An oral and maxillofacial navigation system for implant placement with automatic identification of fiducial points

  • Chunxia Qin
  • Zhenggang Cao
  • Shengchi Fan
  • Yiqun Wu
  • Yi Sun
  • Constantinus Politis
  • Chunliang Wang
  • Xiaojun ChenEmail author
Original Article



Surgical navigation system (SNS) has been an important tool in surgery. However, the complicated and tedious manual selection of fiducial points on preoperative images for registration affects operational efficiency to large extent. In this study, an oral and maxillofacial navigation system named BeiDou-SNS with automatic identification of fiducial points was developed and demonstrated.


To solve the fiducial selection problem, a novel method of automatic localization for titanium screw markers in preoperative images is proposed on the basis of a sequence of two local mean-shift segmentation including removal of metal artifacts. The operation of the BeiDou-SNS consists of the following key steps: The selection of fiducial points, the calibration of surgical instruments, and the registration of patient space and image space. Eight cases of patients with titanium screws as fiducial markers were carried out to analyze the accuracy of the automatic fiducial point localization algorithm. Finally, a complete phantom experiment of zygomatic implant placement surgery was performed to evaluate the whole performance of BeiDou-SNS.

Results and conclusion

The coverage of Euclidean distances between fiducial marker positions selected automatically and those selected manually by an experienced dentist for all eight cases ranged from 0.373 to 0.847 mm. Four implants were inserted into the 3D-printed model under the guide of BeiDou-SNS. And the maximal deviations between the actual and planned implant were 1.328 mm and 2.326 mm, respectively, for the entry and end point while the angular deviation ranged from 1.094° to 2.395°. The results demonstrate that the oral surgical navigation system with automatic identification of fiducial points can meet the requirements of the clinical surgeries.


Surgical navigation Oral and maxillofacial surgery Automatic identification Target registration error Fiducial registration error 



This work was supported by grants from National Key R&D Program of China (2017YFB1302903; 2017YFB1104100), National Natural Science Foundation of China (81828003), the Foundation of Science and Technology Commission of Shanghai Municipality (16441908400;18511108200), Shanghai Jiao Tong University Foundation on Medical and Technological Joint Science Research (YG2016ZD01; YG2015MS26), and SJTU-KTH Collaborative Research and Development Seed Grants.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2018

Authors and Affiliations

  • Chunxia Qin
    • 1
    • 2
  • Zhenggang Cao
    • 2
  • Shengchi Fan
    • 3
  • Yiqun Wu
    • 3
  • Yi Sun
    • 4
    • 5
  • Constantinus Politis
    • 4
    • 5
  • Chunliang Wang
    • 6
  • Xiaojun Chen
    • 2
    Email author
  1. 1.School of Biomedical EngineeringShanghai Jiao Tong UniversityShanghaiChina
  2. 2.School of Mechanical EngineeringShanghai Jiao Tong UniversityShanghaiChina
  3. 3.Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
  4. 4.OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineKatholieke Universiteit LeuvenLouvainBelgium
  5. 5.Department of Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenLouvainBelgium
  6. 6.Department of Biomedical Engineering and Health SystemsKTH Royal Institute of TechnologyStockholmSweden

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