Dynamic navigation: a prospective clinical trial to evaluate the accuracy of implant placement

Aim: The objective of this prospective pilot clinical study was to evaluate the accuracy of a new dynamic navigation system and postoperative clinical outcomes. Materials and methods: Ten patients were recruited and 18 implants were placed. The surgery was performed with the navigation system and according to the virtual planning. Ten implants were placed using a flapless technique and eight implant sites were prepared with a combined piezo-drill method. The deviation between the real implant position obtained from the postoperative cone beam computed tomography (CBCT) scan and the planned implant position was measured. Result: The average deviation was 1.19 \ub1 0.54 mm. The mean deviation measured at the insertion point was 1.04 \ub1 0.47 mm and at the apical point it was 1.35 \ub1 0.56 mm. The depth error was 0.43 \ub1 0.34 mm. The axis deviation was 6.46 \ub1 3.95 degrees. No significant differences were found between the flapless and the open-flap approaches and between the conventional and piezoelectric techniques. No complications occurred. Conclusion: The accuracy values reported in this study are comparable, although not superior, to the literature data regarding dynamic and static computer-guided surgery. Dynamic navigation could increase the quality and safety of interventions and may reduce morbidity when compared with freehand insertion techniques. Deviation at the entry point (mm) Deviation at the apex (mm) Depth deviation (mm) Angular deviation (degrees) Mean 1.04 1.35 0.43 6.46 SD 0.47 0.56 0.34 3.95 Maximum 2.21 2.28 1.41 6.46 Minimum 0.45 0.59 0.03 3.95 Deviation at the entry point (mm)Deviation at the apex (mm)Depth deviation (mm)Angular deviation (degrees)OF0.96 \ub1 0.331.45 \ub1 0.600.35 \ub1 0.227.93 \ub1 5.15FL1.10 \ub1 0.581.27 \ub1 0.570.49 \ub1 0.425.28 \ub1 2.60Data are shown as mean \ub1 SDOF = open-flap surgery; FL = flapless surgery Deviation at the entry point (mm)Deviation at the apex (mm)Depth deviation (mm)Angular deviation (degrees)P1.01 \ub1 0.251.37 \ub1 0.480.44 \ub1 0.267.63 \ub1 4.30C1.06 \ub1 0.621.34 \ub1 0.660.42 \ub1 0.415.52 \ub1 3.81Data are shown as mean \ub1 SDP = piezoelectric tips; C = conventional burs

Dynamic navigation in dental implantology: The influence of surgical experience on implant placement accuracy and operating time. An in vitro study

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\u2019s 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 components of the deviation at the apical point and the angular errors of some operators differed from each other. Conclusions: within the limitations of this study, dynamic navigation can be considered a reliable technique both for experienced and novice clinicians