Dynamic Navigation Takes Implant Precision to the Next Level
Dynamic computer-assisted implant surgery (d-CAIS) offers real-time guidance, high accuracy, and an efficient workflow that allows same-day placement and greater surgical flexibility. While it requires a significant investment and training, d-CAIS provides ergonomic and clinical advantages, especially in complex cases with limited access.
Both dynamic and static computer-assisted surgery techniques result in more precise implant placement and reduce errors compared to freehand methods.1 However, more clinicians are utilizing dynamic computer-assisted implant surgery (d-CAIS) for multiple reasons. In addition to its high accuracy, the workflow is very efficient and fast. The patient can have the implant placed on the same day, without any delay due to surgical guide fabrication as is required with CAI-S. The surgeon is also not limited to a static guide, in case he/she wants to change the implant size or location due to unexpected intraoperative clinical situations.
If the system check confirms the accuracy of calibration and registration, the clinician also has the option to perform the implant surgery in a flapless manner, thus minimizing trauma to the patient. Furthermore, with s-CAIS, the clinician cannot verify the accuracy in real time, he/she usually has to place the implant and then perform an IOS to compare its actual location with the preplanned location. With d-CAIS, however, the clinician can verify the real-time deviation from the planned position and make adjustments accordingly. Studies have shown similar to slightly better accuracy of shoulder, apex, and angular deviations in d-CAIS when compared to s-CAIS.2-4
Dynamic navigation is also ergonomically more advantageous when compared to any other surgery, as the patient is looking at the screen, rather than bending down to look into the patient’s mouth. Moreover, a big benefit of dynamic surgery is in cases of limited mouth opening. The d-CAIS allows for guided implant placement without the need for additional armamentarium that is involved in the s-CAIS (surgical guide, drill handles).
Clinicians should also keep in mind the cost involved in dynamic navigation. Dynamic navigation is a significant investment. In addition to the capital cost, there is the additional per-case expense of the implant planning and X-clips. Learning any new technology can be challenging, but the learning curve is especially steep with dynamic navigation systems. Based on the literature, surgeons become efficient in d-CAIS only after placing 10 to 20 implants.5 The choice of whether to utilize a s-CAIS or d-CAIS workflow will inherently depend on the clinician’s financial capability, level of comfort, and training. Both techniques are great in overcoming the limitations of human vision and increasing the accuracy and precision of implant placement.
References
- Block MS, Emery RW. Static or dynamic navigation for implant placement — choosing the method of guidance. J Oral Maxillofac Surg. 2016;74:269-277.
- Wu D, Zhou L, Yang J, et al. Accuracy of dynamic navigation compared to static surgical guide for dental implant placement. Int J Implant Dent. 2020;6:78.
- Zhou M, Zhou H, Li SY, Zhu YB, Geng YM. Comparison of the accuracy of dental implant placement using static and dynamic computer-assisted systems: an in vitro study. J Stomatol Oral Maxillofac Surg. 2021;122:343-348.
- Wang F, Wang Q, Zhang J. Role of dynamic navigation systems in enhancing the accuracy of implant placement: A systematic review and meta-analysis of clinical studies. J Oral Maxillofac Surg. 2021;79:2061-2070.
- Block MS, Emery RW, Cullum DR, Sheikh A. Implant placement is more accurate using dynamic navigation. J Oral Maxillofac Surg. 2017;75:1377-1386.
This originally appeared in AlQallaf H, Lin SW, Polido W, Yang CC. Exploring dynamic computer-assisted implant surgery. Decisions in Dentistry. 2024;10(6):32-35.
