Sciences 13(6): 3592. https://doi.org/10.3390/app13063592
Google Scholar
Papageorgiou SN, Zogakis IP, Papadopoulos MA (2012) Failure rates and associated risk factors of orthodontic miniscrew implants: A meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics 142(5): 577–595.e7. https://doi.org/10.1016/j.ajodo.2012.05.016
Google Scholar
Riad Deglow E, Toledano Gil S, Zubizarreta-Macho Á, et al. (2021) Influence of the computer-aided static navigation technique and mixed reality technology on the accuracy of the orthodontic micro-screws placement: An in vitro study. Journal of Personalized Medicine 11(10): 964. https://doi.org/10.3390/jpm11100964
Google Scholar
Riad Deglow E, Zubizarreta-Macho Á, González Menéndez H, et al. (2023) Comparative analysis of two navigation techniques based on augmented reality technology for the orthodontic mini-implants placement. BMC Oral Health 23: 542. https://doi.org/10.1186/s12903-023-03261-y
Google Scholar
Seif SA, AlNatheer Y, Al Bahis L, et al. (2024) Surgical removal of an orthodontic mini-screw displaced into the lateral pharyngeal space: A case report and review of pertinent literature. Cureus 16(1): e52343. https://doi.org/10.7759/cureus.52343
Google Scholar
Sohrabi C, Mathew G, Maria N, et al. (2023) The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. International Journal of Surgery 109(5): 1136–1140. https://doi.org/10.1097/JS9.0000000000000373
Google Scholar
Stucki J, Dastgir R, Baur D, et al. (2024) The use of virtual reality and augmented reality in oral and maxillofacial surgery: A narrative review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 137(1): 12–18. https://doi.org/10.1016/j.oooo.2023.07.001
Google Scholar
Suenaga H, Sakakibara A, Kawakami H, et al. (2025) Computer-assisted preoperative simulation and augmented reality for plate fixation positioning in genioplasty. Journal of Maxillofacial and Oral Surgery 24(2): 340–342. https://doi.org/10.1007/s12663-024-02274-6
Google Scholar
Suenaga H, Sakakibara A, Koyama J, et al. (2024) A clinical presentation of markerless augmented reality assisted surgery for resection of a dentigerous cyst in the maxillary sinus. Journal of Stomatology, Oral and Maxillofacial Surgery 125(5): 101767. https://doi.org/10.1016/j.jormas.2024.101767
Google Scholar
Suenaga H, Sakakibara A, Taniguchi A, et al. (2023) Computer-assisted preoperative simulation and augmented reality for extraction of impacted supernumerary teeth: A clinical case report of two cases. Journal of Oral and Maxillofacial Surgery 81(2): 201–205. https://doi.org/10.1016/j.joms.2022.10.017
Google Scholar
Suresh D, Aydin A, James S, et al. (2023) The role of augmented reality in surgical training: A systematic review. Surgical Innovation 30(3): 366–382. https://doi.org/10.1177/15533506221140506
Google Scholar
Wang J, Suenaga H, Yang L, et al. (2017) Video see-through augmented reality for oral and maxillofacial surgery. The International Journal of Medical Robotics and Computer Assisted Surgery 13(2): e1754. https://doi.org/10.1002/rcs.1754
Google Scholar
Williams A, Walker K, Hughes D, et al. (2022) Accuracy and cost effectiveness of a waferless osteotomy approach, using patient specific guides and plates in orthognathic surgery: A systematic review. British Journal of Oral and Maxillofacial Surgery 60(5): 537–546. https://doi.org/10.1016/j.bjoms.2021.05.005
Google Scholar
Wilmes B, Vasudavan S, Drescher D (2019) CAD-CAM–fabricated mini-implant insertion guides for the delivery of a distalization appliance in a single appointment. American Journal of Orthodontics and Dentofacial Orthopedics 156(1): 148–156. https://doi.org/10.1016/j.ajodo.2018.12.017
Google Scholar
Yeo XH, Fan S, Chantler JGM, et al. (2025) Static-Computer Assisted Implant Surgery: Where Are We Now? Australian Dental Journal 70(Suppl 1): S129–S145. https://doi.org/10.1111/adj.70007
Google Scholar
Yuan L, Liu J, Zhao R, et al. (2022) A 2-trajectories surgical guide for infrazygomatic mini-implants insertion. AJO-DO Clinical Companion 2(6): 523–531. https://doi.org/10.1016/j.xaor.2022.09.005
Google Scholar
Zhang J, Lu V, Khanduja V (2023) The impact of extended reality on surgery: A scoping review. International Orthopaedics (SICOT) 47(3): 611–621. https://doi.org/10.1007/s00264-022-05663-z
Google Scholar

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

Supplemental Material

Please find the following supplemental material visualised and available to download via Figshare in the display box below. Where there are more than one item, you can scroll through each tab to see each separate item.

Please note all supplemental material carries the same license as the article it is here associated with

  • Supplemental Video 1

|

Also from Sage