Title Dynamic Navigation for Implant Placement Surgery May be More Accurate than Freehand Placement and as Accurate as Static Guide Protocols
Clinical Question For patients receiving dental implants, is use of dynamic navigation more accurate than freehand or static guided placement?
Clinical Bottom Line Early studies suggest dynamic navigation (DN) is more accurate than freehand (FH) implant placement and as accurate as static guide (SG) protocols; however, more human trials and systematic reviews with meta-analysis of human randomized controlled trials (RCT) are needed to strengthen the evidence.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
31060099Kaewsiri 201960 adults needing single tooth implantRandomized Controlled Trial
Key resultsNo significant differences were found between SG and DN groups for mean deviations in platform deviation (PD), apex deviation (AD), and angular deviation (ANG) using two-sample t test. SG mean values for PD: 0.97±0.44mm, AD: 1.28±0.46mm, and ANG: 2.84°±1.71°. SG 95% CI for PD: 0.80mm, 1.13mm; AD: 1.11mm, 1.45mm; ANG: 2.21°, 3.48°. DN mean values for PD: 1.05±0.44 mm, AD: 1.29±0.50mm, and ANG: 3.06°±1.37°. DG 95% CI for PD: 0.89mm, 1.21mm; AD: 1.10mm, 1.48mm, and ANG: 2.54°, 3.57°. P-value for PD=0.47, AD=0.94, and ANG=0.60.
31063802Gargallo-Albiol 20194,063 implants in 19 studiesSystematic review of non-randomized trials
Key resultsThis systematic review comparing various methods of implant guidance found that fully-guided surgery using a flapless technique and a computer-planned and fabricated tooth-supported SG had the highest accuracy. The lowest accuracy was found in FH placement. DN was found to be more accurate than FH and comparable to SG.
Evidence Search "dynamic navigation and dental implants"
Comments on
The Evidence
Validity: Keawsiri (2019) is an RCT using human subjects to compare DN and SG. The patients were randomly assigned to two groups in blocks of six. No blinding was performed. The surgeon in this study had experience in DN, SG and extensive experience with FH. All patients received pre-and post-op cone beam computer tomography scans for planning and accuracy evaluation. All enrolled patients completed the study. Gargallo-Albiol (2019) is a systematic review describing various implant placement protocols. The literature search covered Medline, Embase, and additional sources. Nine human RCTs, three human control trials, two ex-vivo studies, and five in-vitro studies were included. Exclusion criteria included lack of a control group, retrospective studies, and case series. The small number of RCTs and inclusion of laboratory studies decreases the validity of this study. The results are subjective. Objective results from the individual studies were included but no meta-analysis was performed, likely due to heterogeneity of study designs. Perspective: Based on these studies, DN appears to be a suitable alternative to SG and preferable to FH placement for partially edentulous patients; however, usage in edentulous patients is not discussed. The studies also used different DN systems. The clinician will need to evaluate any prospective DN product to meet the standards in accuracy established by SG as well as safety, ease of use, patient comfort, up-front and recurring costs, and potential expanded protocols for edentulous arches.
Applicability SG has been shown to produce highly accurate implant placement. Current literature supports the assertion that accurate implant placement is possible with DN. DN is a promising method that offers benefits over SG such as same-day workflow, full visualization of the surgical field, flexibility in the plan, and smaller instrumentation. Limitations of this technology include high up-front cost, a learning curve, and no mechanical guidance. DG is appropriate for the same patient demographics that may be treated with SG. Current evidence is sparse for human trials but suggests DN is as accurate as SG and more accurate than FH. The clinician may consider DG over FH but should use SG when it is more appropriate.
Specialty (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Dental implants, dynamic navigation, computer-assisted surgery, fully guided surgery
ID# 3411
Date of submission 12/03/2019
E-mail Oviatt@livemail.uthscsa.edu
Author Alyssa-Joy Oviatt, DDS
Co-author(s) Hoon Min, DMD
Co-author(s) e-mail minh@livemail.uthscsa.edu
Faculty mentor Ryan Sheridan, DMD, MS
Faculty mentor e-mail ryan.r.sheridan.mil@mail.mil
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available