Accuracy of dynamic implant navigation surgery performed by a novice operator.

AIM: The main objective was to evaluate the accuracy of dynamic navigation-guided surgery (DNGS) for implant positioning performed by a novice operator. The secondary objectives were to analyze the operator's learning curve and identify possible complications deriving from the technique. MATERIALS AND METHODS: Twenty-five implants were placed in eight partially edentulous human heads. Preoperative CBCT scans were imported to planning software to determine the implant positions. Implants were placed using a dynamic navigation system. Postoperative CBCTs were superimposed onto the implant planning images. Discrepancies between the virtually planned implant positions and the postoperative positions were evaluated by measuring horizontal platform deviation, apex deviation, apicocoronal (vertical) deviation, and angular deviation. RESULTS: Mean platform, apex, vertical, and angle deviations were 1.55 ± 0.81 mm, 2.45 ± 0.84 mm, 1.59 ± 0.70 mm, and 5.56 ± 4.03 degrees, respectively. No significant differences were found between the maxilla and mandible or between anterior and posterior sites. A flat learning curve was observed, with the exception of the implant platform, where a tendency toward improvement in accuracy was observed between the 8th and the 17th implant placed. No complications were reported. CONCLUSIONS: Based on the results of a study performed by a novice operator on a cadaveric model, DNGS allows accurate implant placement within a 2-mm safety margin in terms of implant platform and vertical positions, and a 3-mm margin in apical vicinities. The technique requires practice to learn the required eye-hand coordination. (Int J Comput Dent 2022;25(4):377-0; doi: 10.3290/j.ijcd.b2588207).

Dynamic Implant Surgery-An Accurate Alternative to Stereolithographic Guides-Systematic Review and Meta-Analysis.

(1) Background: Dynamic guided surgery is a computer-guided freehand technology that allows highly accurate procedures to be carried out in real time through motion-tracking instruments. The aim of this research was to compare the accuracy between dynamic guided surgery (DGS) and alternative implant guidance methods, namely, static guided surgery (SGS) and freehand (FH). (2) Methods: Searches were conducted in the Cochrane and Medline databases to identify randomized controlled clinical trials (RCTs) and prospective and retrospective case series and to answer the following focused question: "What implant guidance tool is more accurate and secure with regard to implant placement surgery?" The implant deviation coefficient was calculated for four different parameters: coronal and apical horizontal, angular, and vertical deviations. Statistical significance was set at a p-value of 0.05 following application of the eligibility criteria. (3) Results: Twenty-five publications were included in this systematic review. The results show a non-significant weighted mean difference (WMD) between the DGS and the SGS in all of the assessed parameters: coronal (n = 4 WMD = 0.02 mm; p = 0.903), angular (n = 4 WMD = -0.62°; p = 0.085), and apical (n = 3 WMD = 0.08 mm; p = 0.401). In terms of vertical deviation, not enough data were available for a meta-analysis. However, no significant differences were found among the techniques (p = 0.820). The WMD between DGS and FH demonstrated significant differences favoring DGS in three parameters as follows: coronal (n = 3 WMD = -0.66 mm; p =< 0.001), angular (n = 3 WMD = -3.52°; p < 0.001), and apical (n = 2 WMD = -0.73 mm; p =< 0.001). No WMD was observed regarding the vertical deviation analysis, but significant differences were seen among the different techniques (p = 0.038). (4) Conclusions: DGS is a valid alternative treatment achieving similar accuracy to SGS. DGS is also more accurate, secure, and precise than the FH method when transferring the presurgical virtual implant plan to the patient.

Fully Guided Versus Half-Guided and Freehand Implant Placement: Systematic Review and Meta-analysis.

PURPOSE: To compare the accuracy of different modalities of implant placement-static fully guided, static half-guided, and freehand surgery-through meta-analysis. MATERIALS AND METHODS: A thorough electronic and manual systematic search was conducted to identify applicable randomized clinical trials (RCTs) for evaluating the implant positioning accuracy between different static implant navigation surgeries. The coronal and apical horizontal deviation, vertical deviation, apical angle, and chair time were estimated as the weighted mean differences and standard deviation with confidence intervals. A P value of .05 was set for statistical significance. RESULTS: Based on the 10 RCTs that met the inclusion criteria for the quantitative analyses, results from the meta-analyses demonstrated the following: (1) a coronal deviation significant difference favoring the fully guided approach compared with the half-guided (weighted mean difference of -0.51 mm) and freehand approaches (weighted mean difference of -1.18 mm); (2) a significant weighted mean difference between the fully guided and half-guided approaches in relation to the apical deviation (weighted mean difference of -0.75 mm); (3) the vertical comparison did not yield significant weighted mean differences between the fully guided and half-guided techniques (-0.23 mm) and lacked statistically significant difference between the fully guided and freehand techniques (weighted mean difference of -0.17 mm); (4) the apical angle deviation demonstrated a significant weighted mean difference in favor of the fully guided approach compared with the half-guided group (weighted mean difference of -3.63 degrees); and (5) the comparison of chair time between the investigated groups did not exhibit a significant difference in any of the techniques. CONCLUSION: Static fully guided implant navigation surgery has the highest accuracy for transmitting the presurgical positioning planning to the patient, followed by static half-guided surgery, while the freehand implant placement provides the least accuracy.