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Perio Update

How Navigation Tech Is Transforming Implant Placement

Freehand implant placement is giving way to high-tech solutions as clinicians embrace computer-assisted technologies for greater accuracy and fewer complications. With both static and dynamic systems offering three-dimensional guidance, oral health professionals can now plan and place implants with confidence.

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With the growing popularity of implant therapy, one of the biggest challenges is placing the implant in the correct position using a prosthetically driven approach.1 Traditionally, implant placement was based on a freehand approach, which involves transferring the preplanned implant position to the clinical situation using only adjacent and opposing teeth as a reference. This led to marked implant positional deviations.2 Malposition of implants is often associated with complications.3-6 The difficulty of visualizing an ideal position and angulation has encouraged dentists to adopt advanced technology for more accurate implant placement.

In recent years, computer software that aids in the three-dimensional (3D) planning of implants has been developed. These computer-assisted technologies have helped dental surgeons place implants in the desired restorative position, by utilizing cone-beam computed tomography (CBCT) with or without intraoral or extraoral optical surface scans (IOS/​EOS).7

Computer-assisted implant surgery improves the accuracy of implant placement, especially in anatomically complex sites, reducing the risk of complications.8 Currently, two types of computer-assisted implant surgery exist:  static computer-assisted implant surgery (s-CAIS) and dynamic computer-assisted implant surgery (d-CAIS).

S-CAIS uses software that virtually plans the implant position based on the CBCT and IOS/​EOS data. A surgical guide is then designed and printed based on the virtual implant location. Subsequently, this surgical guide is fixed on the appropriate area to support the surgeon in placing the implant. On the other hand, the d-CAIS is a real-time navigation tool that continuously tracks sensors fixed on the patient’s mouth and surgical instruments. It displays the surgical site and the implant drill on a computer screen with data on the 3D deviation between the drill and the virtual plan in real time.

The advantages of d-CAIS include:9,10

  • Data collection (CBCT), virtual implant planning, and implant surgery can all be completed in one day.
  • Increase in accuracy, safety, and predictability of implant placement.
  • Ability to view the drill location and deviation from the planned position in real time and adjust the implant location and size during the procedure.
  • Good accessibility when there is insufficient interocclusal space for a static surgical guide and armamentarium.

Navigation systems for oral and maxillofacial surgery are mainly based on optical tracking technology. The patient will have devices attached to his/​her jaw and on the handpiece used during surgery. These devices will have light-emitting diodes or passive reflecting tracking elements that are tracked by the stereoscopic optical camera and guided by the preplanned implant position on the CBCT. The accuracy of these optical tracking systems usually lies between 0.1 and 0.4 mm (Figure 1).11,12

References

  1. Katsoulis J, Pazera P, Mericske‐Stern R. Prosthetically driven, computer‐guided implant planning for the edentulous maxilla: a model study. Clin Implant Dent Relat Res. 2009;11:238-245.
  2. Smitkarn P, Subbalekha K, Mattheos N, Pimkhaokham A. The accuracy of single‐tooth implants placed using fully digital‐guided surgery and freehand implant surgery. J Clin Periodontol. 2019;46:949-957.
  3. Romandini M, Lima C, Pedrinaci I, Araoz A, Soldini MC, Sanz M. Prevalence and risk/​protective indicators of peri‐implant diseases: A university‐representative cross‐sectional study. Clin Oral Implants Res. 2021;32:112-122.
  4. Chen ST, Darby IB, Reynolds EC. A prospective clinical study of non‐submerged immediate implants: clinical outcomes and esthetic results. Clin Oral Implants Res. 2007;18:552-562.
  5. Gamborena I, Avila‐Ortiz G. Peri‐implant marginal mucosa defects: Classification and clinical management. J Periodontol. 2021;92:947-957.
  6. Cavallaro J, Greenstein G. Prosthodontic complications related to non-optimal dental implant placement. Dental Implant Complications–Etiology, Prevention, and Treatment Ames, Iowa: Wiley-Blackwell; 2010:156-171.
  7. Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2014;29:25-42.
  8. Widmann G, Bale RJ. Accuracy in computer-aided implant surgery — a review. Int J Oral Maxillofac Implants. 2006;21:305-313.
  9. Gargallo-Albiol J, Barootchi S, Salomó-Coll O, Wang Hl. Advantages and disadvantages of implant navigation surgery. A systematic review. Ann Anat. 2019;225:1-10.
  10. 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.
  11. Khadem R, Yeh CC, Sadeghi-Tehrani M, et al. Comparative tracking error analysis of five different optical tracking systems. Comput Aided Surg. 2000;5:98-107.
  12. Koivukangas T, Katisko JP, Koivukangas JP. Technical accuracy of optical and the electromagnetic tracking systems. Springerplus. 2013;2:1-7.

This information originally appeared in AlQallaf H, Lin WS, Polido W, Yang CC. Exploring dynamic computer-assisted implant surgery. Decisions in Dentistry. 2024; 10(6):32-35

Hawra Alqallaf, DDS, is a resident in the Department of Periodontics and Allied Dental Programs at Indiana University School of Dentistry.


Wei-Shao Lin, DDS, PhD, is an associate professor, program director in the advanced education program in prosthodontics, and interim chair of the Department of Prosthodontics at Indiana University School of Dentistry in Indianapolis, where he is codirector of the ITI Scholarship Center, and Center for Implant, Esthetic and Innovative Dentistry. He also maintains an intramural dental implant and prosthodontics practice at the School of Dentistry.


Waldemar Polido, DDS, MS, PhD, is a professor in the Department of Oral and Maxillofacial Surgery at IUSD. His main interests are complex implant surgeries and orthognathic surgery. A Fellow of the ITI, Polido is an avid advocate of digital technology applied to treatment planning and surgical accuracy, improving treatment outcomes.


Chao-Chieh Yang, DDS, MSD, is a clinical assistant professor and graduate program director in the Department of Prosthodontics at IUSD. A Diplomate of the American Board of Prosthodontics and a Fellow of the American College of Prosthodontics, he maintains a dental implant and prosthodontics practice at the IUSD Implant Center, providing care to his patients while contributing to the advancement of the field.


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