Accuracy of Dynamic Navigation System in Endodontic Microsurgery: A Systematic Review of In Vitro Studies

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

Analysis of the accuracy of a dynamic navigation system in endodontic microsurgery: A prospective case series study

Evaluation of the accuracy of dynamic navigation versus robot-assisted dental implant placement in models with one missing tooth or multiple missing teeth with a free-end: an in vitro study.

The impact of the experience of the clinician on learning a new skill or equipment was still an intriguing subject. The goal of this research is to determine the accuracy level of a dynamic navigation system to that of freehand drilling by expert and novice practitioners with varied levels of experience. Additionally, the duration of the surgical procedure and the self-confidence level of the surgeons were also evaluated. An analogimpression of the patient was used to make 20 polyurethane simulation models of the maxilla. Five expert and five inexperienced surgeons prepared the site and placed the implants at random on ten models each. Two different techniques were used to insert dental implants: freehand and dynamic navigation systems. Dental implants were placed in Group 1 utilizing a computer-assisted dynamic navigation device. The implants in Group 2 were secured using free-hand drilling. The dental implants were inserted first in the maxillary right first molar, then in the maxillary right lateral incisor, and the maxillary left second premolar. Preoperative and postoperative CBCT scans were superimposed by employing the Evalunav software and contrasted. The coronal 3-D, apex 3-D, apex vertical depth, and angular deviations for both procedures were evaluated. A pre-tested self-confidence questionnaire was also administered to assess the self-confidence of the practitioners. The duration of the surgical time was also documented for each strategy. The t-test was used to measure the difference in accuracy and confidence levels between freehand and dynamic navigation systems among expert and novice surgeons using SPSS software (IBM Corp., Armonk, NY, USA). A total of 60 implants were used (three insertion sites, two methods, and 10 practitioners). Each of the five expert and novice clinicians implanted 15 implants (five models each). Except for entry 3-D, there was a statistically significant difference between the two approaches in all of the primary outcome variables. The apex 3-D (5.89±1.08 mm) and apex vertical (2.08±1.27 mm) dimensions of the dynamic navigation system were significantly smaller than those of the freehand drilling approach (p<005). Dynamic navigation and freehand drilling had angular deviations of 7.16±1.76ᵒ and 9.06±2.18ᵒ, respectively (p=0.0004). The apex vertical deviation was reduced in the navigation technique (2.07±1.5 mm) than in the freehand drilling (2.86±1.4 mm) by experienced practitioners (p=0.04). The difference in time between the two procedures was determined to be statistically highly significant (p<0.001) by both expert and novice surgeons. Furthermore, when contrasting with experienced practitioners, novice practitioners had an overall increase in surgery time (p<0.001) for both approaches. The current in vitro study found that the dynamic navigation system enables more accurate implant placement than the freehand drilling technique, irrespective of the experience of the surgeons. However, this technique appears to benefit novice practitioners more, as they can profoundly minimize their deviations while accomplishing results comparable to those of expert surgeons.

Recent advancements in endodontic surgery have significantly improved outcomes through enhanced technology, including digital planning, cone-beam computed tomography (CBCT), and operating microscopes. The integration of dynamic navigation systems (DNS) has particularly transformed endodontic microsurgery (EM) by providing real-time guidance and precision. This case report explores the application of DNS in a clinical case of EM involving a mandibular first molar with symptomatic apical periodontitis. A 36-year-old male patient presented with masticatory pain in the lower left quadrant. Radiographic and CBCT evaluations revealed an underfilled mesiolingual canal and a periapical lesion. The surgical procedure utilized DNS for precise osteotomy and apicectomy, guided by the Navident® system and incorporating the cortical window technique. Postoperative care included antibiotic therapy and follow-up appointments, demonstrating successful periapical healing at 21 months. DNS technology significantly enhances precision and conservativeness in EM, allowing for real-time guidance and minimizing iatrogenic risks. The cortical window technique, combined with DNS, facilitates effective root access while preserving bone structure. Despite its advantages, DNS is associated with high costs and a steep learning curve. Future research should focus on evaluating the long-term clinical outcomes of DNS, improving system usability, and exploring its applications in other endodontic procedures. This case report demonstrates the successful use of DNS in conjunction with the cortical window technique for EM, achieving favorable clinical outcomes and promoting accelerated healing. Further studies are needed to validate the broader clinical utility of DNS and to refine its integration into routine practice.

Endodontic microsurgery (EMS) represents a significant advancement in the treatment of persistent periapical disease, evolving from conventional apicoectomy techniques into a precise, minimally invasive procedure. Indications for EMS include nonsurgical retreatment has failed or is not feasible, the primary endodontic treatment cannot be improved upon, insufficient residual dentin thickness, extra-radicular infection, among others. EMS follows a precise sequence: diagnosis and planning, surgical access, osteotomy, root-end resection, retrograde preparation and filling, and final closure; performed under advanced magnification and microsurgical techniques. The positive result of EMS is the healing of apical periodontitis. Nowadays, with the use of an operating microscope, which provides high magnification, has demonstrated high success rates, ranging from 91.4% to 94.4%. The integration of three-dimensional (3D) navigation technology into EMS has marked a significant advancement in the field, offering unparalleled precision and control during surgical procedures. Guided EMS, whether through static, dynamic or robotic navigation, enables clinicians to accurately plan and execute osteotomies and apical resections while minimizing damage to surrounding anatomical structures. This article provides an overview of the current state of EMS. It highlights the most recent innovations in clinical protocols and discusses their impact on treatment outcomes. KEY POINTS: Endodontic microsurgery (EMS) is a predictable, minimally invasive treatment for persistent periapical disease, especially when nonsurgical retreatment is not feasible or has failed. Advanced imaging (CBCT), microsurgical techniques, and biocompatible root-end filling materials significantly enhance diagnosis, surgical precision, and long-term treatment outcomes. Guided EMS, using static or dynamic navigation systems, improves accuracy and safety in complex cases, reducing the risk to surrounding anatomical structures and increasing procedural predictability. PLAIN LANGUAGE SUMMARY: Endodontic microsurgery (EMS) is a major improvement in treating ongoing endodontic problems. It updates traditional root-end surgery by making it more precise and less invasive. EMS is used when standard treatments fail or aren't possible, when the initial treatment can't be improved, when there isn't enough tooth dentin, or when there's an external infection. The process includes diagnosing the problem, planning, accessing the tooth, removing the infected root section, filling the area, and final closure. This is done using advanced magnifying microscopes and microsurgery techniques. One key benefit of EMS is its ability to help heal apical periodontitis, an infection at the root end. Using high-magnification microscopes, success rates for this procedure are impressive, ranging from 91.4% to 94.4%. Incorporating 3D navigation technology into EMS allows for even more accuracy during surgery, helping dentists carefully plan procedures while minimizing damage to surrounding tissues. This article reviews the current state of EMS, focusing on the latest advancements in techniques and their positive effects on treatment outcomes.

Objectives: The use of the surgical operating microscope, CBCT imagining, biocompatible filling materials and ultrasonic instruments have improved the success and predictability of apical surgery. Despite these advances, more accurate and precise techniques for creating osteotomies and root-resections (apicoectomies) have not been widely adopted. This study highlights how dynamic navigation systems (DNS) can help avoid unnecessary dentin removal and “mitigate iatrogenic errors” such as root perforation. Methods: A total of 56 root-end resections were planned and completed on two sets of identical TrueJaw Endosurg models (DE Labs, Santa Barbra, CA, USA). One set of maxillary and mandibular jaws were used for 28 preparations, performed with a DNS (X-Guide, X-Nav Technologies, Lansdale, PA, USA). A second set of maxillary and mandibular jaws were used for 28 preparations executed freehand (FH), with pre-op measurements taken from a CBCT scan (CS 9600; Carestream, Atlanta, GA, USA). A Mann-Whitney test was used to compare the accuracy of the two groups Results: The average preparation depth was 10.77 mm. For the DNS group the average angular deviation was 2.35 degrees. The average deviation at the terminal end of the preparations was 0.96 mm (global apical deviation). For the freehand group average angular deviation was 13.55 degrees and the average global apical deviation was 2.62 mm. Significant differences were identified between the DNS and FH groups for angular deviation (p&lt;0.05), apical non-depth deviation (p&lt;0.05) and between the Global apical deviation(p&lt;0.05). Conclusion: Dynamic navigation demonstrated superior accuracy and precision over freehand in the context of apical microsurgery preparations. This study provides further proof of concept for the application of DNS in Endodontics. Clinical significance: Apical surgery can be a daunting task for an endodontist. Surgical guides can make the procedure easier, but they take time and money to make. DNS virtual planning can be completed rapidly and may be altered mid-procedure. This inherent flexibility makes same-day guided apical surgeries practical and predictable.

Endodontic Microsurgery Using Dynamic Navigation System: A Case Report

Integration of an Ultrasonic Device into Dynamic Navigation System for a Fully Guided Dynamic Endodontic Microsurgery Workflow: An In Vitro Study.

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

Endodontic microsurgery (EMS) is a precision-dependent procedure in which accurate localization of the root apex and controlled osteotomy are critical for successful outcomes. Despite advances in cone-beam computed tomography (CBCT), magnification, and microsurgical techniques, discrepancies between preoperative planning and intraoperative execution remain a persistent challenge, largely due to limitations in depth perception and spatial interpretation. Augmented reality (AR) technology has been introduced as an intraoperative guidance tool that enable real-time superimposition of three-dimensional anatomical data onto the surgical field, with the potential to enhance visual spatial integration and procedural accuracy. However, the effectiveness of AR-assisted EMS remains unclear due to limited and methodologically heterogeneous evidence. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Electronic searches were performed in PubMed, Scopus, and Web of Science, supplemented by citation searching. Studies evaluating AR EMS were included. Data extraction was performed using a standardized framework, and outcomes were grouped into accuracy, efficiency, safety, operator-related parameters, and treatment completeness. Risk of bias was assessed using Cochrane RoB 2 for randomized studies and ROBINS-I (version 2) for non-randomized studies. Three studies met the inclusion criteria, comprising one randomized simulation study, one in vitro comparative study, and one ex vivo cadaveric study. AR-assisted workflows consistently demonstrated improved spatial accuracy, reflected by reduced linear and angular deviations during osteotomy and root-end resection. Operator-related outcomes, including confidence and usability, were positively influenced. However, efficiency outcomes were inconsistent across studies, and one study reported increased residual lesion volume, indicating a potential trade-off between precision and treatment completeness. Risk of bias ranged from moderate to high, primarily due to confounding and measurement-related limitations. AR guided EMS demonstrates promising improvements in surgical accuracy and operator interaction however; the current evidence is limited by methodological heterogeneity and lack of clinical validation. AR should be considered a precision-enhancing adjunct rather than a replacement for conventional techniques. Further standardized and clinically relevant studies are required to establish its translational applicability in endodontic practice.

Accuracy of dental implant surgery using dynamic navigation and robotic systems: An in vitro study

(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm3), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity (I2) was estimated. p < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time (p < 0.00001) and less angular (p ≤ 0.0001) and linear deviation (p ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery (p = 0.65, and p < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator's experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS.

To compare the accuracy and treatment time of a robotic system (RS) and a dynamic navigation system (DNS) in osteotomy and root-end resection in an invitro study. In this study, four identical mandibular models were created using three-dimensional (3D) printing, each model including 18 teeth. In the surgical procedures, teeth #35, #33, #32, #42, #43 and #45, along with the mesiobuccal roots of teeth #36 and #46, were specifically selected for operation on each model. Cone-beam computed tomography (CBCT) and intraoral scans were performed on all models. DentalNavi software was used to plan a drilling path and depth as well as design surgical accessories. In the RS, osteotomy and root-end resection were performed with robotic assistance, whereas in the DNS, these procedures were performed using dynamic navigation. Post-operative CBCT scans were obtained. Global platform deviation, global apex deviation, angular deflection, and time were compared to evaluate the accuracy and treatment time of the surgeries. The treatment time was defined as the registration time and drilling time. Statistical analyses were performed using the Shapiro-Wilk and independent sample t-test. The global platform deviation, global apex deviation and angular deflection in the RS group were significantly smaller than those in the DNS group (p <.05). The registration time in the RS group was significantly longer than that in the DNS group (p <.001), whereas the drilling time was significantly shorter (p <.001). The overall surgical time was significantly longer in the RS group than in the DNS group (p <.001). Subgroup accuracy analysis revealed that in both the anterior and posterior tooth regions, the RS group exhibited significantly smaller apical and angular deviations than the DNS group (p <.001). Additionally, in both the anterior and posterior tooth subgroups, the total time for the DNS group was significantly shorter than that for the RS group in the anterior tooth area (p <.01). RS showed higher accuracy and shorter drilling time in osteotomy and root-end resection compared to DNS. The RS holds promise as a reliable technological advancement in endodontic microsurgery. However, future endeavours should prioritize the reduction in registration time.

&lt;p&gt;Abstract: Objectives: Various dynamic navigation systems have been developed to enhance the accuracy of implant positioning and prevent damage to anatomical structures such as the inferior alveolar nerve and maxillary sinus during osteotomies. This case report aims to demonstrate a surgical method that combines a dynamic navigation system with crestal sinus lifting and simultaneous implant placement in the maxillary molar region. Materials and Methods: Two systemically healthy patients with extraction and socket preservation of a hopeless maxillary second molar were included in the study. Preoperative cone-beam computed tomography (CBCT) revealed limited residual bone height for implant placement after the healing period. Virtual planning of the implant was conducted using dynamic navigation planning software. Both patients underwent crestal sinus lifting through hydraulic pressure and simultaneous single implant placement assisted by the dynamic navigation system. Postoperative CBCT was performed 6 to 7 months after the implant placement to evaluate the implant position and increase in bone height. The postoperative implant position and orientation were compared to the preoperative virtual plan. Results: In both cases, the surgeries were uneventful and no postoperative complications occurred. Postoperative evaluation revealed that the global platform deviation was 1.60 and 2.24 mm, the global apex deviation was 1.46 and 2.13 mm, and angular deviation was 1.18&amp;deg; and 5.50&amp;deg; in case 1 and case 2, respectively. Conclusion: Combined dynamic navigation system with crestal sinus lifting by hydraulic pressure and simultaneous implant placement is a safe, accurate, and reduced morbidity surgical protocol in the maxillary molar region.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;