Clinical accuracy assessment of a dynamic navigation system and surgical guide using an oral appliance-secured patient tracker targeting anterior teeth.

Purpose: Dynamic navigation systems and surgical guides have been reported to be equally accurate. However, the accuracy of dynamic navigation systems is affected by the movement of the patient tracker fixed to the tooth. We hypothesized that fixing the patient tracker to the oral appliance could improve accuracy. Therefore, this study aimed to compare accuracy between a dynamic navigation system with a patient tracker fixed to an oral appliance and a surgical guide.

Methods: This observational study was conducted on patients who had undergone complete implant treatment at Kanagawa Dental University from 2020 to September 2024. Fifty implant bodies were placed in 42 patients with anterior tooth defects in both the dynamic navigation and surgical guide groups (25 implants each). DTX Studio™ (Nobel Biocare AG, Kloten, Switzerland) was used to overlay planning data on postoperative Digital Imaging and Communications in Medicine data to calculate entry point, apex point, and angular deviation accuracy.

Results: The entry point, apex point, and angular deviation values were 0.99 ± 0.33 mm, 0.97 ± 0.43 mm, and 2.64 ± 0.87° in the dynamic navigation group and 1.33 ± 0.26 mm, 1.38 ± 0.3 mm, and 3.42 ± 1.03° in the surgical guide group, respectively, differing significantly at all measurement sites (P < 0.01).

Conclusions: The fixation of the X-clip to the oral appliance improved intra-oral stability and inhibited intraoperative movement of the X-clip, resulting in high accuracy. These results suggest that dynamic navigation by oral appliance fixation is more accurate than surgical guides.