First comparison of a new dynamic navigation system and surgical guides for implantology: an in vitro study

Aim: The transfer of 3D implant position planning to the clinical site is challenging. The aim of this study was to compare in vitro this transfer accuracy by using dynamic real-time navigation or static surgical guides. Materials and methods: Deviations between planned and actual pilot drill positions were calculated (Denacam and NobelGuide; each n = 90), matching pre- and postoperative CBCT images: entry point, angle, tip (each 3D); depth, mesiodistal/bucco-oral entry points, and angles (each 1D). The influence of the maxilla and mandible, implant region (anterior/posterior), and marker position (ipsilateral/contralateral, Denacam only) was investigated (Mann-Whitney U test). Results: No significant differences occurred regarding entry point (3D), mesiodistal/bucco-oral entry points (1D) or mesiodistal angle (1D) (P > 0.05). The angular and tip deviations (3D) were significantly smaller using Denacam (2.16 +/- 0.59 degrees, 0.80 +/- 0.55 mm; NobelGuide 2.54 +/- 1.19 degrees, 1.09 +/- 0.56 mm; P = 0.024, P < 0.0001). The deviations in depth and bucco- oral angle (1D) were significantly smaller using NobelGuide (1.05 +/- 0.50 mm, 1.02 +/- 1.16 degrees; Denacam 1.50 +/- 0.64 mm, 1.51 +/- 0.82 degrees; P < 0.0001). Significantly smaller deviations occurred within the mandible (Denacam, 5/8 parameters). Region and marker position showed no influence. No distinct influences were found with the use of NobelGuide. Conclusion: Denacam might possibly be a promising alternative to static surgical guides.