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在过去的几年里，传统的口腔手术的概念已经转变为微创手术。因此，大量的从业者开始在他们的实践中使用放大设备。这些设备提高了工作区域的可视性，并允许限制切割或切口的大小和数量。最常见的是放大镜，但它们有局限性，如收敛的视觉，不足的放大倍率，图像失真，或小的焦点深度。这些限制被外科显微镜(SM)的使用所取代，它允许放大细节和工作区域的良好可视化。SM在口腔微创手术的发展中是非常重要的，但今天，计算机和新的软件发挥了关键作用。利用计算机断层扫描(CT)或磁共振成像(MRI)等医学成像技术，可以确定主要组织类型、器官和病变。尽管这些图像包含了关于患者及其器官的所有必要信息，但可能很难感知病变的范围及其与周围组织的关系。因此，软件对三维可视化的作用是非常重要的。这些软件允许从一组2维(2D)图像可视化3D图像，使用直接体绘制技术; therefore, all acquired data can be composed to a digital 3D virtual model of the patient’s mouth. According to its definition “虚拟现实(VR)是指计算机生成的环境或现实，旨在模拟一个人在特定环境中的真实存在感”。使用虚拟现实技术，口腔外科医生可以看到病变，研究治疗方案，同时可以识别可能的并发症。视觉和触觉是人类在物体操作任务中使用的主要感官输入。使用虚拟现实和触觉技术，口腔外科医生将能够模拟虚拟手术治疗。“触觉”一词来自希腊单词haptikos(意思是能够接触)和haptesthai(意思是触摸或接触)¹．触觉技术，也被称为动觉通信或3D触摸，目前用于机器人辅助微创手术[1]。触觉界面是一种允许虚拟或远程环境刺激人类操作人员的触觉的设备。如今，许多不同结构的触觉界面已经被开发出来，并已投放市场。这些设备已被广泛应用于许多应用，如图形用户界面，游戏，教育和培训等。使用VR和触觉界面，它将有可能创建虚拟病人，也有可能进行虚拟口腔外科手术。在外科模拟中，外科医生、物体和虚拟患者之间的真实交互非常重要，因此外科使用的界面末端执行器覆盖了人手的自然运动范围。目前，这些模拟器是训练学生和外科医生[2]的重要组成部分，但在未来将有可能实现每个病人的触觉全息图。全息图是一种三维图像，通过摄影投影产生，使用触觉界面，这个图像可以变为有形的。这些触觉全息图将模拟患者的组织特征，它将允许病变的再现。 Using haptic hologram surgeons will be able to simulate each oral intervention. After this virtual study of lesions, in the future, it will be possible to create a surgical guide based on augmented reality (AR). Although AR is a form of VR, it is different. The AR allows to the surgeon to overlay virtual objects in a real-world environment and mixed them. Now, this is possible, using a powerful computer with a dedicated software, a tracking device and a display. Tracking devices are used for registration. The registration is the process in which virtual objects, generated by a computer, are merged into the real-world image. Tracking device is an instrument or a pointer to establish correspondence between features in the preoperative images and the surgical scene. The most commonly used tracking devices in oral surgery is optical or mechanical. Today, the AR is particularly useful for the placement of endosseous dental implants. This dental application of AR is named dynamic guided implant surgery. The technique allows to determine in real time the position of a drill by tracking the position of either active or passive markers attacked to the drill. These markers are tracked by a stereoscopic optical camera. The marker is a light. The active system uses surgical drills with light emitting diodes, whilst in the passive system the light, emitted from a light source, is reflected back to the stereo cameras. The camera is a sensor connected with powerful computer which uses a dedicate software. The software allows the coordination of multiple images each other and to determine the location and orientation of the dental handpiece (drill) and the patient [3]. Usually, the display is a common monitor. The problem of the use of the monitor is that the operator needs to take his eyes off from the operation field to see the monitor, this problem can be solved by the use of smart glasses (SM). These glasses are wearable computing device, which comes with a head-mounted display. Using SM, surgeon intraoperatively can observe virtual images superimposed on operatory camp [4]. Thus, the patient becomes virtually transparent and the surgeon can visualize both structure and margins of a lesion that often are not directly visible to the naked eye. Today, the idea to use both virtual and augmented reality in oral surgery is not science fiction but has become reality. It is our opinion that the development of virtual and augmented reality, will allow perform complex oral surgical procedures with more accuracy, speed, and safety.

参考文献

1. Alur A, Shrivastav P, Jumde A(2014)触觉技术的应用综述和未来展望。IJCSIT5: 6039 - 6043
2. Samadbeik M, Yaaghobi D, Bastani P, Abhari S, Rezaee R，等(2018)虚拟现实技术在医疗小组教学中的应用。医学教育杂志6:123 - 129
3. Wang J, Suenaga H, Hoshi K, Yang L, Kobayashi E, et al.(2014)牙科手术中使用3d图像覆盖的自动无标记图像配准增强现实导航。IEEE生物医学工程汇刊61: 1295 - 1304
4. Badiali G, Ferrari V, Cutolo F, Freschi C, Caramella D，等(2014)增强现实技术在颌面手术中的辅助作用:可穿戴系统允许上颌重新定位的验证。J Craniomaxillofac杂志42:1970 - 1976。