The digital revolution is changing dentistry. 3D imaging devices such as Cone-Beam Computed Tomography (CBCT), Intraoral Scanners (IOS) and Facial Scanners (FS) have a considerable impact. The fusion of information obtained from different devices into a single plan is complex due to the different nature of the acquired data. The creation of a 3D virtual patient depends on the integration and fusion of these files.

Currently, point-surface or voxel-related fusion methods are used, often manually selected. Ultimately there are AI software that automate these operations, Until now, implant planning has always required the use of dedicated software into which data from various 3D acquisitions can be imported to create the surgical plan.

A new technology promises to radically transform the world of surgery and implant planning: the Mixed Reality (MR) that refers to a technology capable of generating high-definition
virtual content and models (holograms) atop the existing environment, enhancing the user’s perception of reality.

In recent years, AI and MR have been tested individually for guided implant surgery applications in a few in vitro studies and in vivo reports. However, no clinical studies on the combined use of AI and MR in guided implant surgery were available until the publication of our first proof-of-concept article, in which the two techniques were used together to replace conventional guided implant surgery software. In that article, we demonstrated for the first time the possibility of creating an accurate implant surgical plan, using AI for the segmentation and automatic alignment of models from IOS and CBCT and MR for implant planning in a holographic environment, all authentically in 3D without using any implant planning software. Once the 3D models derived from IOS and CBCT have been loaded into AI software and the virtual models of the different anatomical structures have been segmented and aligned, it is possible to load the .STL files into the holographic system, where the operator can plan the insertion of one or more implants intuitively using their hands or dedicated joypads. Once the ideal position, inclination and depth of the implants have been confirmed, it is possible to save the set of files in the respective positions and use them for the design of a surgical guide following a static computer-assisted implant surgery, (s-CAIS) or dynamic navigation, (DN).

The Mixed Reality revolutionizes the guided implantology by integrating cutting-edge Extended Reality (XR) technologies—Augmented Reality (AR) and Virtual Reality (VR)—into the dental workflow, improving precision, efficiency, and patient acceptance by offering a more engaging, interactive, and transparent experience for patients undergoing implant procedures.

We can summarize the most significant advantages offered by Mixed Reality:
1. Optimize implant planning through AI-driven 3D data integration, allowing seamless fusion of CBCT, IOS, and FS datasets.
2. Enhance surgical accuracy by developing real-time AR-based visualization tools for guided implant procedures.
3. Improve patient education and acceptance by using VR to simulate the entire treatment process and expected outcomes.
4. Facilitate remote collaboration among dental professionals via cloud-based XR platforms, enabling real-time interdisciplinary discussions and second opinions.
5. Validate clinical performance through experimental and real-world applications, ensuring usability, precision, and effectiveness in dental implantology workflows.

One of the most significant barriers to successful dental implant therapy is patient anxiety and uncertainty regarding the procedure. Many patients fear the unknown aspects of implant surgery, leading to hesitation or refusal of treatment. This concern can be solved by leveraging XR technologies to provide patients with a clearer understanding of their treatment. Through AR and VR simulations, patients can visualize the entire process—from the initial planning stage to the expected outcome—allowing them to fully grasp what will happen during their surgery. This interactive and immersive experience not only reduces fear but also empowers patients, helping them feel more in control of their treatment and improving their psychological readiness for surgery. When patients are able to visualize their anticipated outcomes and actively contribute to decision-making, their confidence in the procedure and their clinician increases, leading to higher treatment acceptance rates.

The MR also improves clinical precision by integrating diagnostic data from Cone Beam Computed Tomography (CBCT), intraoral scanners (IOS), and facial scanners (FS) into a seamless 3D model. Using AI-driven algorithms, the system creates highly accurate virtual models, improving the accuracy of implant planning and reducing the likelihood of surgical errors. The integration of AR-based visualization tools offers real-time guidance during the procedure, which enhances surgical accuracy and reduces risks for patients.

Through its innovative approach, the Mixed Reality also supports remote collaboration among dental professionals, allowing for real-time consultations. This facilitates more informed, interdisciplinary decision-making, ensuring the patient receives the best possible care.

The Mixed Reality not only enhances the precision and effectiveness of implantology but also significantly improves patient acceptance of dental implant procedures. It represents a transformative shift in setting new standards for patient-centered care in digital dentistry. The idea was to use advanced software engineering techniques to integrate MR capabilities with existing digital dentistry tools to simplify the digital workflow and make it more accessible to more dentists.