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

Abstract

Background: This prospective clinical study aimed to investigate a possible deviation between the digitally planned implant position and the position achieved using dynamic navigation. The aim of the study was to establish clinical effectiveness and precision of implantation using dynamic navigation. Methods: Twenty consecutive patients received an implant (iSy-Implantat, Camlog, Wimsheim, Germany). One screw implant was placed in one jaw with remaining dentition of at least six teeth. The workflow was fully digital. Digital implant planning was conducted using cone-beam computed tomography (CBCT) and an intraoral scan of the actual condition. Twenty implants were subsequently placed using a dynamic computer-assisted procedure. The clinical situation of the implant position was recorded using an intraoral scan. Using these data, models were produced via 3D printing, and CBCTs of these models were made using laboratory analogs. Deviations of the achieved implant position from the planned position were determined using evaluation software. Results: The evaluation of 20 implants resulted in a mean angle deviation of 2.7° (95% CI 2.2–3.3°). The 3D deviation at the implant shoulder was 1.83 mm (95% CI 1.34–2.33 mm). No significant differences were found for any of the parameters between the implantation in the upper or lower jaw and an open or flapless procedure (p-value < 0.05). Conclusion: The clinical trial showed that sufficiently precise implantation was possible with the dynamic navigation system used here. Dynamic navigation can improve the quality of implant positioning. In particular, the procedure allows safe positioning of the implants in minimally invasive procedures, which usually cannot be performed freehand in this form. A clinical benefit and effectiveness can be determined from the results.

Dynamic navigation system-guided trans-inferior alveolar nerve implant placement in the atrophic posterior mandible: A case report

“…In the present case, the deviations at the implant shoulder of teeth 36 and 37 were 0.831 mm and 0.682 mm, respectively; 0.574 mm and 0.867 mm at the implant apical level, respectively; and angular deviations of 3.118° and 2.317°, respectively. The results were consistent with preliminary studies on the accuracy of dynamic navigation surgeries[ 8 , 15 , 17 ].…”

“…Computer-assisted dynamic navigation systems (CADNSs) based on cone-beam computed topography (CBCT) navigation have been introduced into the field of dental implantology to improve the accuracy of implant placement and avoid potential complications[ 8 , 9 ]. A CADNS is a surgical navigation system which can design the location of a virtual implant according to CBCT data.…”

Clinical and radiological outcomes of novel digital workflow and dynamic navigation for single‐implant immediate loading in aesthetic zone: 1‐year prospective case series

“…67 mm at entry point, 0.9 mm at apex and 2.50° of angular deviation) (Stefanelli et al, 2020 ). Edelmann and colleagues experienced mean deviations of 1.83 mm at entry point, 1.95 mm at apex, and 2.7° of angular deviation with another navigation system (Edelmann et al, 2021 ). A recently published systematic review and meta‐analysis on accuracy of surgery reported an average global platform deviation, global apex deviation, and angular deviation of 1.02 mm (95% CI 0.83–1.21), 1.33 mm (95% CI 0.98–1.67), and 3.59° (95% CI 2.09–5.09) and concluded it was clinically acceptable with potential in clinical usage (Wei et al, 2021 ).…”

Evaluation of a dynamic navigation system for endodontic microsurgery: study protocol for a randomised controlled trial

“…At the beginning, this technology was adopted from implant dentistry. 13 In the field of endodontics, this technology was demonstrated to be safe, fast and accurate in preparing the access cavity, 14 15 locating calcified canals, [16][17][18] intraosseous anaesthesia, 19 removal of fibre posts from root canals 7 and endodontic microsurgery. 20 21 It has several advantages: (1) reducing time and cost; (2) conducive to cooling and avoiding damage to tissue due to heat production; (3) performing operations with insufficient space; (4) increased safety, accurate and predictability and (5) real-time visualisation of the position and angulation of the drill.…”