Robert W. Emery

Static or Dynamic Navigation for Implant Placement—Choosing the Method of Guidance

The purpose of the present report is to contrast and compare 2 methods of dental implant placement. One method uses computed tomography data for computer-aided design and computer-aided manufacturing to generate static guides for implant placement. The second method is a dynamic navigation system that uses a stereo vision computer triangulation setup to guide implant placement. A review of the published data was performed to provide evidence-based material to compare each method. Finally, the indications for each type of method are discussed.

Implant Placement Accuracy Using Dynamic Navigation.

PURPOSE The aim of this prospective study was to determine platform and angle accuracy for dental implants using dynamic navigation, a form of computer-assisted surgery. Three hypotheses were considered: (1) the overall accuracy for implant placement relative to the virtual plan is similar to that of static tooth-borne computerized tomography (CT)-generated guides; (2) the dynamic system is more accurate than freehand methods; and (3) there is a learning curve associated with this method. MATERIALS AND METHODS This study involved three surgeons placing implants in the mandible and maxilla of patients using a dynamic navigation system (X-Guide, X-Nav Technologies). Virtual implants were placed into planned sites using the navigation system computer. Post-implant placement cone beam CT scans were taken on all patients. For each patient, this scan was mesh overlayed with the virtual plan and used to determine platform and angular deviations to the virtual plan. The primary outcome variables were platform and angular deviations, comparing the actual placement to the virtual plan. Secondary analyses included determination of accuracy related to case experience and freehand placement of implants. Comparisons to published accuracy studies were made for implant placement using static guides. RESULTS Accuracy deviations from the virtual plan were similar to those reported for static tooth-based guides using literature references as the comparison. The accuracy of dynamic navigation was superior compared to freehand implant placement. The three surgeons had similar accuracies after their learning curve was achieved. Proficiency based on case series was achieved by the 20th surgical procedure. CONCLUSION Dynamic navigation can achieve accuracy of implant placement similar to static guides and is an improvement over freehand implant placement. In addition, there was a learning curve to achieve proficiency.

A rational and predictable approach to site development and implant placement

including a more complicated surgical procedure, a recommended period of osseointegration prior to loading and expense, which may limit availability to some patients. The MDI system, which has been recently approved as an ongoing minidental implant, avoids some of these limitations by permitting the clinician to insert and, in many instances, immediately load with predictable results. Mini dental implants are finding their way into implant dentistry in that they offer a less expensive form of treatment that can be used as a transitional device in conjunction with conventional fixtures or as a standalone ongoing implant. This presentation will describe the use of mini dental implants, patient selection, limitations, and insertion protocol for use in the edentulous mandible and maxilla. A hands-on exercise will be provided.