Accuracy of dynamic navigation in implant surgery: A systematic review and meta-analysis

• Published in: The journal of evidence-based dental practice p. 101797
• Main Authors: Afrashtehfar, Kelvin I., D.D.S., M.D.S., M.Sc., Dr., FDSRCS, FRCD(C), Jurado, Carlos A., D.D.S., M.S, Moshaverinia, Alireza, D.D.S., M.S., Ph.D., FACP
• Format: Journal Article
• Language: English
• Published: 2022
• Subjects: Dentistry; Accuracy; Implant surgery Meta-analysis Precision; Computer-assisted surgery Dental implants
• ISSN: 1532-3382
• DOI: 10.1016/j.jebdp.2022.101797

SummaryStudy SelectionThree electronic databases (MEDLINE via PubMed, and EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) were searched using terms related to dynamic Computer-Assisted Implant Surgery (dCAIS) or dynamic navigation ((“dental implants” or “tooth implant” or “oral implantology” or implant) and (“dynamic navigation” or “computer-assisted surgery” or “image- guided surgery”)). Additionally 10 relevant journals from 2005 to 2020 were manually searched. Two independent reviewers initially screened the literature searches, read through the full-text records for potential eligibility for inclusion, extracted the data of selected records, and assessed their quality using the Cochrane risk of bias (RoB) tool for randomized controlled trials (RCT) and The Newcastle-Ottawa Scale (NOS) for the other prospective studies. Any disagreements at any stage were solved by discussion. Ten articles met the criterion for final inclusion. Key Study FactorThis systematic review and meta-analysis compared the cone-beam computed tomography (CBCT)/CT plan compared with the dynamic navigation outcome. The dynamic navigation implant systems used were AqNavi (1/10), ImplaNav (1/10), IRIS (1/10), NaviDent (4/10), and X-Guide (3/10). The population of interest in this study was adult human subjects or models with partial or full edentulism requiring one or more dental implants for tooth replacement. All prospective studies including a minimum of 10 patients or model studies including a minimum of 10 implants, had to clearly report the implant position accuracy in English language. Multiple publications on the same population or zygomatic, pterygoid, and orthodontic temporary anchored devices (TADs) or mini-implants were not considered. Main Outcome MeasureThe primary outcome measure of this review was the three-dimensional accuracy (global platform deviation in millimeters [mm], global apex deviation in mm, and angular deviation in degrees) of dCAIS (implant placement or drilling location). Meta-analysis of accuracy (continuous data) was conducted in single-armed studies with random effects . Meta-regression compared study design (human vs model), guidance methods (drill hole vs implant), jaw area (maxilla vs mandible), and system (Navident vs X-Guide vs AqNavi vs ImplaNav vs IRIS). Main ResultsA total of 1298 planned implants and actual drilling/implant positions aided by CBCT were performed in the 10 included and evaluated studies, corresponding to 5 clinical and 5 model studies. The 4 RCTs had low-to-moderate RoB (55% to 77% of criteria met), whereas the 6 prospective studies had medium RoB (score: 5 to 6). The global accuracy meta-analyses resulted in an average platform deviation of 1.02 mm (95% CI 0.83–1.21, I 2 = 98.2%), apex deviation was 1.33 mm (95% CI 0.98–1.67, I 2 = 99.4%), and angular deviation was 3.59° (95% CI 2.09–5.09, I 2 = 99.6%). Meta-regression did not find any statistical difference between model and clinical studies (p = .30, .34, .19), drillings/implants (p= .36, .28, .70), maxilla and mandible (p = .88,.63, .28), and the 5 different navigation systems (p = .76, .34, .34). ConclusionsBased on the findings of this review, the accuracy of dynamic navigation for implant placement can be considered in most scenarios. Thus, this technology has a substantial potential for clinical implementation. No significant differences were found between the studied influencing factors (study design, guidance method, arch, and navigation systems). However, more clinical studies are recommended to elucidate the patient-centered outcomes (PROMs) and cost- effectiveness status of the available dynamic navigation systems.