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 ± 0.54 mm. The mean deviation measured at the insertion point was 1.04 ± 0.47 mm and at the apical point it was 1.35 ± 0.56 mm. The depth error was 0.43 ± 0.34 mm. The axis deviation was 6.46 ± 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 ± 0.331.45 ± 0.600.35 ± 0.227.93 ± 5.15FL1.10 ± 0.581.27 ± 0.570.49 ± 0.425.28 ± 2.60Data are shown as mean ± 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 ± 0.251.37 ± 0.480.44 ± 0.267.63 ± 4.30C1.06 ± 0.621.34 ± 0.660.42 ± 0.415.52 ± 3.81Data are shown as mean ± SDP = piezoelectric tips; C = conventional burs Keywords: computer-assisted surgery, image-guided surgery, implantology, navigation system, real-time tracking, implant placement accuracy