Comparative accuracy of dynamic navigation versus static surgical guides for dental implant placement: an in vitro assessment of free-end and non-free-end configurations

Abstract To compare the accuracy of dynamic navigation and static surgical guides for dental implant placement, with emphasis on free-end versus non-free-end configurations. An in vitro study was conducted using stereolithographic models of partially edentulous maxillary and mandibular arches. Sixty implant sites were virtually planned in 3Shape software and allocated to static surgical guides ( n = 30) or dynamic navigation ( n = 30), each stratified by support configuration (free-end vs. non-free-end) and jaw location (maxilla vs. mandible). Dentium Superline implants (4.0 × 10.0 mm) were placed using 3D-printed static guides or a dynamic navigation system. CBCT scans were acquired before and after placement, and angular (°), entry-point (mm) and apical (mm) deviations were calculated. Dynamic navigation was significantly more accurate than static guides overall (angular 1.95°±0.24° vs. 2.68°±0.54°; entry-point 1.51 ± 0.18 vs. 2.24 ± 0.51 mm; apical 1.75 ± 0.21 vs. 2.51 ± 0.52 mm; all p < 0.001). Pooled across modalities, free-end sites showed higher deviations than non-free-end sites for all three metrics ( p < 0.01); this difference was confined to static guides (angular 3.16° vs. 2.19°) and was not seen with dynamic navigation (1.89° vs. 2.00°). In free-end sites, dynamic navigation reduced angular, entry-point and apical deviations by 40.2% (1.89°±0.23° vs. 3.16°±0.24°), 46.1% (1.46 ± 0.17 vs. 2.71 ± 0.20 mm) and 43.0% (1.70 ± 0.20 vs. 2.98 ± 0.22 mm), respectively (all p < 0.001). In non-free-end sites the advantage was smaller (8.7–12.4%) but significant ( p = 0.032, 0.002 and 0.005). A significant guidance modality × support configuration interaction was found for all outcomes ( p < 0.001; partial η² 0.59–0.68). Jaw location had no significant effect ( p > 0.05). Within the limits of this single-material in vitro model, dynamic navigation was more accurate than static surgical guides, with the largest advantage (40–46% improvement) in free-end sites where guide support is compromised. Dynamic navigation may therefore be preferable for distal extension cases, pending clinical validation.