DYNAMIC NAVIGATION MAY BE USED FOR MOST IMPLANT SURGERY SCENARIOS DUE TO ITS SATISFACTORY ACCURACY

Study Selection Three electronic databases (MEDLINE via PubMed, and EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) were searched using terms re-lated to dynamic Computer-Assisted Implant Surgery (dCAIS) or dynamic navi-gation (("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 Factor This 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 in-cluding 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 Measure The primary outcome measure of this review was the three-dimensional accuracy (global platform deviation in millime-ters [mm], global apex deviation in mm, and angular devia-tion in degrees) of dCAIS (implant placement or drilling lo-cation). Meta-analysis of accuracy (continuous data) was con-ducted in single-armed studies with random effects. Meta-regression compared study design (human vs model), guid-ance methods (drill hole vs implant), jaw area (maxilla vs mandible), and system (Navident vs X-Guide vs AqNavi vs ImplaNav vs IRIS).Main Results A total of 1298 planned implants and actual drilling/implant positions aided by CBCT were performed in the 10 in-cluded 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 accu-racy meta-analyses resulted in an average platform devia-tion of 1.02 mm (95% CI 0.83-1.21, I 2 = 98.2%), apex devi-ation was 1.33 mm (95% CI 0.98-1.67, I 2 = 99.4%), and an-gular deviation was 3.59 degrees (95% CI 2.09-5.09, I 2 = 99.6%). Meta-regression did not find any statistical difference be-tween model and clinical studies ( P = .30, 0.34, 0.19), drillings/implants ( P = .36, 0.28, 0.70), maxilla and mandible ( P = .88,.63, 0.28), and the 5 different navigation systems ( P = .76, 0.34, 0.34).Conclusions Based on the findings of this review, the accuracy of dy-namic navigation for implant placement can be considered in most scenarios. Thus, this technology has a substantial potential for clinical implementation. No significant differ-ences were found between the studied influencing factors (study design, guidance method, arch, and navigation sys-tems). However, more clinical studies are recommended to elucidate the patient-centered outcomes (PROMs) and cost-effectiveness status of the available dynamic navigation systems.