Evaluation of dynamic computer-assisted implant placement accuracy by means of a novel digital method: A feasibility clinical study

Purpose: To present a novel digital method to evaluate dynamic computer-assisted implant surgery (dCAIS) accuracy comparing digital implant planning to real implant position. Methods: Twenty patients in need of implant supported single unit-crowns (SUC), were consequently treated following a standardized digital protocol encompassing (1) a diagnostic digital intra-oral scan (IOS), (2) a cone beam computed tomography (CBCT), (3) 3D digital implant planning, (4) dynamic navigated implant placement (X-Guide, X-Nav Technologies, LLC, Lansdale, PA, USA) and (5) a post-operative IOS with the scan body in situ. Implant position accuracy was evaluated by superimposing the post-operative IOS with the pre-operative digital planning and calculating the resulting angular deviation (o), global head deviation (mm) and global tip deviation (mm). Results: From the original 30 installed implants, 29 could be analyzed. All surgical procedures were successfully completed without any complication. The calculated mean angular deviation was 4.50° ± 2.59°, while the mean deviation at the implant head was 1.18 ± 0.52 mm. Finally, the global tip deviation was 1.43 ± 0.78 mm. Flapless implant placement was significantly associated with a reduction in both head and tip linear deviations (p = 0.026; p = 0.007), as well as with a significant reduction in angular deviation (p < 0.001). Implants placed in the anterior region showed a mean statistically significantly higher deviation at the implant head compared to those in posterior sites (difference: 0.39 mm; p = 0.043). Conclusions: Despite its limitations, the proposed digital method does represent a promising and patient friendly approach to evaluate dCAIS accuracy. Clinical significance: The proposed digital method represents a promising workflow for the evaluation of dCAIS implant placement avoiding the need of post-operative radiations.