Accuracy assessment of dynamic computer–aided implant placement: a systematic review and meta-analysis

Abstract

Objectives To assess the accuracy of dynamic computer-aided implant surgery (dCAIS) systems when used to place dental implants and to compare its accuracy with static computer-aided implant surgery (sCAIS) systems and freehand implant placement. Materials and Methods An electronic search was made to identify all relevant studies reporting on the accuracy of dCAIS systems for dental implant placement. The following PICO question was developed: "In patients or artificial models, is dental implant placement accuracy higher when dCAIS systems are used in comparison with sCAIS systems or with freehand placement? The main outcome variable was angular deviation between the central axes of the planned and final position of the implant. The data were extracted in descriptive tables, and a meta-analysis of single means was performed in order to estimate the deviations for each variable using a random-effects model. Results Out of 904 potential articles, the 24 selected assessed 9 different dynamic navigation systems. The mean angular and entry 3D global deviations for clinical studies were 3.68°(95% CI: 3.61 to 3.74; I 2 = 99.4%) and 1.03 mm (95% CI: 1.01 to 1.04; I 2 = 82.4%), respectively. Lower deviation values were reported in in vitro studies (mean angular deviation of 2.01°(95% CI: 1.95 to 2.07; I 2 = 99.1%) and mean entry 3D global deviation of 0.46 mm (95% CI: 0.44 to 0.48 ; I 2 = 98.5%). No significant differences were found between the different dCAIS systems. These systems were significantly more accurate than sCAIS systems (mean difference (MD): −0.86°; 95% CI: −1.35 to −0.36) and freehand implant placement (MD: −4.33°; 95% CI: −5.40 to −3.25). Conclusion dCAIS systems allow highly accurate implant placement with a mean angular of less than 4°. However, a 2-mm safety margin should be applied, since deviations of more than 1 mm were observed. dCAIS systems increase the implant placement accuracy when compared with freehand implant placement and also seem to slightly decrease the angular deviation in comparison with sCAIS systems. Clinical Relevance The use of dCAIS could reduce the rate of complications since it allows a highly accurate implant placement.

Accuracy of Computer-Assisted Dynamic Navigation in Implant Placement with a Fully Digital Approach: A Prospective Clinical Trial

“…Previously published data on the accuracy of dynamic navigation were analyzed in three systematic reviews. On average, the coronal 3D deviation at the implant shoulder was between 1.00 mm (95% CI 0.83, 1.16 mm) and 1.11 mm (95% CI 0.96, 1.26 mm) [ 31 , 43 , 44 ]. The implant exit point is particularly important for prosthetically predictable results.…”

“…On average, the 3D offset at the implant tip was 1.95 mm (95% CI, 1.39–2.50 mm). A safety distance of at least 2 mm, as specified for static navigation, must be observed [ 21 , 43 ].…”

“…These values showed a similar precision compared to the majority of studies published to date [ 31 ]. The angular deviations reported in these studies were between 3.68° (95% CI, 3.61°–3.74°) [ 43 ] and 4.22° (95% CI, 2.74°–5.68°) [ 44 ]. Without the use of individual abutments, inclined implant axes could impair the correct design of proximal contacts.…”

Computer-Assisted Dental Implant Placement Following Free Flap Reconstruction: Virtual Planning, CAD/CAM Templates, Dynamic Navigation and Augmented Reality

“…When comparing sCAIS with dCAIS, Kaewsiri et al ( 21), Mischkowski et al (22), and Block et al (36) concluded that dynamic navigation provided higher accuracy than any static guide system but without statistical significance. On the other hand, Jorba-Garcıá et al (43) considered that not all commercial dynamic systems are suitable for treating difficult fully edentulous cases, suggesting the use of static systems as the first-line option in guided implant surgery.…”

Accuracy of a Computer-Aided Dynamic Navigation System in the Placement of Zygomatic Dental Implants: An In Vitro Study

“…Otherwise, Jorba-García et al showed a mean angular deviation of 2.1° and a mean horizontal deviation of 0.46 mm at the coronal entry point for computer-aided surgery using dynamic navigation systems [ 28 ]. Xiaojun et al showed a mean horizontal deviation of 1.36 ± 0.59 mm at the coronal entry point of conventional-length dental implants [ 18 ]; Chen et al, 1.12 ± 0.29 mm [ 14 ]; Hung et al, 1.07 ± 0.15 mm [ 20 ]; Hung et al, 1.35 ± 0.75 mm [ 17 ]; Block et al, 0.4 mm [ 29 ]; Kaewsiri et al, 1.05 ± 0.44 mm [ 30 ]; and Zhou et al, 1.56 ± 0.54 mm [ 8 ].…”