title: Use of an image-guided navigation system in dental implant surgery in anatomically complex operation sites.
abstract: BACKGROUND
  Recent developments in computer assisted surgery have brought major improvements to maxillofacial surgery. Computer systems for intra-operative navigation have been introduced enabling the surgeon to locate the continually updated position of the instruments and the operation site on the patient's three-dimensional reconstructed image data set displayed on a monitor in the operating room. Complex surgical procedures can be performed according to the preoperative plan based on CT and/or MRI data minimizing surgical risks and optimizing clinical results. Nowadays computer-assisted-surgery has also proved effective in dental implantology.
  
  
  OBJECTIVE
  The objective of this study was to compare the accuracy of conventional and computer-assisted dental implantation planning and surgery. Analyzing our early experiences, we aimed to evaluate the benefit from utilising computer assisted surgery (CAS).
  
  
  METHODS
  Five patients were treated with the aid of CAS, a total of 18 dental implants being placed. Only difficult operation sites, e.g. following bone augmentation or anatomically malformed jaws were included in this study.
  
  
  METHODS
  An infra-red light based navigation system (Vector Vision 2, BrainLAB, Munich, Germany) including a three-dimensional planning approach for maxillofacial surgery was used. Placement of dental implants in the maxilla included direct visualization when drilling the implant socket according to the axis previously planned on radiographs and CT scans.
  
  
  RESULTS
  In two cases the conventionally planned implant location had to be changed due to insufficient bone being available. With four implants, it proved possible to insert longer fixtures after the CAS system had evaluated all parameters of the surgical region. In one case a shorter implant was installed due to insufficient bone at the designated location.
  
  
  CONCLUSIONS
  The use of an image-guided navigation system provides a valuable tool in implant dentistry and proved superior to conventional implant surgery especially in difficult anatomical regions.
authors.affiliation: Department of Maxillofacial Surgery, University of Cologne, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Siessegger
authors.forename: B T
authors.initials: BT
authors.lastname: Schneider
authors.forename: R A
authors.initials: RA
authors.lastname: Mischkowski
authors.forename: F
authors.initials: F
authors.lastname: Lazar
authors.forename: B
authors.initials: B
authors.lastname: Krug
authors.forename: B
authors.initials: B
authors.lastname: Klesper
authors.forename: J E
authors.initials: JE
authors.lastname: Zöller
mesh_terms: D000540:Alveolar Ridge Augmentation; D003758:Dental Implantation, Endosseous / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007259:Infrared Rays; D007575:Jaw, Edentulous / Q000000981:diagnostic imaging* / Q000601:surgery*; D008437:Maxilla / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D010347:Patient Care Planning; D011862:Radiography, Panoramic; D013813:Therapy, Computer-Assisted; D014057:Tomography, X-Ray Computed