title: Implant Placement Is More Accurate Using Dynamic Navigation.
abstract: OBJECTIVE
  The purpose of this prospective study was to measure and compare the accuracy and precision of dynamic navigation with freehand (FH) implant fixture placement. The authors hypothesized that the evaluated dynamic navigation system would have high accuracy and precision and would be superior to FH methods.
  
  
  METHODS
  The authors designed and implemented a prospective cohort study and enrolled patients who had implants placed from December 2014 through December 2016. The predictor variable was implant placement technique comparing fully guided (FG) and partially guided (PG) dynamic navigation with FH placement. The outcome variables were accuracy measured as deviation from the virtual plan, and precision was represented as the standard deviation of the measurements. Analysis of variance (ANOVA) was used to compare measurements. Virtual implant placement was compared with post-implant placement using mesh analysis. Deviations from the virtual plan were recorded for each implant for each surgeon. FH implant placement was evaluated by comparing a virtual plan with postoperative scans for patients who did not have the navigation system used for their implant placement. One-way ANOVA was performed to determine within-group and between-groups differences to determine whether there were meaningful differences among surgeons and methods (FG, PG, and FH) of placement.
  
  
  RESULTS
  Prospective data from 478 patients involving 714 implants were evaluated. There were no demographic differences among surgeons. The sample size differed by the number of implants placed by each surgeon. Within each method group, the only difference among surgeons was angular deviation. All surgeons' data were combined. For FG navigation, the mean angular deviation was 2.97 ± 2.09°, the mean global platform position deviation was 1.16 ± 0.59 mm, and the mean global apical position deviation was 1.29 ± 0.65 mm. For PG navigation, the mean angular deviation was 3.43 ± 2.33°, the mean global platform position deviation was 1.31 ± 0.68 mm, and the mean global apical position deviation was 1.52 ± 0.78 mm. For FH placement, the mean angular deviation was 6.50 ± 4.21°, the mean global platform position deviation was 1.78 ± 0.77 mm, and the mean global apical position deviation was 2.27 ± 1.02 mm. Differences in measurements comparing FG and PG navigation with FH indicated significantly less deviation from the virtual plan (P < .05) using navigation.
  
  
  CONCLUSIONS
  Accuracy and precision for implant placement were achieved using dynamic navigation. The use of this type of method results in smaller deviations from the planned placement compared with FH approaches.
authors.affiliation: Private Practice, Metairie, LA. Electronic address: drblock@cdrnola.com.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Block
authors.affiliation: Private Practice, Washington, DC.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Emery
authors.affiliation: Private Practice, Coeur D'Alene, ID.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Cullum
authors.affiliation: Software Engineer, X-Nav Technologies, LLC, Lansdale, PA.
authors.forename: Ali
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003757:Dental Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted; D055815:Young Adult