Dynamic navigation: a prospective clinical trial to evaluate the accuracy of implant placement (original) (raw)
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International Journal of Environmental Research and Public Health
Aim: the aim of this in vitro study was to test whether the implant placement accuracy and the operating time can be influenced by the operator’s experience. Materials and methods: sixteen models underwent a (Cone Beam Computer Tomography) CBCT and implant positioning was digitally planned on this. The models were randomly assigned to four operators with different levels of surgical experience. One hundred and twelve implant sites were drilled using a dynamic navigation system and operating times were measured. Based on postoperative CBCTs, dental implants were virtually inserted and superimposed over the planned ones. Two-dimensional and 3D deviations between planned and virtually inserted implants were measured at the entry point and at the apical point. Angular and vertical errors were also calculated. Results: considering coronal and apical 3D deviations, no statistically significant differences were found between the four operators (p = 0.27; p = 0.06). Some vectorial component...
Dynamic Navigation in Implant Dentistry: A Systematic Review and Meta-analysis
The International Journal of Oral & Maxillofacial Implants, 2021
Dynamic navigation is a technique that allows for the placement of dental implants using a computer-guided approach according to preoperative planning. Its accuracy has been assessed in several previous studies. The purpose of this study was to summarize data on implant placement accuracy using dynamic navigation, to synthesize the frequency of intraoperative complications and implant failures, and to compare this technique with static computer-guided surgery and a freehand approach. Materials and Methods: Electronic and manual literature searches until December 2019 were performed. The outcome variables were implant placement accuracy using dynamic navigation, accuracy differences between dynamic and static techniques and between dynamic and freehand techniques, intraoperative complications, and implant failures. Random-effects meta-analyses were performed. Results: A total of 32 studies were included; 29 reported accuracy values (2,756 implants), and 10 focused on complications and implant failures (1,039 implants). The pooled mean implant placement errors were 0.81 (95% CI: 0.677 to 0.943) mm at the entry point and 0.910 (95% CI: 0.770 to 1.049) mm at the apical point. The pooled mean vertical and angular deviations were 0.899 (95% CI: 0.721 to 1.078) mm and 3.807 (95% CI: 3.083 to 4.530) degrees. The navigation group showed significantly lower implant placement errors with respect to the freehand technique (P < .01) and similar accuracy values (P ≥ .05) compared with the static technique. The pooled prevalence of failures was 1% (95% CI: 0.00% to 2%). Conclusion: Dynamic navigation provided small implant placement errors, comparable with those obtained using static computer-guided surgery, and can be considered a more accurate technique than conventional freehand surgery.
Accuracy of Implant Placement with a Navigation System, a Laboratory Guide, and Freehand Drilling
2018
Purpose: Computer-aided surgery under navigation system guidance is widely applied in dental implant procedures. However, the accuracy of drilling with such navigation systems has not been comparatively evaluated alongside those of laboratory guide-based and freehand drilling. Therefore, this study aimed to compare the accuracies of these three drilling systems. Materials and Methods: A navigation system, a laboratory guide, and freehand drilling were used to drill 150 holes on 30 cast models. Two master models-one each for the maxilla and mandible-were prepared with the idea of placing five implants per cast. After drilling five holes on each cast, postoperative cone beam computed tomography images were acquired to measure the magnitude of errors. Results: The navigation system and laboratory guide were more accurate than freehand placement with respect to total errors at the entry and apex, lateral error at the apex, and angular error. The navigation system was more accurate than the laboratory guide with respect to angular error. Laboratory guide-based drilling was more accurate than freehand drilling in terms of lateral error at entry. Conclusion: In comparison with the laboratory guide and freehand placement, the navigation system exhibited lower angular and axial errors. Despite its higher accuracy, the navigation system requires the operator to pay greater attention.
Implant Placement Is More Accurate Using Dynamic Navigation
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2017
The purpose of this prospective study was to measure and compare the accuracy and precision of dynamic navigation with freehand (FH) implant fixture placement. The authors hypothesized that the evaluated dynamic navigation system would have high accuracy and precision and would be superior to FH methods. The authors designed and implemented a prospective cohort study and enrolled patients who had implants placed from December 2014 through December 2016. The predictor variable was implant placement technique comparing fully guided (FG) and partially guided (PG) dynamic navigation with FH placement. The outcome variables were accuracy measured as deviation from the virtual plan, and precision was represented as the standard deviation of the measurements. Analysis of variance (ANOVA) was used to compare measurements. Virtual implant placement was compared with post-implant placement using mesh analysis. Deviations from the virtual plan were recorded for each implant for each surgeon. F...
2021
The use of virtual reality simulation (VRS) developed a new era in dentistry, where a pre-operative virtual planning in conjunction with a surgical guide could help the surgeon with a prosthetically-driven correct implant placement, especially in difficult clinical cases. Materials & methods: regarding this study, 14 patients were recruited with bounded partially edentulous spans in the maxilla. The patients were randomly assorted into 2 groups. The first group (control) is the static guide group (SG), while the second group (test group) is the dynamic navigation group (DN). After implant installation, a postoperative CBCT was obtained & the obtained image was superimposed over the original implant plan to determine the linear and angular deviation between the proposed plan and actual implant position. Results: Regarding the linear deviation between the planned and actual positions in both groups was measured at both the coronal apical areas. The independent sample t test showed a s...
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2015
In this study, we have developed an advanced navigational implant surgery system to overcome some disadvantages of the conventional method and have evaluated the accuracy of the system under in vitro environment. The patient splint for registration and tracking was improvised using a bite splint without laboratory work and the offset of an exchanged drill was calibrated directly without pivoting during surgery. The mean target registration errors (TRE) were 0.35 ± 0.11 mm using the registration body, 0.34 ± 0.18 mm for the registration method with prerecorded fiducials, and 0.35 ± 0.16 mm for the direct calibration of a drill offset. The mean positional deviations between the planned and placed implants in 110 implant surgeries were 0.41 ± 0.12 mm at the center point of the platform and 0.56 ± 0.14 mm at the center point of the apex. The mean angular deviation was 2.64°± 1.31 for the long axis of the implant. In conclusion, the developed system exhibited high accuracy, and the impro...
Clinical Oral Implants Research, 2019
Introduction ……………………………………………………………………………. Is there a need for computer-guided implant surgery ……………………….…... Osseointegrated dental implants…………………………………………………. Analog implant installation procedure…………………………………………… Digital advancements in the implant planning and installation procedure………. Integration of an intraoral surface scan …………………………………………. Fusion of data from CBCT and intraoral scanning ……………………………… Different types of guided implant surgery ………………………………………. Dynamic guided implant surgery…………………………………………………. Template guided implant surgery-static ………………………………………... Bone supported guides …………………………………………………………… Mucosal supported guides ………………………………………………………. Tooth supported guides …………………………………………………………. Planning procedures-guided implant surgery …………………………………. Surgical guide production………………………………………………………… Manual production ………………………………………………………. Digital additive manufacturing …………………………………………. Clinical application of surgical templates ………………………………………. Learning curve …………………………………………………………………… Implant survival …………………………………………………………………. Mispositioning of the surgical guide ……………………………………………. Assessment of deviations between planned and achieved implant positions …… Clinical outcome of guided implant surgery……………………………………...
The Art of Using Computer-Assisted Navigation Systems in Guided Implant Surgery: A Review
2021
Background and Aim: Computer-aided design/computer-aided manufacturing (CAD/ CAM) has been widely used in implant dentistry. Recent computer-guided dynamic navigation systems promise an accurate approach to minimally invasive implant placement. Robot-assisted surgery has been used in dentistry since 2017. The present study aims to review the properties, clinical outcomes, advantages, and limitations of navigation, robotics, and CAD/CAM in implant placement surgery. Materials and Methods: An electronic search of the literature was conducted mainly through PubMed, ScienceDirect, Cochrane Library, and Google Scholar databases. Studies in the English language were considered for inclusion if they evaluated robotics, CAD/CAM, and navigation in implant placement. Finally, 21 articles were selected. Results: Guided implant surgery is assumed accurate, precise, and reliable; it also has a lower complication rate compared to freehanded implant surgery. Surgical guides could be indicated for patients with limited mouth opening, tight interdental spaces, a strong gag reflex, and distal implants. Several studies have reported that computerassisted surgery improves the accuracy of implant placement. Expensive equipment, high costs, and gaps between the guides and drill bite are the disadvantages of digital implant placement. Conclusion: Computer-aided implant navigation systems can improve implant placement outcomes. Digital procedures have shown accurate outcomes in implant surgery. Despite the advantages of guided surgery, deviation of implant position from the planned position still occurs. However, improvements in digital dentistry are slowly overcoming these challenges.
Scientific Reports, 2023
Lack of evidence exists related to the investigation of the accuracy and efficacy of novice versus experienced practitioners for dental implant placement. Hence, the following in vitro study was conducted to assess the accuracy of implant positioning and self-efficacy of novice compared to experienced surgeons for placing implant using freehand (FH), pilot drill-based partial guidance (PPG) and dynamic navigation (DN) approaches. The findings revealed that DN significantly improved the angular accuracy of implant placement compared with FH (P < 0.001) and PPG approaches (P < 0.001). The time required with DN was significantly longer than FH and PPG (P < 0.001), however, it was similar for both novice and experienced practitioners. The surgeon's self-confidence questionnaire suggested that novice practitioners scored higher with both guided approaches, whereas experienced practitioners achieved higher scoring with PPG and FH compared to DN. In conclusion, implant placement executed under the guidance of DN showed high accuracy irrespective of the practitioner's experience. The application of DN could be regarded as a beneficial tool for novices who offered high confidence of using the navigation system with the same level of accuracy and surgical time as that of experienced practitioners. Dental implant surgery is a widely accepted therapeutic option for partially and fully edentulous patients. An ideal three-dimensional (3D) implant positioning and angulation is a prerequisite to ensure its long-term stable esthetic and functional outcome and to facilitate a correct prosthetic phase 1. In contrast, non-ideal implant positioning may cause collateral damage to the vital anatomical structures within the vicinity of the placed implant and lead to certain intra-operative complications, such as maxillary sinus and/or cortical perforation, inferior alveolar nerve injury and damage to adjacent teeth 2. Furthermore, an imprecise positioning of the implant has also been known to cause peri-implant bone loss and peri-implantitis at follow-up 2. Hence, it is necessary that a surgeon should have a high level of experience and sufficient 3D spatial awareness to avoid complications associated with non-ideal placement of dental implants 3. The wide adoption of cone-beam computed tomography (CBCT) coupled with computer-aided design and computer-aided manufacturing (CAD/CAM) in a dental practice has improved the implant placement accuracy compared to freehand (FH) approach and allowed delivery of predictable prosthetically-driven treatment
Evaluation of the Accuracy of a New Geometric Approach to Implant Guidance
The International Journal of Oral & Maxillofacial Implants
S urgical guides utilized during implant placement have become routine in usage, making implant placement more predictable and allowing a prosthetic guided approach to be utilized. 1 The surgical guide acts as a template, providing guidance of the osteotomy drills at the correct ridge position, angulation, and depth, to avoid anatomical structures that could be damaged during freehand implant placement, thereby decreasing the risk of iatrogenic damage of anatomical structures. Further, it acts as an aid in the accuracy of treatment planning, permitting implant placement based on a prosthetic designed plan, assuring adequate implant spacing with esthetic placement to allow proper maintenance and hygiene. 2 This becomes more critical when treating the edentulous arch, as visible landmarks that could aid in guiding the osteotomy (ie, teeth) are not present, and orientation to underlying anatomical structures is lost. Evaluation of radiographs is used to guide the osteotomy, where typically a surgical guide was not used. This consisted of panoramic and periapical radiographs, with the surgeon using that information for freehand placement. 3 CBCT has permitted better implant placement guidance with the fabrication of surgical guides that is based on the anatomy present and fully guiding the implants based on a prosthetic oriented plan. 4-6 The risk of anatomical damage