Expectation and reality of guided implant surgery protocol using computer-assisted static and dynamic navigation system at present scenario: Evidence-based literature review

Abstract

In the field of modern dentistry, ideal three-dimensional positioning of dental implant with optimal prosthetic fit offers successful long-term outcomes. To achieve such accurate implant placement, presurgical evaluation of hard and soft tissue matters the most. Their efforts can be attained using various application programs such as digital imaging, implant planning software, laboratory- or computer-assisted surgical guides, and dynamic navigation approach. To overcome different opinions and choices regarding guided surgery, this article explains an evidence-based literature review to assess its various outcomes and allowing informed choices before using various guided surgical techniques based on its expectation and reality outcomes. This highlights a clinician's choice to guide his successful implant surgery without causing distress in the midway of treatment. An online search was done on PubMed/Medline database to bring in accuracy to the expertise. This review includes reference of publications from 2000 to 2019, which is related to promising outcomes using computer-assisted static or dynamic navigation system for the placement of implant. Out of these, 809 were related to the computer-guided implant placement. Relevant papers were chosen in accordance with the inclusion and exclusion criteria. This review article contemplates to reflect the fact that computer-guided approach is considered to offer more predictable, safer, and faster implant placement with the predetermined final prosthetic outfit. Thus, digital planning and placing of dental implants in the correct position keep escalating to a higher achievement levels than a classical freehand approach. Nevertheless, this guided surgical approach also holds some errors and risks, which must be identified and rectified.

Keywords: Accuracy; computer-assisted surgery; dental implants; dynamic navigation system; flapless approach; guided implant surgery; static guidance system; surgical guide.

Chart 1

The steps used for study selection

Figure 1

Preoperative scanning by cone beam computed tomography in order to provide cross sectional view

Figure 2

Types of guide supporting surfaces

Figure 3

Design of sleeves in the surgical guide. (a) Metallic sleeve; (b) non-metallic sleeve; (c) customized open sleeve

Figure 4

Proper placement of stereolithographic guide using index in static-guided approach

Figure 5

Dynamic navigation system. (a) Components: Patient jaw attachment, handpiece attachment and a system consisting of a camera, overhead blue emitting lights, computer and sensor; (b) ) Surgical procedure: I- Thermoplastic stent attaches with the remaining teeth in the arch using the radiographic marker; II-Digital planning; III and IV-Preoperative planning; V- Osteotomy drilling by viewing on the screen; VI- Postoperative image after implant placement

Figure 6

Fracture of surgical guide during the procedure