Computerised navigation in implant dentistry

Wednesday, January 4, 2017

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A recent paper has outlined the positives and negatives associated with computer navigated implant surgery. This method of implant surgery, described as being ‘like GPS for your drill’, involves computer-guided systems which use motion tracking technology combined with data from CBCT scans to improve implant placement procedures. This is intended to enhance accuracy and reduce the risk of human error.

The paper examined a number of available systems, all of which are marketed by different companies. While these all function slightly differently, they work in essentially the same way. First, the ideal implant position is planned digitally, using bone morphology and anatomical landmarks as references. Then during surgery, sensors which are attached to both the patient and the surgical handpiece transfer 3D positional data to a camera or detector. This allows the surgeon to track the position of both the dental drill and the position of the patient throughout. It also enables the surgeon to make changes to the virtual surgical plan.

Another advantage is the ability to plan surgery better in advance, which can help the surgeon anticipate and avoid potential complications. It also allows for more flapless surgery to be conducted, which decreases patient discomfort, trauma and recovery time. Flapless surgery has generally been seen as a ‘blind’ procedure in the past, due to difficulties associated with evaluating alveolar bone shape. The 3D imaging provided by computer navigation allows surgeons to better assess whether flapless surgery is an option.

One of the main benefits is that navigation systems reduce chair time. This benefits the patient, while also allowing the surgeon to carry out more procedures in a day. It might seem that increasing procedure numbers would increase strain on a surgeon, but the dynamic navigation actually improves surgeons’ ergonomics.

Despite these benefits there are also a number of disadvantages highlighted by the paper. The high cost of purchasing and maintaining these machines limits their availability to surgeons, as does the space required to house them. Furthermore, technical issues can arise due to sensor errors, which can affect accuracy. Indeed, studies regarding accuracy are controversial, with the most recent ones having been performed in pre-clinical settings only. In general, computer navigation surgery shows a lot of promise and if refined could considerably improve the accuracy and safety of dental implant placements. This study was conducted by researchers from Tufts University in Massachusetts, USA. It was published in Trends in Clinical Periodontology and Implant Dentistry.