Placement accuracy and primary stability of implants in the esthetic zone using dynamic and static computer-assisted navigation: A retrospective case-control study

Statement of problem. Both the placement accuracy and primary stability of implants are important to implant therapy in the esthetic zone. The effect of dynamic and static computer -assisted navigation on the primary stability of implants in the esthetic zone remains uncertain. Purpose. The purpose of this case -control study was to investigate the effect of dynamic and static computer -assisted navigation on the placement accuracy and primary stability of implants in the esthetic zone. Material and methods. Partially edentulous participants who received at least 1 implant in the anterior maxilla using either fully guided static or dynamic computer -assisted implant surgery (s-CAIS, d-CAIS) from January 2020 to February 2022 were screened. Participant demographic information, timing of implant placement, primary stability represented by the insertion torque value (ITV) in Ncm, and implant survival were collected from the treatment record. Bone quality at the implant sites was determined according to the Lekholm and Zarb classification. The accuracy of implant placement represented by the linear (platform: Dpl, mm; apex: Dap, mm) and angular deviations (axis: Dan, degree) between the planned and placed implants was evaluated based on the preoperative surgical plan and postoperative cone beam computed tomography (CBCT) data. A statistical analysis of the data was completed by using the chi -squared, Fisher exact, Student t, and Mann -Whitney U tests (a=.05). Results. A total of 32 study participants (38 implants) were included. The groups of s-CAIS (16 participants, 18 implants) and d-CAIS (16 participants, 20 implants) were statistically comparable in sex (P=.072), age (P=.548), bone quality (P=.671), and timing of implant placement (P=.719). All implants survived during an average follow-up period of 13 months. The d-CAIS group showed close linear deviations (Dpl 1.07 +/- 0.57 mm, Dap 1.26 +/- 0.53 mm) but lower angular deviation (Dan 2.14 +/- 1.20 degrees) and primary stability (ITV 25.25 +/- 7.52 Ncm) than the s-CAIS group (Dpl 0.92 +/- 0.46 mm, Dap 1.31 +/- 0.43 mm, Dan 3.31 +/- 1.61 degrees, ITV 30.56 +/- 11.23 Ncm, PDpl=.613, PDap=.743, PDan=.016, PITV=.028). Conclusions. Comparable linear positioning accuracy and higher angular deviation were found for implants placed in the esthetic zone by using s-CAIS than when using d-CAIS. Higher primary stability of implants may be achieved by using s-CAIS, as s-CAIS seemed to have higher osteotomy accuracy than d-CAIS. (J Prosthet Dent 2024;131:427-35)