What are the indications for three-dimensional X-ray-diagnostics and image-based computerised navigation aids in dental implantology?

Purpose: The objective of this systematic review as a basis for an expert consensus was to answer the following question: What are the indications for three-dimensional (3D) X-ray-diagnostics and image-based computerised navigation aids in dental implantology? Materials and methods: Independent professionals performed a systematic literature search up to 30 June 2010, looking upon existing national and international guidelines, consensus papers of scientific societies and the literature database of the Cochrane Library and MEDLINE. As there were only a few randomised controlled trials (RCTs) and other systematic, clinical studies on this subject, the research was supplemented by results from basic research and animal studies and related topics. Additional literature was included on the basis of recommendations by experts involved in the consensus process. The paper was given consent at the DGI Consensus Conference in a structured consensus process guided by an independent moderator of the AWMF (Association of the Scientific Medical Societies in Germany). This led to the following clinical recommendations. Results and conclusions: Part 1: No randomised or controlled studies on humans confirmed the superiority of 3D imaging regarding the quality of the surgical result and or the incidences of complications in implantology. The clinician should be aware of the additional increased radiation exposure compared to 2D images, especially critical in young individuals. Possibilities of reducing the field of view and therefore the radiation exposure should be utilised. The ALARA principle (as low as reasonably achievable) should be followed. Indications for 3D imaging were formulated. Part 2: The application of navigation-supported implantology requires surgical experience in the field of non-navigation-based implantology. The surgeon should always be capable of switching to conventional surgery in a clinical case. Indications for computerised navigation aids were formulated. Keywords: computed tomography, cone beam computed tomography, dental implants, navigation, three-dimensional imaging