Comparative Evaluation of the Accuracy, Operator Comfort and Time Taken for Implant Placement among Different Practitioners under Dynamic Navigation

Introduction: Dynamic Navigation (DN) can be an effective alternative in cases where there are anatomical limitations. It can serve as an advanced training tool for young practitioners in implantology. The learning curve with the DN system can be steep; however, with practice and proper protocol implementation in an institutional set-up, DN can become an invaluable tool for implant placement in challenging situations.Aim: To evaluate operator comfort, accuracy, and time taken for implant placement among different practitioners using DN.Materials and Methods: This prospective cohort study was conducted at the Department of Implantology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, from October 2022 to February 2023. Three groups, each consisting of five practitioners, were included: Group 1 (experienced practitioners), Group 2 (intermediate practitioners), and Group 3 (beginners in the field of implantology). The practitioners underwent orientation to the DN system through lectures and digital planning sessions. They performed hands-on in-vitro implant placement on 3D printed models and one implant placement each on live patients. Surgical time, operator comfort, and accuracy of implant placement were assessed among the three groups. Statistical analysis was performed using the Kruskal-Wallis test.Results: In comparison to the digitally planned position, beginners in implantology showed the least variation in implant placement position. The apicocoronal variation was 0.494 +/- 0.428 mm in implant placements for patients in the beginners group, while the maximum variation was 2.140 +/- 1.355 mm in the experienced practitioners group. There was a sequential increase in accuracy and lesser deviation from the originally planned implant sites when comparing the virtual simulation device, model, and patient implant placement. Beginners took significantly less time for implant placement in patients (p=0.004).Conclusion: There was a sequential improvement in the accuracy in implant angulation from virtual simulation to placement of implants in patients. The beginners group exhibited the shortest implant placement time in patients.