Advantages of Navigated dental implant surgery – quotes from scientific medical publications

  1. Reduces errors. With Navident, implants are typically placed 3 times more accurately than freehand, providing increased safety and improved esthetics
  • Image-guided insertion of dental implants is significantly more accurate than manual insertion.11
  • There are situations where highly accurate implantation is mandatory: when there is relatively little amount of bone available, so that malpositioning of the implant would result in perforation of the cortical bone, the mandibular nerve or the schneiderian membrane, systems for guidance of the implantologist can give additional safety.11
  • Computer-navigated surgery may optimize several treatment processes, and with appropriate training, experience, and pre-surgical planning, could be useful in situations where there is complex anatomy and where minimally invasive surgery is desirable. 2
  • Computerized planning might even allow for the provision of implant therapy where complex anatomical limitations had previously precluded treatment. 2
  • For improved accuracy, implants should be inserted in a fully guided manner (versus guided implant bed preparation alone) whenever possible. 1
  • The prototype dynamic CAS system was comparably accurate to static CAS systems.9
  • Dynamic intraoperative navigation systems that reproduce the virtual implant position in real-time and allow intraoperative changes in implant position had a mean error at entry point of 0.62 mm with a maximum error of 3.4 mm. The same systems demonstrated a mean error of 0.68 mm at the apex with a maximum error of 3.5 mm. Nonetheless, it is interesting that they are more accurate than CAD/CAM surgical guides. This is because of the fact that if an error is encountered during the drilling process using a dynamic guide, the clinician can recognize the issue in real-time and make adjustments as needed. By contrast, when using a CAD/CAM guide, clinicians, particularly those with less experience, may not recognize an inaccuracy in osteotomy position, inclination, or depth.6
  • In areas of complex anatomy, computer-aided navigational surgery is definitely superior to conventional implant surgery in treatment planning and avoiding iatrogenic injuries.12
  • The use of computer-aided navigation technology can contribute to considerable quality improvement. Preoperative planning is exactly realized and intraoperative safety is increased, because damage to nerves or neighboring teeth can be avoided.13
  • The accurate reporting of the exact position of the drilling bur should minimize the potential risk of damage to critical anatomic structures. The accurate intraoperative navigation allows the surgeon to precisely transfer the presurgical plan to the patient.14
  • The benefit of the navigation technology relies on the ability to control depths, position and angle of the implant. The bone density can be evaluated within the CT-data intra-operatively to avoid an implant malpositioning in such a way that primary stability is not given. Navigation technology provides the ability to accurately pre-plan implant treatment.15
  1. Reduces or eliminates the need for bone augmentation in marginal cases, saving time, cost, pain and hassles.
  • By visualizing bone volume preoperatively, it may be possible to place implants more precisely in the available bone, with a consequent reduction in any grafting requirements. 2
  • Bone augmentation procedures may be avoided or reduced by optimizing implant positioning in accessible bone (Fortin et al. 2009).4
  • Navigation systems provide ability to re-localize the position of implant bodies; excisions to expose the implant after the healing period can then be performed minimally invasively.15
  1. Enables flapless drilling, which reduces chair time, patient trauma, pain, and recovery time.
  • Computerized planning also helps avoid anatomical complications and can be used with flapless surgery, which can lead to reduced morbidity. 2
  • Guided surgery may be utilized with a flapless or raised flap approach. 1
  • A clinical advantage with flapless guided surgery is that the technique is likely to decrease pain and discomfort in the immediate postoperative period.4
  • One of the advantages of guided implant surgery is reduced complications associated with implant placement in flapless procedures versus non-guided procedures.7
  • A minimally invasive trans-gingival approach using navigational guidance on the basis of preoperative image data is possible. This is helpful in high-risk patients, such as cardiovascular patients with anticoagulation medication. Finally, navigation systems may reduce the operating time.15
  1. Enables immediate loading of temporary restorations prepared in advance of the implantation, reducing chair time and patient discomfort.
  • Guided surgery may be used with different loading protocols, in partially and fully edentulous indications. 1
  • They can also be used for the optimization of implant placement in critical esthetic cases and for immediate loading with preformed restorations.
  1. Maximizes planning flexibility. The plan can be modified at any time, even during operation.
  • Optical tracking systems seem to be more accurate and have more flexibility during surgery but require more training for the staff. 5
  • Unlike static guides, changes to implant position can be made during operation, and still maintain fully navigated implant insertion.8
  1. Reduces dentist anxiety
  • With navigational technology, implant surgery need not be “blind”. With real-time direct virtual vision, both surgeons and patients are reassured of surgical safety. This increases the confidence and reduces surgical stress in both the patient and the clinician.12
  1. Improves prosthetic outcome
  • The subsequent improved accuracy of implant placement should improve the prosthetic outcome and could also facilitate prefabrication of the prosthesis. 2
  1. Improves implant survival rates
  • Increased surgical precision may lead to improvements in implant survival rates.2
  • High implant survival rates after only 12 months of observation in different indications and a reasonable level of accuracy.3
  • The limited scientific evidence available suggests that guided placement has at least as good implant survival as conventional protocols. 4
  1. Price – Specific advantage of Navident
  • Dynamic navigation systems have largely been abandoned mainly due to cost of implementation. Nonetheless, it is interesting that they are more accurate than CAD/CAM surgical guides.10
  1. Other
  • In time, these systems might have the potential as teaching tools.2

References

  1. Consensus Statements and Recommended Clinical Procedures Regarding Contemporary Surgical and Radiographic Techniques in Implant Dentistry. Bornstein MM, Al Nawas B, Kuchler U, Tahmaseb A. Int J Oral Maxillofac Implants. 2013 Aug 15. doi: 10.11607/jomi.2013.g1
  2. Consensus statements and recommended clinical procedures regarding computer-assisted implant dentistry. Hämmerle CH1, Stone P, Jung RE, Kapos T, Brodala N. Int J Oral Maxillofac Implants. 2009;24 Suppl:126-31.
  3. Computer technology applications in surgical implant dentistry: a systematic review. Jung RE, Schneider D, Ganeles J, Wismeijer D, Zwahlen M, Hämmerle CH, Tahmaseb A. Int J Oral Maxillofac Implants. 2009;24 Suppl:92-109.
  4. Clinical advantages of computer-guided implant placement: a systematic review. Hultin M, Svensson KG, Trulsson M. Clin Oral Implants Res. 2012 Oct;23 Suppl 6:124-35
  5. Computer-aided manufacturing technologies for guided implant placement. Neugebauer J, Stachulla G, Ritter L, Dreiseidler T, Mischkowski RA, Keeve E, Zöller JE. Expert Rev Med Devices. 2010 Jan;7(1):113-29. doi: 10.1586/erd.09.61. Review.
  6. Glossary of Oral and Maxillofacial Implants. Laney WR, ed in chief. Chicago, IL: Quintessence Publishing Co, Ltd; 2007. (in 2013 Assessing Image-Guided Implant Surgery in Today’s Clinical Practice)
  7. Flapless surgery and its effect on dental implant outcomes. Brodala N. Int J Oral Maxillofac Implants. 2009;24(suppl):118-125. (in 2013 Assessing Image-Guided Implant Surgery in Today’s Clinical Practice)
  8. Accuracy of implantation using the RoboDent navigation system: a prospective, multicentric, clinical observation. Doctoral Thesis of Juliane Ernst, Department of Medicine – Charité – University Medicine Berlin, June 2008
  9. Somogyi-Ganss E, Holmes HI, Jokstad A. Accuracy of a novel prototype dynamic computer-assisted surgery system. Clin. Oral Impl. 2014 May 19. doi: 10.1111/clr.12414
  10. Norkin FJ, Ganeles J, Zfaz S, Modares A. Assessing image-guided implant surgery in today’s clinical practice. Compend Contin Educ Dent. 2013 Nov-Dec;34(10):747-50; quiz 751
  11. Accuracy of image-guided implantology. Brief J, Edinger D, Hassfeld S, Eggers G. Clin Oral Implants Res. 2005 Aug;16(4):495-501.
  12. Computer-assisted navigational surgery enhances safety in dental implantology. Ng FC, Ho KH, Wexler A. Ann Acad Med Singapore. 2005 Jun;34(5):383-8.
  13. Computer-aided navigation in dental implantology: 7 years of clinical experience. Ewers R Schicho K, Truppe M, Seemann R, Reichwein A, Figl M, Wagner A. J Oral Maxillofac Surg. 2004 Mar;62(3):329-34.
  14. Navigation surgery for dental implants: assessment of accuracy of the image guided implantology system. Casap N, Wexler A, Persky N, Schneider A, Lustmann J. J Oral Maxillofac Surg. 2004 Sep;62(9 Suppl 2):116-9.
  15. Accuracy of navigation-guided socket drilling before implant installation compared to the conventional free-hand method in a synthetic edentulous lower jaw model. Hoffmann J, Westendorff C, Gomez-Roman G, Reinert S. Clin Oral Implants Res. 2005 Oct;16(5):609-14.

Accuracy of a novel prototype dynamic computer-assisted surgery system9

A study conducted at University of Toronto compared the accuracy of drilling guided by a Navident prototype and by 4 different static surgical guides. The results showed that the Navident prototype was comparable in average accuracy to the guides, but with lower outliers, which is a key safety factor.

Since the study was conducted, numerous improvements to the accuracy and guidance feedback provided by Navident were made. We believe that were the study to be conducted with the current design, the results would have shown a clear advantage to Navident.

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