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Implant placement accuracy using a dynamic navigation system- a prospective clinical trial
EAO Online Library. Pellegrino G. Oct 8, 2018; 234705; OC-57
Gerardo Pellegrino
Gerardo Pellegrino
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Nowadays many surgical procedures use computer-guided surgery, which can be a helpful tool for the surgeon. Dynamic navigation is an advanced technique specifically dedicated to oral and maxillofacial surgery, that can allow the surgeon to virtually plan the procedures before the surgery and to be guided while placing implants as previously planned.The objective of this prospective clinical study was to evaluate the implant placement accuracy of a new dynamic navigation system, the influence on it of the surgical technique and to assess clinical outcomes and intra- and postoperative complications.Ten patients were selected recruited and 18 implants were placed. The implant site preparation and the placement of the fixtures were performed with the navigation system (ImplaNav system) according to the preoperative virtual planning. Ten implants were placed using a flapless technique and eight implants with an open-flap approach+ eight implant sites were prepared with a combined piezo-drill method and ten with the standard technique. The accuracy of the navigation system was determined with a dedicated software recording the deviation of the real position of each implant from the virtually planned one, matching postoperative CBCT scan to the preoperative one. Point-to-point distances were computed to calculate the average deviation. Then the deviations were measured at the implant insertion point and at the apical point based on the 3D coordinate system+ the implant axis deviation and the positioning error in depth were also calculated. The influence of the surgical technique (flapless or open-flap approach), the use of piezoelectric drills and the implant length were investigated with regard to implant deviation.The average linear deviation was 1.19 ± 0.54 mm. A mean deviation of 1.04 ± 0.47 mm was measured at the insertion point and 1.35 ± 0.56 mm at the apical point. The depth error was 0.43 ± 0.34 mm and the axis deviation was 6.46° ± 3.95°. No significant differences were found in implant placement accuracy between the flapless and the open-flap approach (p>0.05) and between the conventional and piezoelectric techniques (p>0.05). No significant correlation was found between implant length and the accuracy of implant position, neither for linear error (R2 = 0.03+ p = 0.07) nor angular deviation (R2 = 0.10+ p = 0.24). No intra- or postoperative complications occurred.The accuracy values reported in this study are comparable with the literature data regarding dynamic and static computer-guided surgery. Dynamic navigation could increase the quality and safety of interventions and may reduce the morbidity. Further clinical studies should evaluate the benefits of this technique, especially in advanced implantology.
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