Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study

The learning curve of a dynamic navigation system used in endodontic apical surgery

Background/purpose

Quantitative in vitro research was conducted on the learning process of a dynamic navigation system. This study provides guidance for the promotion and application of dynamic navigation technology in the endodontic apical surgery field.

Materials and methods

Standardized models were designed and 3D printed to form the approach operation of endodontic apical surgery. 6 clinicians with no experience in dynamic navigation performed the operation. The distance deviation tolerance was set as 0.6 mm, and the angle deviation tolerance was set as 5°. Fifteen mm deep approach operation was completed using dynamic navigation. Each operator performed 10 consecutive exercises on the models. The positioning deviation and operation time of each operator for each practice were recorded. Based on this, the learning curve of the dynamic navigation of every operator was mapped. The learning difficulty of dynamic navigation was evaluated.

Results

The learning curves of all operators reached a stable level after the 7th practice, which can ensure that the distance and angle deviations are maintained within the deviation tolerances (0.6 mm, 5°).

Conclusion

Operators with no experience in dynamic navigation technology need practice to master dynamic navigation operations. For this navigation system, operators with no operational experience can master dynamic navigation operations after 7 exercises.

Accuracy of robotic computer-assisted implant surgery for immediate implant placement: A retrospective case series study

OBJECTIVES

This study investigated the accuracy of robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement.

METHODS

Twenty cases with 20 implant sites were selected based on predefined inclusion criteria. The preparation of the implant bed and implant placement followed the standardized dental implant robotic surgery protocol. Postoperative cone-beam computed tomography scans were conducted to assess possible discrepancies between actual and planned implant positions.

RESULTS

The r-CAIS technology for immediate implant placement exhibited a mean global coronal deviation of 0.71 ± 0.27 mm (95% CI: 0.58-0.83 mm), a mean global apical deviation of 0.69 ± 0.26 mm (95% CI: 0.56-0.81 mm), and an angular deviation of 1.27 ± 0.47° (95% CI: 1.05-1.49°). A substantial number of deviations were observed buccally at both coronal (90%) and apical (95%) levels, with a consistent tendency for buccal deviation.

CONCLUSIONS

The r-CAIS technology proved a promising approach for immediate implantation in the anterior region, with satisfactory clinical outcomes. However, an optimized surgical protocol for r-CAIS technology is required for particular implant sites like extraction sockets or bone defects.

Comparison of robotic system and dynamic navigation for zygomatic implant placement: An in vitro study

OBJECTIVES

To compare the accuracy of robotic and dynamic navigation systems in assisting zygomatic implant (ZI) using an in vitro model experiment.

METHODS

Preoperative cone-beam computed tomography (CBCT) images of patients who underwent ZI treatment between 2011 and 2023 were collected from local databases. Corresponding three-dimensional resin models were printed and assigned to two groups: the robotic and dynamic navigation system groups. Following preoperative plans, ZIs were placed in the models with the assistance of either a robotic or dynamic navigation system. Deviations in the in vitro navigation surgery were measured and compared between the groups.

RESULTS

A total of 110 ZIs were placed in 56 models, with 55 ZIs in each group. No significant differences were observed in entry and angle deviations between the groups (p>0.05). However, the exit deviation in the robotic system group (2.39±1.24 mm) was larger than that in the dynamic navigation group (1.83±1.25 mm) (p<0.05). On the exit side, the Z-axis deviation in the robotic group (left: -0.28±1.43 mm, right: -0.21±1.30 mm) was smaller than that in the dynamic navigation group (left: 0.76±1.11 mm, right: 0.85±1.52 mm) (p<0.05), while no significant differences were found in X- and Y-axis deviations (p>0.05).

CONCLUSIONS

Compared with the dynamic navigation system, the robotic system can effectively prevent ZI overextension. However, its accuracy on the exit side is slightly lower than that of the dynamic navigation system.

CLINICAL SIGNIFICANCE

This preliminary in vitro study showed that the accuracy of the robotic system was slightly inferior to that of the dynamic navigation system in terms of exit deviation when used in ZI placement. Further clinical studies are required to confirm these findings.

Accuracy of dental implant placement using different dynamic navigation and robotic systems: an in vitro study

Computer-aided implant surgery has undergone continuous development in recent years. In this study, active and passive systems of dynamic navigation were divided into active dynamic navigation system group and passive dynamic navigation system group (ADG and PDG), respectively. Active, passive and semi-active implant robots were divided into active robot group, passive robot group and semi-active robot group (ARG, PRG and SRG), respectively. Each group placed two implants (FDI tooth positions 31 and 36) in a model 12 times. The accuracy of 216 implants in 108 models were analysed. The coronal deviations of ADG, PDG, ARG, PRG and SRG were 0.85 ± 0.17 mm, 1.05 ± 0.42 mm, 0.29 ± 0.15 mm, 0.40 ± 0.16 mm and 0.33 ± 0.14 mm, respectively. The apical deviations of the five groups were 1.11 ± 0.23 mm, 1.07 ± 0.38 mm, 0.29 ± 0.15 mm, 0.50 ± 0.19 mm and 0.36 ± 0.16 mm, respectively. The axial deviations of the five groups were 1.78 ± 0.73°, 1.99 ± 1.20°, 0.61 ± 0.25°, 1.04 ± 0.37° and 0.42 ± 0.18°, respectively. The coronal, apical and axial deviations of ADG were higher than those of ARG, PRG and SRG (all P < 0.001). Similarly, the coronal, apical and axial deviations of PDG were higher than those of ARG, PRG, and SRG (all P < 0.001). Dynamic and robotic computer-aided implant surgery may show good implant accuracy in vitro. However, the accuracy and stability of implant robots are higher than those of dynamic navigation systems.

Robot-assisted surgery for dental implant placement: A narrative review

OBJECTIVE

To determine the current status and accuracy of robotic computer-assisted implant surgery (CAIS) applications by examining the associated clinical and experimental outcomes.

DATA AND SOURCES

PubMed, Medline, and Cochrane Library databases were searched for relevant studies published between January 2000 and November 2023, and focusing on robotic CAIS in dental implant surgery. All search results were then manually reviewed to identify only the pertinent articles. Only in vitro and clinical studies were included in this narrative review, with implant placement accuracy considered the main outcome.

RESULT

Based on our inclusion and exclusion criteria, we included 21 studies (with 1085 implant sites); of them, 8 were clinical studies, 12 were in vitro studies, and 1 included both an in vitro study and a case series. The ranges of the mean implant shoulder, apical, and angular deviations were respectively 0.43-1.04 mm, 0.53-1.06 mm, and 0.77°-3.77° in the clinical studies and 0.23-1.04 mm, 0.24-2.13 mm, and 0.43°-3.78° in the in vitro studies, respectively.

CONCLUSION

The accuracy of robotic CAIS in dental implant procedures appears to be within the clinically acceptable ranges. However, further relevant clinical trials validating the existing evidence are needed.

CLINICAL SIGNIFICANCE

Robotic CAIS can achieve clinically acceptable implant placement accuracy. This innovative technology may improve the precision and success rates of dental implant procedures, with benefit for surgeons and patients.

The precision of drill calibration for dynamic navigation

OBJECTIVES

To quantify the reproducibility of the drill calibration process in dynamic navigation guided placement of dental implants and to identify the human factors that could affect the precision of this process in order to improve the overall implant placement accuracy.

METHODS

A set of six drills and four implants were calibrated by three operators following the standard calibration process of NaviDent® (ClaroNav Inc.). The reproducibility of the position of each tip of a drill or implant was calculated in relation to the pre-planned implants' entry and apex positions. Intra- and inter-operator reliabilities were reported. The effects of the drill length and shape on the reproducibility of the calibration process were also investigated. The outcome measures for reproducibility were expressed in terms of variability range, average and maximum deviations from the mean distance.

RESULTS

A satisfactory inter-rater reproducibility was noted. The precision of the calibration of the tip position in terms of variability range was between 0.3 and 3.7 mm. We noted a tendency towards a higher precision of the calibration process with longer drills. More calibration errors were observed when calibrating long zygomatic implants with non-locking adapters than with pointed drills. Flexible long-pointed drills had low calibration precision that was comparable to the non-flexible short-pointed drills.

CONCLUSION

The clinicians should be aware of the calibration error associated with the dynamic navigation placement of dental and zygomatic implants. This should be taken in consideration especially for long implants, short drills, and long drills that have some degree of flexibility.

CLINICAL SIGNIFICANCE

Dynamic navigation procedures are associated with an inherent drill calibration error. The manual stability during the calibration process is crucial in minimising this error. In addition, the clinician must never ignore the prescribed accuracy checking procedures after each calibration process.

Learning curve of dynamic navigation-assisted zygomatic implant surgery: An in vitro study

STATEMENT OF PROBLEM

Dynamic computer-assisted zygomatic implant surgery (dCAZIS) has been reported to provide clinical efficacy with high accuracy and low risk of complications. However, the learning curve before performing dCAZIS effectively is unknown.

PURPOSE

The purpose of this in vitro study was to explore the learning curve of dCAZIS in dentists with different levels of experience in implant dentistry and navigation surgery.

MATERIAL AND METHODS

Six senior dental students were randomly divided into 3 groups for initial training (FH-CI group: pretraining on freehand conventional implant surgery; FH-ZI group: pretraining on freehand ZI surgery; DN-CI group: pretraining on conventional implant surgery under dynamic navigation). Then, every operator conducted 6 repeated dCAZIS training sessions on edentulous 3-dimensional (3D) printed skull models and was asked to complete a self-report questionnaire after each training session. A total of 36 postoperative cone beam computed tomography (CBCT) scans with 144 ZI osteotomy site preparations were obtained and superimposed over the preoperative design for accuracy measurements. The operation time, 3D deviations, and results of the self-reports were recorded. Comparisons among groups were analyzed with independent-sample Kruskal-Wallis tests (α=.05), and correlations between study outcomes and the number of practices were calculated.

RESULTS

Operator experience and increased practice times did not significantly affect the accuracy of dCAZIS (P>.05). However, the operation time varied among groups (P<.001), and significantly shortened with more practice, reaching 11.51 ±1.68 minutes at the fifth attempt in the FH-CI group (P<.001 compared with the first practice), 14.48 ±3.07 minutes at the third attempt in the FH-ZI group (P=.038), and 8.68 ±0.58 minutes at the sixth attempt in the DN-CI group (P<.001). All groups reached their own learning curve plateau stage within 6 practice sessions. As the number of practice sessions increased, the results from the self-report questionnaires gradually improved.

CONCLUSIONS

Among dentists with different levels of experience in implant dentistry and navigation surgery, dCAZIS was found to have a learning curve with respect to operation time but not implant accuracy. Experience in ZI surgery had little impact on the learning curve of dCAZIS, but experience in navigation surgery was a key factor.

Does dynamic navigation assisted student training improve the accuracy of dental implant placement by postgraduate dental students: an in vitro study

OBJECTIVES

To assess the accuracy of implant placement in models and satisfaction in dynamic navigation assisted postgraduate dental students training.

METHODS

Postgraduate dental students who had at least one year of dental clinical practice with no experience in dental implant surgeries were included. Students were instructed to make treatment plans in the dynamic navigation system. Each student placed two maxillary right incisors, using freehand approach at first and then under dynamic navigation. The implant position was compared with treatment plan. Factors influencing the accuracy of implants placed under dynamic navigation were analyzed. Student acceptance towards the training and use of dynamic navigation was recorded using a questionnaire.

RESULTS

A total of 21 students placed 42 implants. For freehand implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 3.79 mm, 4.32 mm, and 10.08°. For dynamic guided implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 1.29 mm, 1.25 mm, and 4.89° (p < 0.001). The accuracy of dynamic guided implant was not influenced by student gender or familiarity with computer games. All students were satisfied with the training.

CONCLUSIONS

Dynamic navigation system assisted students in improving the accuracy of implant placement and was well accepted by students.

Accuracy of dynamic navigation compared to static surgical guides and the freehand approach in implant placement: a prospective clinical study

BACKGROUND

Computer-guided implant surgery has improved the quality of implant treatment by facilitating the placement of implants in a more accurate manner. This study aimed to assess the accuracy of implant placement in a clinical setting using three techniques: dynamic navigation, static surgical guides, and freehand placement. We also investigated potential factors influencing accuracy to provide a comprehensive evaluation of each technique's advantages and disadvantages.

MATERIALS AND METHODS

Ninety-four implants in 65 patients were included in this prospective study. Patients were randomly assigned to one of three groups: dynamic navigation, static surgical guides, or freehand placement. Implants were placed using a prosthetically oriented digital implant planning approach, and postoperative CBCT scans were superimposed on preoperative plans to measure accuracy. Seven deviation values were calculated, including angular, platform, and apical deviations. Demographic and consistency analyses were performed, along with one-way ANOVA and post-hoc tests for deviation values.

RESULTS

The mean global platform, global apical, and angular deviations were 0.99 mm (SD 0.52), 1.14 mm (SD 0.56), and 3.66° (SD 1.64°) for the dynamic navigation group; 0.92 mm (SD 0.36), 1.06 mm (SD 0.47), and 2.52° (SD 1.18°) for the surgical guide group; and 1.36 mm (SD 0.62), 1.73 mm (SD 0.66), and 5.82° (SD 2.79°) for the freehand group. Both the dynamic navigation and surgical guide groups exhibited statistically significant differences in all values except depth deviations compared to the freehand group (p < 0.05), whereas only the angular deviation showed a significant difference between the dynamic navigation and surgical guide groups (p = 0.002).

CONCLUSION

Our findings highlight the superior accuracy and consistency of dynamic navigation and static surgical guides compared to freehand placement in implant surgery. Dynamic navigation offers precision and flexibility. However, it comes with cost and convenience considerations. Future research should focus on improving its practicality.

TRIAL REGISTRATION

This study was retrospectively registered at the Thai Clinical Trials Register-Medical Research Foundation of Thailand (MRF) with the TCTR identification number TCTR20230804001 on 04/08/2023. It was also conducted in accordance with the Declaration of Helsinki and approved by the institutional ethics committee at the Xian Jiaotong University Hospital of Stomatology, Xian, China (xjkqII[2021] No: 043). Written informed consent was obtained from all participants.

Surgical performance of dental students using computer-assisted dynamic navigation and freehand approaches

INTRODUCTION

Nowadays, the training of implant placement has shifted from once entirely instructor-student teaching to the increasing use of computer-assisted simulation. Based on computerized virtual planning, dynamic navigation has been used for implant placement with higher accuracy than the traditional freehand protocol. However, whether dynamic navigation benefits to the training of dental students in implant placement remains controversial. This study aimed to compare the surgical performance of dental students in implant placement using computer-assisted dynamic navigation and freehand approaches.

MATERIALS AND METHODS

A total of 20 dental students (6 males, 14 females, age: 25.6 ± 0.5 years) were enrolled in this study. With the traditional freehand approach (training 1) as the control protocol, computer-assisted dynamic navigation (training 2) was used in the training of dental students in implant placement. For each training, both the operating time (OT) of students and placement accuracy represented by the linear (at the implant platform, Dpl, and apex, Dap) and angular (Dan) deviations between the virtually planned and placed implants were recorded. Statistical comparisons were made between the two training protocols as well as male and female surgeons.

RESULTS

OT2 was around twice of OT1 (p < .0001), whereas Dan1 was almost three times of Dan2 (p < .0001). Dap1 and Dpl1 were significantly higher than Dap2 (p = .014) and Dpl2 (p = .033) respectively. Besides, male students showed statistically higher Dpl1 (p = .033) and Dan1 (p = .002) than females. No significant difference was found between male and female students in OT1, OT2, Dpl2, Dap1, Dap2 and Dan2.

CONCLUSIONS

Within the limitations of this study, the use of computer-assisted dynamic navigation in the preclinical training could improve the surgical performance of the dental students in implant placement. The combination of dynamic navigation with the traditional preclinical surgical training may benefit to dental students and could be applied in dental education.

Effect of guided implant placement learning experiences on freehand skills: A pilot study

OBJECTIVES

Guided implant systems can be used as a training approach for placing implants. This in vitro prospective randomized pilot study evaluated the learning progression and skill development in freehand placement of two implants supporting a three-unit fixed prosthesis on a simulation model among novice operators.

MATERIAL AND METHODS

Four senior dental students with no prior implant placement experience participated in the study. As a baseline, each student placed two mandibular and two maxillary implants by freehand technique on a simulation model. Sixteen consecutive guided placements using a static guide, dynamic navigation, and template-based guide followed totaling 32 guided implant placements into maxillary and mandibular models. Freehand implant placements before and after the various guided navigation attempts were compared to assess their impact on freehand skill. Metrics compared included surgical time, horizontal, vertical, and angulation discrepancies between the planned and placed implant positions measured on superimposed CBCT scans and analyzed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = .05).

RESULTS

Before training with guided techniques, the average baseline freehand implant placement took 10.2 min and decreased to 8.2 after training but this difference was not statistically significant (p = .1670) There was marginal evidence of a significant difference in the 3D apex deviation with an average improvement of 0.89 mm (95% CI: -0.38, 2.16, p = .1120); and marginal evidence of a significant improvement in the overall angle with an average improvement of 3.74° (95% CI: -1.00, 8.48, p = .0869) between baseline and final freehand placement attempts.

CONCLUSIONS

Within the limitations of this pilot study, guided implant placement experiences did not significantly benefit or hinder freehand placement skills. Dental students should be exposed to various placement techniques to prepare them for clinical practice and allow them to make informed decisions on the best technique based on their skills and a given clinical scenario.

Accuracy of 3 calibration methods of computer-assisted dynamic navigation for implant placement: An in vitro study

STATEMENT OF PROBLEM

Dynamic navigation for implant placement has been reported to be more accurate than freehand surgery. However, the accuracy of the calibration methods used for navigation in partially edentulous individuals with distal extensions remains unknown.

PURPOSE

The purpose of this in vitro study on dental models was to evaluate the accuracy of 3 calibration methods of dynamic navigation for implant placement in the distal extension of partially edentulous arches.

MATERIAL AND METHODS

Eleven standardized polyurethane mandibular models with distal extensions were prepared. The left first molar, second molar, and second premolar from each model (33 tooth sites) were randomly assigned to 1 of the 3 calibration methods: U-shaped tube embedded with radiopaque markers, anatomic tooth cusps, and bone markers with the random number table method. Preoperative and postoperative cone beam computed tomography images were obtained for deviation analyses. The primary outcomes were 3-dimensional (3D) deviation at the implant platform and apex and angular deviation. Differences among the test groups were analyzed by using a 1-way analysis of variance (ANOVA) and the least significant difference (LSD) post hoc test (α=.05).

RESULTS

The mean ±standard deviation 3D deviations were 0.78 ±0.34, 1.86 ±0.91, and 1.44 ±0.57 mm at the implant platform and 0.79 ±0.35, 2.19 ±1.01, and 1.49 ±0.50 mm at the apex in the U-shaped tube, tooth cusp, and bone marker groups, respectively. The 3D deviations at the implant platform and apex were significantly different among the groups (P<.01). The angular deviation was 1.36 ±0.54, 2.95 ±2.07, and 2.92 ±2.45 degrees, with no significant differences among the groups (P=.092).

CONCLUSIONS

In the dynamic navigation of implant placement in the distal extension of partially edentulous arches, the U-shaped tube calibration with radiopaque markers was more accurate than the anatomic tooth cusp or bone marker calibration.

Comparative Evaluation of Accuracy of Adjacent Parallel Implant Placements Between Dynamic Navigation and Static Guide: A Prospective Study

Aim The study aims to compare the accuracy of dynamic navigation (DN) and static guides (SGs) for simultaneous adjacent parallel placement of implants, the time taken for the surgery, and the ease of handling the instruments. Materials and methods This prospective trial was carried out at the Department of Implantology of Saveetha Dental College from October 2022 to February 2023. A total of 20 patients who needed simultaneous adjacent dental implants were allocated randomly into two groups: Group 1 SG surgery and Group 2 DN surgery. Forty implants were placed, 20 under DN and 20 under SG. Bucco-lingual displacement, apico-coronal displacement, mesiodistal displacement, and mesiodistal angulation were compared between the two groups. The patients' data in both groups were evaluated by operating surgeons along with the surgical time taken and the ease of handling of instruments. Results The 20 patients who underwent implant placement in the DN and SG groups all had adjacent missing teeth in posterior sites, including lower posteriors (70%) and upper posteriors (30%). There was improved precision in relation to the mesiodistal displacement and angulation of the anterior implant of the adjacent parallel implants. The mesiodistal displacement in Group 1 (SG) was 5.61 + 3.1 mm, which was higher than Group 2 (DN), which was 0.55 + 0.56 mm. The mesiodistal angulation was 3.1 + 2.9 degrees in Group 2 and 0.42 + 0.5 degrees in Group 1. The second implant had a significant difference (p < 0.005) in mesiodistal displacement, mesiodistal angulation, and bucco-lingual displacement. The difference between the intergroup surgical time (mean + SD) in Group 1 was 30 + 4.5 mins and in Group 2 was 60.7 + 10.1 mins, with p < 0.05 statistically significant. The comfort of the operator was better in the SG group. Conclusion Any digitally aided implant placement technique can improve placement accuracy but each has its downfalls. Achieving the highest levels of precision and long-lasting prosthetic results hinges on both the suitability of the chosen case and the expertise of the surgeon performing the implant placement.

Accuracy Comparison between Robot-Assisted Dental Implant Placement and Static/Dynamic Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis of In Vitro Studies

Background and Objectives: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to static computer-assisted implant surgery (SCAIS), dynamic computer-assisted implant surgery (DCAIS), and freehand procedures. This study aims to provide a comprehensive understanding of the precision of robot-assisted dental implant placement and its comparative efficacy in relation to other placement techniques. Methods: The guidelines recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to organize and compose this review. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane) were systematically searched for pertinent articles. Articles were selected following the inclusion and exclusion criteria. Qualitative and quantitative analyses of the selected articles were performed. Results: The initial electronic search resulted in 1087 hits. Based on the inclusion and exclusion criteria, five articles were selected for qualitative analysis, out of which three were considered for quantitative analysis. Three parameters were considered for accuracy evaluation (angular, coronal, and apical deviation). The mean angular deviation was -1.22 degrees (95% CI, -1.06--1.39), the mean coronal deviation was -0.15 mm (95% CI, -0.24--0.07), and the mean apical deviation was -0.19 mm (95% CI, -0.27--0.10). Conclusions: The robotic implant system was found to have significantly lower angular deviations and insignificantly lower coronal and apical deviations compared to DCAIS. Within the limitations of this review, it can be concluded that robot-assisted implant placement in resin models permits higher accuracy compared to DCAIS and SCAIS systems. However, due to the limited number of comparative studies with high heterogeneity, the findings of this review should be interpreted with caution. Further research is necessary to confirm the clinical application of robotics in implant surgery.

Influence of Kennedy class and number of implants on the accuracy of dynamic implant navigation: An in vitro study using an X-ray free evaluation methodology

OBJECTIVES

The aim of this in vitro study was to evaluate the accuracy of fully guided dynamic implant navigation surgery in Kennedy I, II, and III class dental arch defects with two different implant designs, using an X-ray free evaluation method.

METHODS

Polyurethane resin maxillary models simulated posterior edentulous defects. Four cone beam computed tomography (CBCT) scans and four intraoral (IOS) scans were obtained for each model and a digital wax-up with the correct implant positions was made. The accuracy of implant positions was evaluated using an IOS-based X-ray-free method (3Shape). Four deviation characteristics were evaluated: insertion point, depth deviation, horizontal and angle deviation.

RESULTS

The insertion point deviation measures ranged from 0.19 mm to 1.71 mm. Depth (s) and (u) deviations ranged from -1.47 mm to 0.74 mm and from 0.02 mm to 1.47 mm, respectively. Horizontal deviation ranged from 0.09 mm to 1.37 mm.

CONCLUSIONS

There is a tendency of a decreasing insertion point deviation for an increasing number and distribution area of the teeth (increasing Kennedy class number). Kennedy class II and distal implant position had the most influence for the higher deviations.

CLINICAL SIGNIFICANCE

Dynamic implant guidance provides accurate spacing, angulation, depth and position of the implants. It is important to understand how the number of missing teeth and implant design could influence the accuracy of dynamic implant navigation. Thus, it is important to evaluate factors influencing the accuracy of dynamic systems by using a X-ray-free post-operative method and to overcome the limitations of providing multiple CBCT scans.

Impact of fully guided implant planning software training on the knowledge acquisition and satisfaction of dental undergraduate students

BACKGROUND

A majority of dental school students do not undergo hands-on clinical training in implantology in the undergraduate curriculum. Training is usually restricted to pre-implant evaluation and post-implant prostheses. Virtual implant planning software (VIPS) provides an alternative opportunity for undergraduate students to experience implant planning much before gaining hands-on experience. However, not many studies have the contribution of VIPS to the knowledge acquisition of students. We conducted a preliminary study to evaluate the knowledge acquisition of the students when exposed to a hands-on session of VIPS. We also evaluated students' satisfaction levels, when exposed to hands-on training in fully guided implant planning software.

METHODS

A two-part theory lecture on fully guided implant planning was delivered to 90, 5th (final)-year dental undergraduate students by the oral radiology faculty. The students were then randomly divided into three groups. Group A was exposed to didactic lectures only. Group B was shown a video for fully guided implant planning in addition to the didactic lecture. Group C was shown a video for fully guided implant planning in addition to a didactic lecture and then performed a hands-on session of virtual implant planning under faculty guidance. Students from all groups were given an MCQ-based test. After the completion of the test students from group A and B also received VIPS hands-on training. Students from all three groups answered and a feedback questionnaire regarding their satisfaction levels with VIPS.

RESULTS

The overall test score of students in Group C was higher than their colleagues in both Groups A and B and the differences were statistically significant (p = 0.01). More than 85% of the students were satisfied with the teaching approach.

CONCLUSIONS

The utilization of VIPS in the training of dental undergraduate students improves their performance confirming better knowledge acquisition and content mastery.

Clinical and radiological outcomes of dynamic navigation in endodontic microsurgery: a prospective study

OBJECTIVES

This study was aimed at evaluating the clinical and radiological outcomes of novel dynamic navigation (DN)-aided endodontic microsurgery (EMS), with an analysis of potential prognostic factors.

MATERIALS AND METHODS

Forty-six teeth from 32 patients who received DN-aided EMS were included. Clinical and radiographic assessments were performed at least 1 year postoperatively. Two calibrated endodontists assessed radiological outcomes according to two-dimensional (2D) periapical radiography (PA) and three-dimensional (3D) cone-beam computed tomography (CBCT) imaging using Rud's and Molven's criteria and modified PENN 3D criteria, respectively. Fisher's exact test was used for statistical analysis of the predisposing factors.

RESULTS

Of the 32 patients with 46 treated teeth, 28 with 40 teeth were available for follow-up. Of the 28 patients, four (five teeth) refused to undergo CBCT and only underwent clinical and PA examinations, and the remaining 24 (35 teeth) underwent clinical, PA, and CBCT examinations. Combined clinical and radiographic data revealed a 95% (38/40) success rate in 2D healing evaluations and a 94.3% (33/35) success rate in 3D healing evaluations. No significant effect was found in sex, age, tooth type, arch type, preoperative lesion volume, preoperative maximum lesion size, presence/absence of crown and post, and the root canal filling state on the outcome of DN-aided EMS.

CONCLUSIONS

DN-aided EMS has a favorable prognosis and could be considered an effective and reliable treatment strategy. Further investigations with larger sample sizes are required to confirm these results.

CLINICAL RELEVANCE

DN-aided EMS could be considered an effective and reliable treatment strategy.

Acceptability of fully guided virtual implant planning software among dental undergraduate students

BACKGROUND

Fully guided implant surgery as a technique is gaining popularity. It has been observed that use of surgical guides improves precision and predictability for dental implant placement. However, like any other newer technology, the acceptance of fully guided dental implant technology among users is based upon its perceived usability. This study aimed at evaluating the perception about using Virtual Implant Planning Software (VIPS) among undergraduate dental students at the university of Sharjah.

METHODS

Ninety-Six dental surgery students from the University of Sharjah were included in the study. One week after the Virtual Implant Planning Software (Planmeca Romexis version 6.2 procedure, students were asked to complete a Combined technology acceptance model and the theory of planned behaviour (C-TAM TPB) questionnaire. Sixty-six students responded to the questionnaire.

RESULTS

Cronbach's alpha surpassed 0.7 for perceived usefulness, perceived ease of use, perceived behavioral control, and subjective norm. Attitude and behavioural intention reported Cronbach's alpha values less than 0.7. Spearman's correlation coefficient was significant for all the constructs. Perceived ease of use explained 49%, 33%, and 42% of the variance of perceived usefulness (R² = 0.49), attitude (R² = 0.33), and perceived behavioral control (R² = 0.42) respectively. Perceived usefulness explained 25%, 18%, and 23% of the variance of attitude (R² = 0.25), behavioral intention (R² = 0.18), and perceived behavioral control (R² = 0.23) respectively. Attitude accounted for 25%, 33%, and 29% of the variance of behavioral intention (R² = 0.25), perceived behavioral control (R = 0.33), and subjective norm (R = 0.29) respectively.

CONCLUSION

The fully guided VIPS was acceptable by dental students specifically because of its usability. This makes VIPS a very effective tool for teaching implantology for dental students. VIPS also allows students to perform multiple repetitions of the implant planning procedure which enhances understanding and content retention.

Training of novice surgeons using dynamic computer assisted dental implant surgery: An exploratory randomized trial

BACKGROUND

Dynamic Computer Assisted Implant Surgery (CAIS) systems have been shown to improve accuracy of implant placement, thus training in the use of such systems is becoming increasingly important. There is a scarcity of research on how to implement dynamic CAIS training in the settings of postgraduate university education.

PURPOSE

To determine the effectiveness of two modes of CAIS training programs on motor skill acquisition of novice surgeons.

MATERIALS AND METHODS

Thirty-six postgraduate students without experience in dynamic CAIS systems were randomly assigned to a distributed training program (3 training sessions over 3 days) or a massed training (3 training sessions over the same day). A post-test involving the placement of one implant was conducted for both groups, 7 days after completion of the training. Surgical time and implant accuracy were recorded and analyzed, using independent t-tests, with 0.05 significant level.

RESULTS

Both groups reached the accuracy benchmarks expected by current standards in the use of CAIS. No significant differences with regards to accuracy were found between the groups, but a trend was documented favoring performance of distributed (mean difference-0.4, 95% confidence interval-0.7-0.1) in the accuracy at platform level. Distributed training students performed faster than massed for the third trial (mean difference-95.0, 95% confidence interval-178.8 to -11.2).

CONCLUSIONS

Novice students reached the accuracy benchmarks with the use of CAIS through both a massed and a distributed training program, while there was a strong but marginally not significant trend for higher accuracy in the distributed group. Students who received the training in the distributed format over the process of different days, performed faster. Trial registered in Thai Clinical Trials Registry: https://www.thaiclinicaltrials.org/show/TCTR20230109002. This clinical trial was not registered prior to participant recruitment and randomization.

Accuracy of automatic and manual dynamic navigation registration techniques for dental implant surgery in posterior sites missing a single tooth: A retrospective clinical analysis

OBJECTIVES

To assess the relative accuracy of manual (U-shaped tube) and automatic (two-in-one) dynamic navigation registration techniques for implant surgery performed in posterior sites missing one tooth.

MATERIALS AND METHODS

This study included 58 partially edentulous patients with 58 implants, including 31 and 27 in the manual and automatic groups. Deviations between the planned and actual implant placement were assessed.

RESULTS

The angular deviation in the overall study cohort was 2.54 ± 1.21°, while the 3D deviations at the implant platform and apex were 0.90 ± 0.46 mm and 1.04 ± 0.47 mm, respectively. The respective angular deviations in the manual and automatic groups were 2.82 ± 1.17° and 2.21 ± 1.19° (p > .05), while platform deviations were 0.89 ± 0.48 mm and 0.91 ± 0.45 mm (p > .05), and apex deviations were 0.99 ± 0.48 mm and 1.11 ± 0.46 mm (p > .05). No significant differences in absolute buccolingual, mesiodistal, or apicocoronal deviations were detected between these groups at either level (p > .05) nor were did deviation distributions differ in the buccolingual, mesiodistal, or apicocoronal directions at the platform or apex levels (p > .05).

CONCLUSIONS

Manual and automatic dynamic navigation registration techniques can achieve excellent accuracy when placing implants in posterior sites missing a single tooth. The two-in-one automatic registration technique can reduce the amount of time and intraoperative steps necessary to complete the registration process relative to the manual U-shaped tube registration technique. Further follow-up studies are necessary to expand on these results.

The effect of implant surgery experience on the learning curve of a dynamic navigation system: an in vitro study

BACKGROUND

Dynamic navigation systems have a broad application prospect in digital implanting field. This study aimed to explore and compare the dynamic navigation system learning curve of dentists with different implant surgery experience through dental models.

METHODS

The nine participants from the same hospital were divided equally into three groups. Group 1 (G1) and Group 2 (G2) were dentists who had more than 5 years of implant surgery experience. G1 also had more than 3 years of experience with dynamic navigation, while G2 had no experience with dynamic navigation. Group 3 (G3) consisted of dentists with no implant surgery experience and no experience with dynamic navigation. Each participant sequentially placed two implants (31 and 36) on dental models according to four practice courses (1-3, 4-6, 7-9, 10-12 exercises). Each dentist completed 1-3, 4-6 exercises in one day, and then 7-9 and 10-12 exercises 7 ± 1 days later. The preparation time, surgery time and related implant accuracy were analyzed.

RESULTS

Three groups placed 216 implants in four practice courses. The regressions for preparation time (F = 10.294, R² = 0.284), coronal deviation (F = 4.117, R² = 0.071), apical deviation (F = 13.016, R² = 0.194) and axial deviation (F = 30.736, R² = 0.363) were statistically significant in G2. The regressions for preparation time (F = 9.544, R² = 0.269), surgery time (F = 45.032, R² = 0.455), apical deviation (F = 4.295, R² = 0.074) and axial deviation (F = 21.656, R² = 0.286) were statistically significant in G3. Regarding preparation and surgery time, differences were found between G1 and G3, G2 and G3. Regarding implant accuracy, differences were found in the first two practice courses between G1 and G3.

CONCLUSIONS

The operation process of dynamic navigation system is relatively simple and easy to use. The linear regression analysis showed there is a dynamic navigation learning curve for dentists with or without implant experience and the learning curve of surgery time for dentists with implant experience fluctuates. However, dentists with implant experience learn more efficiently and have a shorter learning curve.

Comparison of Accuracy and Time for Four Implant Placement Techniques Supporting Fixed-Partial Denture

Various guiding methods are used to place implants. This ex vivo pilot study used a convenience sample to examine time and accuracy for placement of 2 dental implants supporting a 3-unit fixed prosthesis on a simulation model using freehand and 3 guided placement techniques. Four operators with no prior implant placement experiences were randomly assigned placement of 2 maxillary or mandibular implants for a fixed prosthesis. Techniques included dynamic navigation (DN), static guide (SG), template-based guide (TBG), and freehand placement (FH). Preoperative and operative times were recorded. Discrepancies between the planned and placed implant positions were assessed by superimposing preoperative and postoperative cone beam computerized tomography scans. Data were analyzed with repeated-measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). Dynamic navigation was associated with the longest operative time (13.5 minutes vs 5-10.2, P = .0001) but overall fastest when incorporating preoperative time (32.1 minutes vs 143-181.5, P < .0001). All deviation measures were significantly associated with the placement method (P < .05) except apex vertical deviation (P = .3925). Implants placed by SG had significantly lower entry 2-dimensional deviation than the other methods, particularly on the mandible. The DN and SG methods had significantly lower Apex 3D and overall angle deviations, again particularly on the mandible. The mandible had significantly higher deviations than maxilla. Within limitations of this study, implant placement by novice operators is more accurate when using dynamic and static guidance compared to freehand and template-based techniques.

Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches

Purpose

This study aimed to investigate the performance of novice versus experienced practitioners for placing dental implant using freehand, static guided and dynamic navigation approaches.

Methods

A total of 72 implants were placed in 36 simulation models. Three experienced and three novice practitioners were recruited for performing the osteotomy and implant insertion with freehand, surgical guide (pilot-drill guidance) and navigation (X-Guide, X-Nav technologies) approaches. Each practitioner inserted 4 implants per approach randomly with a 1-week gap to avoid memory bias (4 insertion sites × 3 approaches × 6 practitioners = 72 implants). The performance of practitioners was assessed by comparing actual implant deviation to the planned position, time required for implant placement and questionnaire-based self-confidence evaluation of practitioners on a scale of 1–30.

Results

The navigation approach significantly improved angular deviation compared with freehand (P < 0.001) and surgical guide (P < 0.001) irrespective of the experience. Surgical time with navigation was significantly longer compared to the freehand approach (P < 0.001), where experienced practitioners performed significantly faster compared to novice practitioners (P < 0.001). Overall, self-confidence was higher in favor of novice practitioners with both guided approaches. In addition, the confidence of novice practitioners (median score = 26) was comparable to that of experienced practitioners (median score = 27) for placing implants with the navigation approach.

Conclusions

Dynamic navigation system could act as a viable tool for dental implant placement. Unlike freehand and static-guided approaches, novice practitioners showed comparable accuracy and self-confidence to that of experienced practitioners with the navigation approach.

Graphical Abstract

Learning Curve and Comparison of Dynamic Implant Placement Accuracy Using a Navigation System in Young Professionals

The aim of the current study was to evaluate the learning curve and accuracy of implant placement by young professionals using a dynamic computer-assisted surgical system for dental implant placement. Ten students tried to place eight implants with a dynamic surgical system in predefined positions on two consecutive weekends, resulting in 160 implant placements in total. Postoperatively, the positions of the implants were scanned with an intraoral scanner and compared for deviations at the entry point, the apex, as well as angular deviations to the master model. The mean values of all measurements improved; statistical significance was found for the changes in the angle as well as for the position of the implants to the apex (p < 0.001). Furthermore, the young professionals indicated subjective improvement in handling the dynamic surgery system. Navigated surgical dental implant placement can be learned quickly and can support young professionals in everyday clinical practice, especially in difficult anatomic situations.

Comparative Analysis of Implant Prosthesis Treatment Planning and Execution Following Bone Repair Procedures Using Dynamic Surgical Navigation in Augmented Areas

Successful implant placement in augmented sites depends on the appropriate bone volume and quality, as well as careful planning of the procedure. Minimizing risks during the surgical and healing phases is also of great importance. A very promising technique has been introduced, which partially meets the above criteria. This technique is designed to increase the precision and reduce the invasiveness associated with surgical procedures during implantation. The aim of this clinical study was to analyze the accuracy of computer-guided implant surgery in augmented sites in patients treated with dental implants introduced using dynamic implant navigation. Eleven healthy patients who had planned and performed implant-prosthetic treatment after bone augmentation were analyzed. Twenty-three implants were placed with Navident dynamic navigation using the tissue punch flapless technique. This study evaluated the position of the inserted implant relative to the virtual plan and determined the correlation. The treatments were successful in all the treated patients, and the integration period (3 or 6 months) was uneventful and enabled implant-prosthetic treatment. The accuracy values provided in this study are comparable to, but not better than, data provided in the literature on dynamic and static computer-assisted surgery. Dynamic navigation may improve the quality and safety of surgical procedures and reduce the risk of complications.

Duration, deviation and operator's perception of static computer assisted implant placements by inexperienced clinicians

INTRODUCTION

This study measured the duration, deviation and operator's perception of implant placement by fully guided (FG), pilot-guided (PG) and freehand (FH) protocols by postgraduate students with minimal implant experience.

MATERIALS AND METHODS

Twenty postgraduate students participated in the study. Half of them placed single anterior (S-Ant) and single posterior (S-Post) implants, and the other half placed anterior (B-Ant) and posterior (B-Post) implants in a wide edentulous area. The PG placement involved surgical guides that only controlled pilot drilling, whilst the FG placement controlled all the drilling steps and implant placement. The duration of implant placement and the operator's perception (ease of drilling, ease of implant placement and operator's preference) were measured. The deviations of placed implants were quantified by measuring the trueness and angulation deviations in relation to the planned implants.

RESULTS

The PG placement was the quickest for inserting implants, followed by FG and FH placements, respectively (p < .05). The location of the implant had influenced the duration of implant placement only for the PG placement. In relation to ease of drilling, ease of implant placement and operator's preference, there was no significant difference amongst the different placement protocols or implant locations. The FG placement was associated with least deviations, followed by PG and FH placements, respectively (p < .05).

CONCLUSIONS

In the hands of postgraduate students with minimal implant experience, FG and PG placements reduced the implant placement duration in comparison with FH placement. The FG placement was consistently more accurate followed by PG placement.

The accuracy and learning curves of active and passive dynamic navigation-guided dental implant surgery: An in vitro study

OBJECTIVES

Infrared dynamic navigation principles can be categorized into active and passive navigation systems based on whether the surgical instruments can emit or only reflect light, respectively. This in vitro study aimed to compare the accuracy of implant placement and the learning curves of both active and passive dynamic navigation systems using different registration methods.

METHODS

Implants (n=704) were placed in 64 sets of models and divided into active (Yizhime, DCARER, Suzhou, China) and passive (Iris-Clinic, EPED, Kaohsiung, China) dynamic navigation groups. Both marker point-based registration (M-PBR) and feature point-based registration (F-PBR) were employed by two groups mentioned above. Based on preoperative and postoperative cone-beam computed tomography imaging, the coronal, midpoint, apical, and angular deviations were analyzed from 2D and 3D views. The operation time was recorded for each group.

RESULTS

The active dynamic navigation group exhibited significantly greater accuracy than the passive dynamic navigation group for outcome variables (angular deviation, 4.13 ± 2.39° and 4.62 ± 3.32°; coronal global deviation, 1.48 ± 0.60 and 1.86 ± 1.12 mm; apical global deviation, 1.75 ± 0.81 and 2.20 ± 1.68 mm, respectively). Significant interaction effects were observed for both registration methods and four quadrants with different dynamic navigation systems. Learning curves for the two dynamic navigation groups approached each other after 12 procedures, and finally converged after 27 procedures.

CONCLUSIONS

The accuracy of active dynamic navigation system was superior to that of passive dynamic navigation system. Different combinations of dynamic navigation systems, registration methods, and implanted quadrants displayed various interactions.

CLINICAL SIGNIFICANCE

Our findings could provide guidance for surgeons in choosing an appropriate navigation system use in various implant surgeries. Furthermore, the time required by surgeons to master the technique was calculated for reference. Nevertheless, there are certain limitations to this in vitro study, and therefore further research is required.

Accuracy of Dynamic Navigation for Non-Surgical Endodontic Treatment: A Systematic Review

In recent years, the application of Guided Endodontics has gained interest for non-surgical endodontic treatment and retreatment. The newest research focuses on the accuracy of Dynamic Navigation (DN). This article systematically reviewed existing data on the accuracy of non-surgical endodontic treatment procedures that were completed using DN. Following the PRISMA criteria, an electronic database search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library. Studies comparing the accuracy of non-surgical endodontic treatment using DN and the conventional freehand technique were eligible. The literature search resulted in 176 preliminary records. After the selection process six studies were included. The risk of bias was evaluated using the modified Cochrane Collaboration Risk of Bias 2.0 tool. Five studies examined the aid of DN for planning and executing endodontic access cavities, and one for fiber post removal. In two studies, endodontic access cavities were performed in teeth with pulp canal obliteration. The main outcomes that were measured in the included studies were preparation time, global coronal entry point and apical endpoint deviations, angular deviation, tooth substance loss, qualitative precision, number of unsuccessful attempts or procedural mishaps. The risk of bias was rated from low to raising some concerns. Overall, DN showed increased accuracy compared to the freehanded technique and could be especially helpful in treating highly difficult endodontic cases. Clinical studies are needed to confirm the published in vitro data.

Does machine-vision-assisted dynamic navigation improve the accuracy of digitally planned prosthetically guided immediate implant placement? A randomized controlled trial

OBJECTIVES

This randomized controlled clinical trial was designed to compare the accuracy of machine-vision (MV)-based dynamic navigation (DN)-assisted immediate implant placement with the conventional freehand technique.

MATERIAL AND METHODS

A total of 24 subjects requiring immediate implant placement in maxillary anterior teeth were randomly assigned to either the control (freehand by an experienced surgeon, n = 12) or the test group (MV-DN, n = 12). Implant platform, implant apex, angular, and depth deviations with respect to prosthetically guided digital planning and differences in implant insertion torque (ITV) and implant stability quotient (ISQ) were compared between the groups.

RESULTS

MV-DN resulted in more accurate immediate implant position: significantly smaller global platform deviation (1.01 ± 0.41 mm vs. 1.51 ± 0.67 mm, p = .038), platform depth deviation (0.44 ± 0.46 mm vs. 0.95 ± 0.68 mm, p = .045), global apex deviation (0.88 ± 0.43 mm vs. 1.94 ± 0.86 mm, p = .001), and lateral apex deviation (0.68 ± 0.30 mm vs. 1.61 ± 0.88 mm, p = .004) were found in MV-DN compared to controls. No significant intergroup differences were observed for ITV and ISQ.

CONCLUSIONS

MV-DN achieved more precise immediate implant position and comparable primary stability. Further trials are necessary to assess the benefits in terms of esthetics and tissue health/stability.

Exploring training dental implant placement using static or dynamic devices among dental students

BACKGROUND

Static computer-assisted surgery (s-CAIS) and dynamic computer-assisted implant surgery (d-CAIS) are the main digital approaches in guiding dental implant placement.

PURPOSE

The aim of this study was to explore and compare the learning curves for s-CAIS and d-CAIS by beginners.

MATERIALS AND METHODS

Three dental students used each dental model for drilling five positions with missing teeth. Operators performed the drilling test for five sets of dental models with an interval of 7 ± 1 days assisted by the d-CAIS system. After a six-month break, the same students performed the drilling test again in the same way but with the s-CAIS system. A total of thirty models were used, and 150 implants were inserted. The operation time and relative deviations were recorded and calculated. Correlations between various deviation parameters and attempts were tested with independent-samples Kruskal-Wallis tests.

RESULTS

A significant difference between the two groups was found in the operation time (p < .001). For accuracy, the difference was found in the first attempt of coronal and apical deviations but disappeared as the training went on. As the practice progressed, improvement was evident in the d-CAIS group but not in the s-CAIS group. When reaching the plateau stage of the learning curve of the d-CAIS group (after five attempts), the influence of different methods of guidance was limited between the two groups.

CONCLUSIONS

A learning curve effect was found in d-CAIS but not in s-CAIS in vitro tests by beginners. The operating procedure of dynamic navigated and static template-guided implant placement was easy to master.

Comparison of the accuracy of two different dynamic navigation system registration methods for dental implant placement: A retrospective study

BACKGROUND

Dynamic navigation approaches are widely employed in the context of implant placement surgery, with registration being integral to the accuracy of such navigation. Relatively few studies to date, however, have compared different registration approaches, and such a comparison has the potential to guide the development of more accurate and reliable clinical registration methodology.

PURPOSE

This study was developed to compare the accuracy of dynamic navigation-based dental implant placement conducted using either U-tube or cusp registration methods.

MATERIALS AND METHODS

Medical records from all patients that had undergone implant surgery between August 2019 and October 2020 in the First Clinical Division of the Peking University Hospital of Stomatology were retrospectively reviewed, with 64 patients and 99 implants ultimately meeting with study inclusion criteria. Implant placement accuracy was gauged via the superimposition of the planned implant position in preoperative cone-beam computed tomography (CBCT) images with the true postoperative implant position in postoperative CBCT images. Accuracy was measured based upon the angular deviation, entry deviation (3-dimensional [3D] deviation in the coronal aspect of the alveolar ridge), and apex deviation (3D deviation in the apical area of the implant) when comparing these two positions.

RESULTS

The angular deviation, entry deviation, and apex deviation of all analyzed implants were 3.29 ± 0.17°, 1.29 ± 0.07 mm, and 1.43 ± 0.08 mm, respectively, while in the cusp registration group these respective values were 3.25 ± 1.58°, 1.28 ± 0.60 mm, and 1.34 ± 0.63 mm as compared to 3.35 ± 1.78°, 1.30 ± 0.78 mm, 1.55 ± 0.9 mm in the U-tube group, respectively. No significant differences in accuracy were observed when comparing these two registration techniques.

CONCLUSION

Dynamic computer-assisted surgical systems can facilitate accurate implantation, and both the U-tube and cusp registration methods exhibit similar levels of accuracy. As the cusp registration technique can overcome some of the limitations of the U-tube strategy without the need for an additional registration device, it may be more convenient for clinical use and warrants further research.

Effectiveness of Virtual Reality and Interactive Simulators on Dental Education Outcomes: Systematic Review

In recent years, virtual reality and interactive digital simulations have been used in dental education to train dental students before interacting with real patients. Scientific evidence presented the application of virtual technology in dental education and some recent publications suggested that virtual and haptic technologies may have positive effects on dental education outcomes. The aim of this systematic review was to determine whether virtual technologies have positive effects on dental education outcomes and to explore the attitudes of dental students and educators toward these technologies. A thorough search was conducted in PubMed, Scopus, MEDLINE (via EBSCO), The Cochrane Library (via Wiley), Web of Science Core Collection (via Thomson Reuters), and Dentistry and Oral Science source (via EBSCO) using the keywords (student, dental) AND (education, dental) AND (virtual reality) OR (augmented reality) OR (haptics) OR (simulation) AND (dentistry) OR (dental medicine). The quality of the reported information was assessed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement for systematic reviews. A total of 73 publications were considered for this review. Fifty-two of the selected studies showed significant improvement in educational outcomes and virtual technologies were positively perceived by all the participants. Within the limitations of this review, virtual technology appears to improve education outcomes in dental students. Further studies with larger samples and longer term clinical trials are needed to substantiate this potential positive impact of various virtual technologies on dental education outcomes.

Current State of Serious Games in Dentistry: A Scoping Review

Objective: Over the past decade, serious games (SGs) have played a growing role in medical education and health promotion; however, little is known about their use in the field of oral health. This study provides a comprehensive synthesis about SGs developed for training oral health professionals or for health promotion in oral health. Material and Methods: A systematic search was conducted. The following electronic databases were reviewed: MEDLINE (1966 to September 2019), Embase (1980 to September 2019), and Cochrane Central Register of Controlled Trials (CENTRAL), LILACS and Scopus from inception to September 2019. Two reviewers independently screened and assessed the study's quality and extracted data. The Sardi and collaborators' tool was used to assess the quality of the evidence presented. Results: A total of 19 studies (25 articles) were selected. Games were divided into two categories: for specific educational purposes and for oral health promotion. Most studies involved oral health professions' students (n = 9) or school/preschool children (n = 9). Two studies included preschool children and parents. Interactive SGs were as effective as traditional noninteractive methods in improving oral health outcomes. Nonetheless, participants' feedback reflected a higher level of satisfaction in learning through games. The quality of the studies was limited due to the lack of a proper technical description of the games and the absence of discussion of the limitations and challenges of the games. Conclusion: The use of SGs in oral health is limited, and little valid empirical evidence is available to confirm their effectiveness. Further studies are required for using more rigorous designs, evaluation, and follow-ups.

Accuracy and Efficiency of 3-dimensional Dynamic Navigation System for Removal of Fiber Post from Root Canal-Treated Teeth

INTRODUCTION

The purpose of this study was to investigate the accuracy and efficiency of the 3-dimensional dynamic navigation system (DNS) compared with the freehand technique (FH) when removing fiber posts from root canal-treated teeth.

METHODS

Twenty-six maxillary teeth were included. Teeth were root canal treated and restored with Parapost Taper Lux (Coltene/Whaledent, Altstätten, Switzerland) luted with RelyX Unicem (3M ESPE, St Paul, MN). A core buildup was then performed using Paracore (Coltene/Whaledent). Teeth were mounted in tissue-denuded cadaver maxillae. Teeth were divided into 2 groups: the DNS group (n = 13) and the FH group (n = 13). Cone-beam computed tomographic scans were taken pre- and postoperatively. The drilling path and depth were planned virtually using X-guide software (X-Nav Technologies, Lansdale, PA) in both groups. For the DNS group, drilling was guided with X-Nav software and the FH group under a dental operating microscope. Global coronal and apical deviations, angular deflection, operation time, and the number of mishaps were compared between the groups to determine the accuracy and efficiency. The 3-dimensional volume (mm³) of all teeth was calculated before and after post removal using the Mimics Innovation Suite (Materialise NV, Leuven, Belgium). The Shapiro-Wilk, 1-way analysis of variance, and Fisher exact tests were used (P < .05).

RESULTS

The DNS group showed significantly less global coronal and apical deviations and angular deflection than the FH group (P < .05). DNS required less operation time than FH. Moreover, the DNS technique had significantly less volumetric loss of tooth structure than the FH technique (P < .05).

CONCLUSIONS

The DNS was more accurate and efficient in removing fiber posts from root canal-treated teeth than the FH technique.

Effect of repeated use of an implant handpiece on an output torque: An in-vitro study

PURPOSE

This study aimed to evaluate the effect of repeated use of an implant handpiece under an implant placement torque (35 Ncm) and overloading torque condition (50 Ncm) on an output torque.

MATERIALS AND METHODS

Two types of implant handpiece systems (Surgicpro/X-DSG20L [NSK, Kanuma, Japan] and SIP20/CRB46LN [SAESHIN, Daegu, South Korea]) were used. The output torque was measured using a digital torque gauge. The height and angle (x, y, and z axes) of the digital torque gauge and implant handpiece were adjusted through a jig for passive connection. The experiment was conducted under the setting torque value of 35 Ncm (implant placement torque) and 50 Ncm (overloading torque condition) and 30 times per set; a total of 5 sets were performed (N = 150). For statistical analysis, the difference between the groups was analyzed using the Mann-Whitney U test and the Friedman test was used to confirm the change in output torque (α=.05).

RESULTS

NSK and SAESHIN implant handpieces showed significant differences in output torque results at the setting torques of 35 Ncm and 50 Ncm (P<.001). The type of implant handpiece and repeated use influenced the output torque (P<.001).

CONCLUSION

There may be a difference between the setting torque and actual output torque due to repeated use, and the implant handpiece should be managed and repaired during long-term use. In addition, for successful implant results in dental clinics, the output torque of the implant handpiece system should be checked before implant placement.

A Novel Guided Zygomatic and Pterygoid Implant Surgery System: A Human Cadaver Study on Accuracy

The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.

Accuracy assessment of dynamic computer-aided implant placement: a systematic review and meta-analysis

OBJECTIVES

To assess the accuracy of dynamic computer-aided implant surgery (dCAIS) systems when used to place dental implants and to compare its accuracy with static computer-aided implant surgery (sCAIS) systems and freehand implant placement.

MATERIALS AND METHODS

An electronic search was made to identify all relevant studies reporting on the accuracy of dCAIS systems for dental implant placement. The following PICO question was developed: "In patients or artificial models, is dental implant placement accuracy higher when dCAIS systems are used in comparison with sCAIS systems or with freehand placement? The main outcome variable was angular deviation between the central axes of the planned and final position of the implant. The data were extracted in descriptive tables, and a meta-analysis of single means was performed in order to estimate the deviations for each variable using a random-effects model.

RESULTS

Out of 904 potential articles, the 24 selected assessed 9 different dynamic navigation systems. The mean angular and entry 3D global deviations for clinical studies were 3.68° (95% CI: 3.61 to 3.74; I² = 99.4%) and 1.03 mm (95% CI: 1.01 to 1.04; I² = 82.4%), respectively. Lower deviation values were reported in in vitro studies (mean angular deviation of 2.01° (95% CI: 1.95 to 2.07; I² = 99.1%) and mean entry 3D global deviation of 0.46 mm (95% CI: 0.44 to 0.48 ; I² = 98.5%). No significant differences were found between the different dCAIS systems. These systems were significantly more accurate than sCAIS systems (mean difference (MD): -0.86°; 95% CI: -1.35 to -0.36) and freehand implant placement (MD: -4.33°; 95% CI: -5.40 to -3.25).

CONCLUSION

dCAIS systems allow highly accurate implant placement with a mean angular of less than 4°. However, a 2-mm safety margin should be applied, since deviations of more than 1 mm were observed. dCAIS systems increase the implant placement accuracy when compared with freehand implant placement and also seem to slightly decrease the angular deviation in comparison with sCAIS systems.

CLINICAL RELEVANCE

The use of dCAIS could reduce the rate of complications since it allows a highly accurate implant placement.

Accuracy of dynamic navigation in implant surgery: A systematic review and meta-analysis

OBJECTIVE

To assess the accuracy of dynamic computer-assisted implant surgery.

MATERIALS AND METHODS

An electronic search up to March 2020 was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trial to identify studies using dynamic navigation in implant surgery, and additional manual search was performed as well. Clinical trials and model studies were selected. The primary outcome was accuracy. A single-arm meta-analysis of continuous data was conducted. Meta-regression was utilized for comparison on study design, guidance method, jaw, and systems.

RESULTS

Ten studies, four randomized controlled trials (RCT) and six prospective studies, met the inclusion criteria. A total of 1,298 drillings and implants were evaluated. The meta-analysis of the accuracy (five clinical trials and five model studies) revealed average global platform deviation, global apex deviation, and angular deviation were 1.02 mm, 95% CI (0.83, 1.21), 1.33 mm, 95% CI (0.98, 1.67), and 3.59°, 95% CI (2.09, 5.09). Meta-regression shown no difference between model studies and clinical trials (p = .295, 0.336, 0.185), drilling holes and implant (p = .36, 0.279, 0.695), maxilla and mandible (p = .875, 0.632, 0.281), and five different systems (p = .762, 0.342, 0.336).

CONCLUSION

Accuracy of dynamic computer-aided implant surgery reaches a clinically acceptable range and has potential in clinical usage, but more patient-centered outcomes and socio-economic benefits should be reported.

Accuracy of Dynamic Computer-Assisted Implant Placement: A Systematic Review and Meta-Analysis of Clinical and In Vitro Studies

The aim of this systematic review and meta-analysis is to analyze the accuracy of implant placement using computer-assisted dynamic navigation procedures. An electronic literature search was carried out, supplemented by a manual search. The literature search was completed in June 2020. The results of in vitro and clinical studies were recorded separately from each other. For inclusion in the review, the studies had to examine at least the prosthetically relevant parameters for angle deviation, as well as global deviation or lateral deviation at the platform of the implant. Sixteen of 320 articles were included in the investigation: nine in vitro and seven clinical studies. The meta-analysis showed values of 4.1° for the clinical studies (95% CI, 3.12-5.10) and 3.7° for the in vitro studies (95% CI, 2.31-5.10) in terms of the angle deviation. The global deviation at the implant apex of the implant was 1.00 mm for the clinical studies (95% CI, 0.83-1.16) and 0.91 mm for the in vitro studies (95% CI, 0.60-1.12). These values indicate no significant difference between the clinical and in vitro studies. The results of this systematic review show a clinical accuracy of dynamic computer-assisted navigation that is comparable to that of static navigation. However, the dynamic navigation systems show a great heterogeneity that must be taken into account. Moreover, currently there are few clinical data available. Therefore, further investigations into the practicability of dynamic navigation seem necessary.

The Modern and Digital Transformation of Oral Health Care: A Mini Review

Dentistry is a part of the field of medicine which is advocated in this digital revolution. The increasing trend in dentistry digitalization has led to the advancement in computer-derived data processing and manufacturing. This progress has been exponentially supported by the Internet of medical things (IoMT), big data and analytical algorithm, internet and communication technologies (ICT) including digital social media, augmented and virtual reality (AR and VR), and artificial intelligence (AI). The interplay between these sophisticated digital aspects has dramatically changed the healthcare and biomedical sectors, especially for dentistry. This myriad of applications of technologies will not only be able to streamline oral health care, facilitate workflow, increase oral health at a fraction of the current conventional cost, relieve dentist and dental auxiliary staff from routine and laborious tasks, but also ignite participatory in personalized oral health care. This narrative article review highlights recent dentistry digitalization encompassing technological advancement, limitations, challenges, and conceptual theoretical modern approaches in oral health prevention and care, particularly in ensuring the quality, efficiency, and strategic dental care in the modern era of dentistry.

The Challenge of Dental Education After COVID-19 Pandemic - Present and Future Innovation Study Design

The present work suggests research and innovation on the topic of dental education after the COVID-19 pandemic, is highly justified and could lead to a step change in dental practice. The challenge for the future in dentistry education should be revised with the COVID-19 and the possibility for future pandemics, since in most countries dental students stopped attending the dental faculties as there was a general lockdown of the population. The dental teaching has an important curriculum in the clinic where patients attend general dentistry practice. However, with SARS-CoV-2 virus, people may be reluctant having a dental treatment were airborne transmission can occur in some dental procedures. In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are extremely important. Therefore, dental education has to adapt the curriculum to embrace new technology devices, instrumentations systems, haptic systems, simulation based training, 3D printer machines, to permit validation and calibration of the technical skills of dental students.

Evaluation of a dynamic navigation system for training students in dental implant placement

OBJECTIVE

Computer-guided simulation systems may offer a novel training approach in many surgical fields. This study aimed to compare dental students' learning progress in dental implants placement between a dynamic navigation system and a traditional training method using a simulation model.

METHODS

Senior dental students with no implant placement experience were randomly assigned to implant placement training using a dynamic navigation system or a traditional freehand protocol. After training, 3-dimensional (3D) deviation at implant platform, 3D deviation at implant apex, and deviation of implant axis between the planned and placed implant positions were measured using superimposed cone beam computed tomography scans.

RESULTS

Six students were trained in this study. Students showed significantly greater improvement in implant placement after training using the dynamic navigation system than after using the traditional freehand protocol. Overall deviation of implant axis (P < 0.001) and 3D apex deviation (P = 0.014) improved with training using the dynamic navigation system, but differences in 3D platform deviation (P = 0.513) were not statistically significant.

CONCLUSIONS

A dynamic navigation system may be a useful teaching tool in the early development of clinical skills in implant placement for the novice practitioners. Novice practitioners exhibited significant improvement in angulation deviation across implant placement attempts with dynamic navigation system training.

Effects of two Postprocessing Methods onto Surface Dimension of in-Office Fabricated Stereolithographic Implant Surgical Guides

PURPOSE

To evaluate the effects of two postprocessing methods in terms of the overall, intaglio, and cameo surface dimensions of in-office stereolithographic fabricated implant surgical guides.

MATERIALS AND METHODS

Twenty identical implant surgical guides were fabricated using a stereolithographic printer. Ten guides were postprocessed using an automated method. The other ten guides were postprocessed using a series of hand washing in combination with ultrasonics. Each guide was then scanned using cone-beam computed tomography to produce a set of digital imaging and communications in medicine (DICOM) files which were converted into standard tessellation language (STL) files. The STL file was then superimposed onto the original STL design file using the best fit alignment. The average positive and negative surface discrepancy differences in terms of means and variances were analyzed using t-test (α = 0.05).

RESULTS

For the alternative group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 77.38 ± 10.68 µm and -67.74 ± 6.55 µm; 78.83 ± 8.65 µm and -68.16 ± 5.26 µm; and 70.5 ± 8.48 µm -64.84 ± 5.55 µm, respectively. For the automated group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 51.88 ± 4.38 µm and -170.7 ± 11.49 µm; 64.3 ± 4.44 µm and -89.45 ± 6.25 µm; and 83.59 ± 4.81 µm and -144.26 ± 13.19 µm, respectively. There was a statistical difference between the means of the two methods for the overall, intaglio, and cameo positive and negative discrepancies (p < 0.001).

CONCLUSIONS

For a single implant tooth-supported implant guide, using hand washing with ultrasonics appeared to be consistently better than the automated method. The manual method presented with more positive discrepancies, while the automated method presented with more negative discrepancies.

Dynamic Navigation in Dental Implantology: The Influence of Surgical Experience on Implant Placement Accuracy and Operating Time. An in Vitro Study

AIM

the aim of this in vitro study was to test whether the implant placement accuracy and the operating time can be influenced by the operator's experience.

MATERIALS AND METHODS

sixteen models underwent a (Cone Beam Computer Tomography) CBCT and implant positioning was digitally planned on this. The models were randomly assigned to four operators with different levels of surgical experience. One hundred and twelve implant sites were drilled using a dynamic navigation system and operating times were measured. Based on postoperative CBCTs, dental implants were virtually inserted and superimposed over the planned ones. Two-dimensional and 3D deviations between planned and virtually inserted implants were measured at the entry point and at the apical point. Angular and vertical errors were also calculated.

RESULTS

considering coronal and apical 3D deviations, no statistically significant differences were found between the four operators (p = 0.27; p = 0.06). Some vectorial components of the deviation at the apical point and the angular errors of some operators differed from each other.

CONCLUSIONS

within the limitations of this study, dynamic navigation can be considered a reliable technique both for experienced and novice clinicians.