Journal of Prevention and Treatment for Stomatological Diseases ›› 2020, Vol. 28 ›› Issue (6): 341-348.doi: 10.12016/j.issn.2096-1456.2020.06.001

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Clinical application and new progress of dynamic navigation system in the field of oral implantology

MAN Yi(),ZHOU Nan,YANG Xingmei   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2019-10-18 Revised:2019-11-14 Online:2020-06-20 Published:2020-05-28
  • Contact: Yi MAN E-mail:manyi780203@126.com

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Abstract:

Currently, computer-aided implant surgeries include implant placement surgery under the guidance of a dynamic navigation system. With the use of software inherent in the navigation system, doctors can make a preoperative plan including the ideal position of the implant. Then the plan can be accurately transferred to the surgery, during which the real-time condition of the drill and its relationship with the surgical region will be visualized by the surgeon and the drill can be adjusted in a timely manner. Currently the dynamic navigation system is increasingly widely utilized, especially in cases of esthetic zones or surgical sites with important anatomical structures. However, the clinical workflow of the navigation system is complicated, including CBCT taken after the registration device placement, prosthetic-driven 3D design, calibration, registration, navigated borehole preparation and implant placement surgery. Many details should be considered when the device is applied, including implant position design, fixation of the tracking device, registration, and stable borehole preparation under the guidance of dynamic navigation. Therefore, this article introduces the dynamic navigation system into the clinical workflow and evaluates, the effects of the application and the clinical features. The new progress of the navigation system in the field of implantology is demonstrated at the same time, including navigated surgery in fully edentulous arches and in the zygomatic zone. Further improvements in the navigation system in terms of the accuracy and simplification of the workflow are needed in the future.

Key words: dentition defect, oral implantology, esthetic zone, insufficient bone mass in posterior region, dental implant, computer-aided implant surgery, dynamic navigation, accuracy, precision medicine, digital, clinical application

CLC Number: 

  • R783.4

Figure 1

The process of navigated implant surgery a： registration device with radiation information; b： the intraoral noninvasive registration device was placed; c： registration process was made with two calibration drills; d： simulated restoration-driven implant placement in the mesiodistal direction; e： simulated restoration-driven implant placement in the buccolingual direction; f： borehole preparation under the guidance of the dynamic navigation system in the horizontal direction; g： borehole preparation under the guidance of the dynamic navigation system in the mesiodistal direction ; h： borehole preparation under the guidance of the dynamic navigation system in the buccolingual direction; i： 3d view of borehole preparation under the guidance of the dynamic navigation system; j： quintain under the guidance of the dynamic navigation system; k： axial alignment under the guidance of the dynamic navigation system; l： depth control under the guidance of the dynamic navigation system"

Figure 2

The navigated implant surgery in the edentulous mandible a: the bone markers were utilized as the registration markers; b: the implant placed in the anterior region was utilized to connect the reference template, and the mandibular position could be tracked during the surgery; c: the boreholes were prepared and four implants were inserted under the guidance of the dynamic navigation system; d: the accuracy of the surgery was assessed"

Figure 3

The zygomatic implant placement surgery was performed under the guidance of the dynamic navigation system a： the patient lost the right part of the maxillary jaw after the tumor surgery; b： after registration device placement, the patient underwent a CBCT scan of the surgical region. The surgical plan of zygomatic implant placement with the aid of the dynamic navigation system was designed; c： intraoral digital scan; d： the intraoral digital scan data and CBCT data were combined, and then the virtual tooth arrangement was made. The design for zygomatic implant placement was prosthetically-driven; e： the zygomatic implant placement surgery was performed under the guidance of the dynamic navigation system; f： postoperative CBCT scan of the surgical site"

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