Effectiveness of real-time dynamic navigation in third molar extraction: a systematic review

Impacted third-molar surgery can be technically challenging because of anatomical variability and proximity to critical neurovascular structures, which may increase operative difficulty and the risk of complications. Real-time dynamic navigation (RDN) has been introduced to improve surgical precision through real-time instrument tracking and three-dimensional guidance.This systematic review evaluated the clinical effectiveness of RDN in impacted third-molar surgery compared with conventional techniques, with emphasis on operative time, surgical precision, intraoperative complications, and postoperative recovery.A systematic search of major electronic databases was conducted for English-language studies published up to January 2026 in accordance with PRISMA guidelines. The protocol was registered in PROSPERO (CRD420251025269). Eligible studies included clinical trials, case series, and case reports evaluating RDN-assisted extraction, coronectomy, or retrieval of impacted third molars. Study quality was assessed using Cochrane and Joanna Briggs Institute tools. Meta-analysis was not performed because of methodological heterogeneity.Out of 364 publications, 13 studies met the eligibility criteria. RDN introduced an additional preparation phase of approximately 10-20 min but may shorten the operative phase in some cases by facilitating guided osteotomy and reducing intraoperative adjustments. Several studies suggested improved spatial control, reduced adjacent-tooth injuries, improved bleeding control, and favorable performance near critical anatomical structures. Some reports also described lower pain and swelling, faster healing, and favorable neurosensory outcomes; however, these findings were not consistent across studies. Reported complications were more frequent in anatomically or pathologically complex cases.Current evidence suggests that RDN may have clinical value in impacted third-molar surgery, particularly in selected high-risk or anatomically complex cases. Although it requires additional preparation time and training, it may offer a favorable balance between precision and efficiency. However, the certainty of the available evidence remains limited. RDN should therefore be considered a selective adjunct rather than a routine alternative to conventional techniques until higher-quality studies better define its indications, outcomes, and cost-effectiveness.Trial registration: PROSPERO registration number: CRD420251025269.