Comparing Guided Surgical Endodontics Using Static Guidance, Dynamic Navigation, and Augmented Reality: A Systematic Review and Meta-analysis.

Abstract

Objective: Endodontic microsurgery is a treatment for persistent periapical pathology, where precision in root-end surgery is crucial for success. Advances in digital technology have introduced guided endodontic microsurgery, incorporating static guidance (SG), dynamic navigation (DN), and augmented reality (AR) to enhance surgical accuracy and efficiency. This systematic review and meta-analysis aimed to evaluate and compare the accuracy of SG, DN, and AR in endodontic microsurgery.

Materials and methods: This review followed PRISMA guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews database (CRD42024583867). A comprehensive search of PubMed, Scopus, and Google Scholar was conducted from inception to February 2026. Studies comparing SG, DN, and AR in endodontic microsurgery were included. Risk of bias was assessed using ROBINS-I V2, the JBI Checklist, and the QUIN tool. Meta-analysis and subgroup analysis were performed on studies with comparable accuracy parameters. Heterogeneity was assessed using Cochran's Q-test and I ² statistics.

Results: Thirty-three studies met the predefined inclusion criteria: 1 nonrandomized clinical trial, 1 case series, and 31 in vitro and cadaver studies. Due to limited clinical studies, the clinical trial and case series identified were synthesized qualitatively, while the meta-analysis pooled only in vitro and cadaveric studies. A meta-analysis demonstrated that SG and DN significantly reduced 3D global deviation at the bur tip compared with FH (p < 0.01). While the drilled root length error did not differ between SG and DN, DN exhibited significantly greater resection angle deviation than SG (p < 0.01). AR showed potential benefits in accuracy, but the data were insufficient for meta-analysis. SG required the least operating time.

Conclusion: SG and DN enhance accuracy and efficiency in endodontic microsurgery compared with freehand techniques in in vitro and cadaveric studies. Standardized outcome measures and further clinical trials with long-term follow-up are needed to validate these findings.

Clinical relevance: Further clinical studies with long-term follow-up are warranted to confirm the effects of guided surgical endodontics on clinical outcomes.