The Workflow of a New Dynamic Navigation System for the Insertion of Dental Implants in the Rehabilitation of Edentulous Jaws: Report of Two Cases

Abstract

Background: This case series describes the surgical workflow during maxillary full-arch rehabilitations in two patients through the All-on-4 concept (standard and hybrid) assisted by DTX Studio Implant Software planning and X-Guide Navigation. Results: The X-Guide Navigation enabled the drills and implants to be positioned and oriented precisely, allowing the implants to be positioned favorably under the surgical and prosthetic points of view through the avoidance of damage to the maxillary sinus and nasal cavity. Dynamic navigation-assisted surgery provided advantages, including the possibility to modify the implants’ system, length, or location perioperatively. However, it must be underlined that to achieve proficiency with this technology it is necessary to consider a necessary learning curve. Conclusion: The insertion of dental implants assisted by dynamic navigation for maxillary full-arch rehabilitations was considered a safe and predictable procedure. Nevertheless, it can be improved (such as with a simpler fiducial markers protocol), aiming to simplify the procedure.

Dynamic Navigation for Zygomatic Implants: A Case Report about a Protocol with Intraoral Anchored Reference Tool and an Up-To-Date Review of the Available Protocols

“…Lopes et al described a case of one ZI placement where the presence of three fixtures inserted in a previous rehabilitation allowed the operator to anchor a markers plate directly to the maxilla. The authors concluded that a simpler fiducial markers protocol could make the surgery faster and less complicated, considering that the screws insertion is time consuming and could condition the implant positioning [ 20 ].…”

“…The second point conditions the tracking of the handle instruments in relation to the patient position detected by a camera. The evolution from an invasive cranial anchorage used in major surgeries [ 18 ] to more manageable intra-orally connected patient reference tool [ 10 , 19 , 20 ] made the DN supported implantology less invasive and more ergonomic.…”

“…Since Schramm et al [ 21 ] first successfully inserted a ZI supported by DN technology, in vitro experiments and case reports have testified the usefulness of this procedure in terms of predictability, shortening treatment times, and morbidity reduction as compared to a free-hand approach [ 20 , 22 , 23 , 24 ]. Most of the studies about DN supported ZIs placement employed bulky system with cranial anchorage patient reference tools [ 8 , 20 , 22 , 24 ]. Lopes et al [ 20 ] reported a case treated with an intra-oral reference tool anchorage, while Pellegrino et al adopted a DN technology with intra-oral anchorage and no invasive fiducial markers in partially resected maxillae [ 25 ] and with an ultrasonic implant path way preparation [ 10 ].…”

“…Most of the studies about DN supported ZIs placement employed bulky system with cranial anchorage patient reference tools [ 8 , 20 , 22 , 24 ]. Lopes et al [ 20 ] reported a case treated with an intra-oral reference tool anchorage, while Pellegrino et al adopted a DN technology with intra-oral anchorage and no invasive fiducial markers in partially resected maxillae [ 25 ] and with an ultrasonic implant path way preparation [ 10 ]. The use of ultrasonic instruments further reduces the invasiveness in implantology [ 26 ].…”

Accuracy And Efficiency Of Digital Implant Planning And Guided Implant Surgery

“…There is no need for a special drill kit, reference markers can be fixed to every drill set. This technology allows guidance even when the mouth opening is limited (Stefanelli et al, 2019;Guzmán et al, 2019;Lopes et al, 2020).…”