Dynamic Navigation for Dental Implant Placement

Summary

Dynamic computer-aided implant surgery (DCAIS) is a controlled implant surgical placement method performed without a surgical template using optical control. The real-time intraoperative control of movement and position of the surgical device simplifies the procedure and gives more freedom to the surgeon, providing similar precision as static navigation methods.

Abstract

In modern implantology, the application of surgical navigation systems is becoming increasingly important. In addition to static surgical navigation methods, a guide-independent dynamic navigation implant placement procedure is becoming more widespread. The procedure is based on computer-guided dental implant placement utilizing optical control. This work aims to demonstrate the technical steps of a new dynamic computer-aided implant surgery (DCAIS) system (design, calibration, surgery) and check the accuracy of the results. Based on cone-beam computed tomography (CBCT) scans, the exact positions of implants are determined with dedicated software. The first step of the operation is the calibration of the navigation system, which can be performed in two ways: 1) based on CBCT images taken with a marker or 2) based on CBCT images without markers. Implants are inserted with the aid of real-time navigation according to the preoperative plans. The accuracy of the interventions can be evaluated based on postoperative CBCT images. The preoperative images containing the planned positions of the implants and postoperative CBCT images were compared based on the angulation (degree), platform, and apical deviation (mm) of the implants. To evaluate the data, we calculated the standard deviation (SD), mean, and standard error of the mean (SEM) of deviations within planned and performed implant positions. Differences between the two calibration methods were compared based on this data. Based on the interventions performed so far, the use of DCAIS allows for high-precision implant placement. A calibration system that does not require labeled CBCT recording allows for surgical intervention with similar accuracy as a system that uses labeling. The accuracy of the intervention can be improved by training.

Introduction

To increase the accuracy of dental implant placement and reduce the complications, a range of navigation techniques based on imaging studies have been developed. Preoperative imaging and special 3D implant planning software can be used to plan the exact position of the dental implant^1,2.

The aim of implant surgery navigation is to accomplish a more anatomically precise placement of the dental implant to achieve the most ideal position, to reduce the risk of possible iatrogenic complications (nerve, vascular, bone, and sinus injuries). The navigated surgery decreases the invasiveness....

Protocol

Informed consent was obtained from every patient before surgery. After the interventions anonymized retrospective data was used in this study.

1. Steps in the traditional workflow of dynamic navigation systems using labeled clip calibration method (only for use on jawbone with teeth):

1. Attach a radiopaque fixation clip to the teeth of the jawbone where the treatment is to be performed (maxilla/mandible) using a thermoplastic material.
2. Make a CBCT examination of the patient with a labeled clip in the mouth (CBCT, FOV 8 cm x 11 cm, 12 mA, 95 kV).
3. Plan the position of the implant according to the....

Results

To use DCAIS correctly, the system must be calibrated. There are several calibration methods that can affect the accuracy of the implant placement. This study aimed to assess the potential impact of different calibration methods on the accuracy of DCAIS.

Based on the interventions performed so far, the use of DCAIS allows a high-precision implant placement. In our early studies, we compared 41 clip calibrated dynamic navigated implant placements with 17 tracer calibrated dynamic navigated impl.......

Discussion

In the labeled clip-used dynamic navigation implant placement system, the traditional workflow is done by clip calibration. There are three radiopaque metal spheres on the surface of the clip, which are clearly visible on the CBCT scan. In the case of the tracer calibration method, these metal spheres containing clips are neither necessary for the CBCT scanning nor system calibration. In cases with existing teeth, both the labeled and unlabelled clips can be used (two different calibration methods). The clip is attached .......

Materials

Name	Company	Catalog Number	Comments
DTX Implant Studio Software	Nobel Biocare	106182	3D surgical planing software
MeshLab	ISTI - CNR research center	2020.12	3D mesh processing software
Nobel Replace CC implant	Nobel Biocare	37285	Implant
X-Guide	X-Nav - Nobel Biocare	SN00001310	dinamic navigation surgery system
X-Guide - XClip	X-Nav - Nobel Biocare	XNVP008381	3D navigation registration device
X-Guide planing software	X-Nav - Nobel Biocare	XNVP008296	3D surgical planing and operating software
X-Mark probe	X-Nav - Nobel Biocare	XNVP008886	3D navigation registration tool
PaX-i3D Smart	Vatech		CBCT
Prolene 5.0			5.0 monofilament, nonabsorbable polypropylene suture