Clinical Evaluation of Dynamic Navigation System in Dental Implant Placement

Objectives: Application of cone-beam computed tomography (CBCT) imaging to treatment planning and subsequent fabrication of surgical guides for implant therapy has been already considered as an essential treatment strategy. In recent years, another guide system, dynamic navigation system, has been developed. It provides guidance and visual feedback to accomplish the accurate implant placement as planned. Dynamic navigation could be an effective method to transfer the planned implant’s position to the real patient. To evaluate the in vivo accuracy of the dynamic navigation system, we performed the following operations.
Methods: The patient was 63 years old healthy male who was referred to our clinic to replace the missing maxillary right first premolar with a dental implant. After CBCT scan was completed for the entire maxillary arch, the image of CBCT scan was transferred into the navigation software (Navident, ClaroNav). Implant placement was simulated on the software. The surgery was performed under the guidance of dynamic navigation system. To evaluate the accuracy of outcomes, the preoperative CBCT plan was volumetrically registered to a post-implant placement CBCT scan. Deviations between the planned and placed implant positions were analyzed with an accuracy evaluation software (EvaluNav, ClaroNav).
Results: Data was obtained on this implant using a minimal flap approach. In this implant placement, the discrepancies were: 0.85 mm for entry point (2D lateral) and 1.24 mm at the apex (2D vertical) and 1.87 mm at the apex (3D). The angle discrepancy was 2.69 degrees from actual vs planned implant positions.
Conclusions: Computer guided navigation system has become a helpful and useful equipment to prevent iatrogenic injuries because jaw bones have the anatomical complexity. Moreover, the real-time view of the exact position of the drill can minimize the potential risk in implant surgery.