Accuracy of dynamic navigation in implant surgery: A systematic review and meta‐analysis

Abstract

Objective To assess the accuracy of dynamic computer‐assisted implant surgery. Materials and methods An electronic search up to March 2020 was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trial to identify studies using dynamic navigation in implant surgery, and additional manual search was performed as well. Clinical trials and model studies were selected. The primary outcome was accuracy. A single‐arm meta‐analysis of continuous data was conducted. Meta‐regression was utilized for comparison on study design, guidance method, jaw, and systems. Results Ten studies, four randomized controlled trials (RCT) and six prospective studies, met the inclusion criteria. A total of 1,298 drillings and implants were evaluated. The meta‐analysis of the accuracy (five clinical trials and five model studies) revealed average global platform deviation, global apex deviation, and angular deviation were 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). Meta‐regression shown no difference between model studies and clinical trials (p = .295, 0.336, 0.185), drilling holes and implant (p = .36, 0.279, 0.695), maxilla and mandible (p = .875, 0.632, 0.281), and five different systems (p = .762, 0.342, 0.336). Conclusion Accuracy of dynamic computer‐aided implant surgery reaches a clinically acceptable range and has potential in clinical usage, but more patient‐centered outcomes and socio‐economic benefits should be reported.

Accuracy and primary stability of tapered or straight implants placed into fresh extraction socket using dynamic navigation: a randomized controlled clinical trial

“…Compared to dynamic navigation accuracy in literatures [5,15] (1.05 mm, 1.29 mm and 3.06°/1.01 mm, 1.83 mm and 5.59°), our data were also comparable. Besides, our result showed slightly higher accuracy than a recent meta-analysis [4] (1.02 mm, 1.33 mm, and 3.59°), which may due to various dynamic navigation systems and different degrees of surgeon proficiency. Also, an interesting finding was that the platform deviation was greater than apex deviation, which may be due to the resistance of the palatal bone wall at the implant shoulder during immediate implant placement.…”

“…It has various advantages, such as reducing surgery risk and facilitating operation [3]. A recent meta-analysis [4] concludes platform, apex, and angular deviation of dynamic navigation are 1.02 mm, 1.33 mm, and 3.59°, which is clinically acceptable compared to static navigation [5]. However, evidences of dynamic navigation assisted immediate implant placement are still scarce.…”

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.…”

“…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.…”

“…The results of in vitro investigations could be transferred to the clinically achievable accuracy of the system presented here. In a systematic review by Wei et al, no significant differences between in vitro and clinical studies were observed [ 44 ]. In the clinical implementation of dynamic navigation on the patient, possible influencing factors, such as the opening of the mouth, movements of the patient, or the restricted view of the operating field, did not seem to cause any deterioration in the results.…”