What is the “Open Source Guided Surgery”

After more than two decades of research and clinical experience, it has been proven that computer-guided surgery and guided implant surgery provides significantly higher accuracy than conventional methods.

What is happening presently?

Today, there are a number of commercial applications and services on the market that provide doctors with the ability to implement digital surgical placement and prosthetic rehabilitation procedures. However, this digital transformation trend, albeit impressive in recent years, has not been accompanied by cost reduction and so costs have remained high, thus preventing many potential users from exploiting these technologies.

Therefore many surgeons do not use computer designed methods for the benefit of their patients in their practice and so clinical feedback remains limited though it is vital in understanding and evolving the relevant technology.

But it is not just the cost. This reality is underlined by the fact that the spread of alternative applications based on free and open source software (FOSS) is limited and it can be confirmed by the relatively scant literature that is available. There are, however, research efforts and some have indeed led to clinical applications.

The potential of FOSS

In free and open source software applications more or fewer tools may be available than those in proprietary closed – source or commercial software. Also for the same or similar tool there may be more or fewer options.

The bottom line is that today, computing tools are public and can be used in either free or commercial applications producing the same result for the end-user. Toolbox of commercial software is more standardized in comparison to free open source software where tools can be modified, adapted or even “collaborate” depending on their respective clinical uses.

Biomedical engineers, software engineers and physicians are the key scientific teams that work together to support and promote digital transformation. Technical and medical disciplines, despite having clearly defined boundaries, are increasingly narrowing the gap that separates them today due to technological developments. 

It is very likely in the near future, that cognitive subjects such as 3D / 4D technology and artificial intelligence (AI) will act as catalysts and lead to combined educational courses in technology institutes and medical schools.

Options for the immediate future

In recent years, the global community of computing physicians either in research or as end-users, is growing at a much faster rate than in the 2000’s. Today, a physician interested in participating has more options, which could be summarized in two categories.

The first category is that as an end user of commercial computer products, software packages or services that are usually accompanied by training in the relevant programs. This is a good choice for those who consider computers simply as an additional tool and in addition can afford the cost of keeping pace with developments in science and the market.

The second category concerns those who regard computing not just as a renewal of their clinical quiver but as a different perspective of clinical work, from the treatment plan to clinical practice, which will soon dominate their professional daily life. In this case, at least for the time being, they should be familiar with the system of free and open source software through personal, systematic and creative engagement.

This is due to the fact that a physician taking advantage of free access to such powerful platforms, which are constantly updated with new tools created and shared by researchers from around the world, can choose, design, implement or even contribute to the improvement of surgical and rehabilitation procedures. After all it is a matter of medical/dental practitioner’s responsibility toward the patient.

As it has been mentioned, there is already relevant research and applications, which mainly concern collaborations between different software platforms, most of which are not open source. However, what is required today is the development of FOSS with an environment where it will be possible to implement all stages of computational design. For example in the field of static computer- assisted implant surgery (sCAIS) it would be optimal to have access to all the relevant tools, from the import of medical images to the design of the surgical guide and the evaluation of the accuracy of placement, in a single FOSS environment. 

This goal can be achieved, as an example, by the proposed digital sequence “PIGA” (Preparation, Implant, Guide, Accuracy) – presented in a series of videos on this site – which is developed in a single FOSS platform providing the necessary tools or allowing their input for a specialized clinical project, but also for the control of accuracy.


Therefore, in this transitional phase of “computing maturity”, which has already begun and will be characterized by the gradual narrowing of the gap between technical and medical disciplines, the next step is to become acquainted with such free and open source platforms and assist in their development and dissemination.

The creation of the “Open Source Guided Surgery” website is a small contribution in this direction.

Dimitris Trikeriotis DMD, OMFS