Dynamic Navigation for Dental Implant Placement

Digital computerized implant systems enable real-time objectified instrument control within a GPS-like framework. The position of the instrument during surgery can be monitored live on a three-dimensional image on a monitor. This technique is precise, minimal invasive, does not need a surgical guide template, and easy to use in a small mouth.

The planning and surgery can be performed on the same day, and modification is possible during the surgery. It is recommended to practice the method on a dental image before using it in a live situation. The procedure will be demonstrated by Tamas Huszar, an assistant professor from our department.

Begin by attaching a radio pack fixation clip to the teeth of the jawbone at the treatment site with the help of a thermoplastic material. Make a cone beam computed tomography or CBCT examination of the patient with a labeled clip in the mouth. Plan the position of the implant according to the prosthetic architecture with the appropriate software.

Register the headpiece by calibrating the handpiece chuck and the rotating marker disc, inserted into the handpiece. Then assemble the arm between the patient tracker and the labeled clip and calibrate it. To check the device calibration, fix the labeled clip holding the optical marker or tracker on the teeth on which jaw the implant placement will occur.

Ensure to insert the clip in the same position registered on the preoperative CBCT. Then touch the clip's metal spheres with the pivot of the probe to calibrate the labeled clip. To perform the navigated implant placement and local anesthesia, measure the drill length and check the real-time visual accuracy.

Determine the entry point of drilling and explore the operation site without the flap. Next, drill the bone with dynamic navigation control. After measuring the implant length, place the implant with the handpiece wearing the dynamic navigation system controlled tracker.

Close the wound with 5/0 monofilament non-absorbable polypropylene suture or fix the prefabricated prosthetic work. Then acquire a control radiologic image. Perform CBCT on the patient without a clip in the mouth.

Use appropriate software to plan the position of the implant according to the prosthetic architecture and calibrate the device as described previously. For calibrating the system without a labeled clip, transfer the plan of surgical placement of the implant into the navigation system software. Then select the workspace on the three-dimensional CT image of the navigation software.

Fix the tracker on the teeth with an unlabeled clip, or, in the case of an edentulous jaw, fix a special tracker holding arm. Then select a minimum of three typical anatomical points on a 3D CT image of the navigation system. Identify the selected anatomical points in the mouth by touching them with a probe tool.

Perform the refinement procedure on three to four areas by drawing on the surface of the anatomical structure with a probe. Under local anesthesia, place the implant with navigation and measure the drill length. Check the real-time visual accuracy of the tooth or at the surface of the bone before determining the drilling point and exploring the operation site without the flap.

Drill the bone with dynamic navigation control. Measure the implant length before placing the implant with the handpiece wearing the dynamic navigation controlled tracker. Close the wound with a 5/0 monofilament non-absorbable polypropylene suture, or fix the prefabricated prosthetic work.

Then, start control radiologic imaging. The data from the early study showed that there was no significant correlation between the platform and angular deviation in buccolingual and mesiodistal directions. When the planned and final position of the implants was compared, the clip calibration method proved more accurate compared to the tracer calibration method with no significant difference.

It is essential to check the continuity of the calibration and the tracking of the procedure. The system will signal any malfunction. The procedure allows for a number of tracked dental treatments, such as root apex amputation, orthognathic surgery, endodontic procedures, or complicated wisdom tooth removal.