Comparison of implant placement accuracy in two different preoperative digital workflows: navigated vs. pilot-drill-guided surgery

Abstract

Background The aim of the study is to evaluate the accuracy of a new implant navigation system on two different digital workflows. Methods A total of 18 phantom jaws consisting of hard and non-warping plastic and resembling edentulous jaws were used to stimulate a clinical circumstance. A conventional pilot-drill guide was conducted by a technician, and a master model was set by using this laboratory-produced guide. After cone beam computed tomography (CBCT) and 3D scanning of the master models, two different digital workflows (marker tray in CBCT and 3D-printed tray) were performed based on the Digital Imaging Communication in Medicine files and standard tessellation language files. Eight Straumann implants (4.1 mm × 10 mm) were placed in each model, six models for each group, resulting in 144 implant placements in total. Postoperative CBCT were taken, and deviations at the entry point and apex as well as angular deviations were measured compared to the master model. Results The mean total deviations at the implant entry point for MTC (marker tray in CBCT), 3dPT (3d-printed tray), and PDG (pilot-drill guide) were 1.024 ± 0.446 mm, 1.027 ± 0.455 mm, and 1.009 ± 0.415 mm, respectively, and the mean total deviations at the implant apex were 1.026 ± 0.383 mm, 1.116 ± 0.530 mm, and 1.068 ± 0.384 mm. The angular deviation for the MTC group was 2.22 ± 1.54°. The 3dPT group revealed an angular deviation of 1.95 ± 1.35°, whereas the PDG group showed a mean angular deviation of 2.67 ± 1.58°. Although there were no significant differences among the three groups (P > 0.05), the navigation groups showed lesser angular deviations compared to the pilot-drill-guide (PDG) group. Implants in the 3D-printed tray navigation group showed higher deviations at both entry point and apex. Conclusions The accuracy of the evaluated navigation system was similar with the accuracy of a pilot-drill guide. Accuracy of both preoperative workflows (marker tray in CBCT or 3D-printed tray) was reliable for clinical use.

Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches

“…Although the dynamic navigation system offers comparable accuracy to a static guided approach, its application is limited in a clinical practice due to high costs, steep learning curve, early developmental stage and risk of inaccurate implant placement due to system error associated with either registration or calibration steps especially in completely edentulous cases [ 26 ]. Furthermore, the majority of evidence assessing the accuracy of navigation systems is based on in vitro studies and clinical studies are still scarce.…”

Accuracy of intraoral real-time navigation versus static, CAD/CAM-manufactured pilot drilling guides in dental implant surgery: an in vitro study

“…Other authors used similar models or additional gingival masks in order to simulate a situation, that is as close to reality as possible but at the same time remaining reproducible [ 18 , 28 ]. For the DENACAM ® system, so far only very few studies regarding its accuracy existed [ 40 , 41 ]. They suggested similar accuracies to static guided pilot drilling, yet did not discriminate between free end position and interdental gaps.…”

Learning Curve and Comparison of Dynamic Implant Placement Accuracy Using a Navigation System in Young Professionals

“…The surgeon detects deviations in the entry point, apex, and angle on a screen during surgery. Thus, the current drill position and the planned implant placement can be coordinated [ 11 ].…”

“…Nevertheless, the new technique would need to be learned by experienced surgeons, which may be a reason to reject the application in daily clinical practice. However, for young professionals, dental implant surgery could become easier with the help of navigation systems [ 11 ]. Further development and adaptation of navigated implantation using virtual and augmented reality technologies should gain more impact in dental surgery [ 12 ].…”