Dynamic computer-assisted surgery for the placement of dental implants

[eng] INTRODUCTION: Computer-Assisted Surgery (CAIS) in Dentistry has been designed with the purpose of minimizing discrepancies between preoperative planning and the final position of the implant. Dynamic CAIS (dCAIS), also known as navigation systems, allows the position of the surgical drill and/or implant to be determined with respect to the patient, showing it in real time on the CBCT images. These systems guide the surgeon in real time during the surgical procedure, ensuring that the three-dimensional placement of the implant is precisely adjusted to the preoperative planning. A systematic review and meta-analysis have been carried out to evaluate the accuracy of the different dCAIS systems in implantology and in the clinical studies included in the meta-analysis, angular and platform deviations were observed using dCAIS of 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. Deviations were smaller in in vitro studies with a mean angular deviation of 2.01° (95% CI 1.95 to 2.07; I2 = 99.1%) and a mean platform deviation of 0.46 mm (95% CI: 0.44 to 0.48; I2 = 98.5%). The dCAIS systems proved to be significantly more accurate than the sCAIS systems (MD: -0.86°; 95% CI: -1.35 to -0.36) and that freehand implant placement (MD: -4.33°; 95% CI -5.40 to -3.25). HYPOTHESIS: dCAIS is significantly more accurate and safer than conventional freehand (FH) surgery. On the other hand, patient registration using the protocol without radiographic markers (MTR) is more accurate than the traditional protocol with radiographic markers (MRR). Finally, the superimposition of an intraoral scan (STL) on the CBCT does not provide greater precision to the dCAIS. OBJECTIVES: To assess the accuracy of dCAIS in various in vitro and clinical scenarios and compare it to freehand implant placement. On the one hand, we aimed to evaluate and compare the accuracy and safety of dCAIS compared to conventional freehand surgery. Additionally, we tried to analyze the accuracy of the patient record using the MTR vs. RMR protocols and through the use of an intraoral vs. CBCT scan.