Minimally Invasive Navigation-Guided Quad Zygomatic Implant Placement: A Comparative In Vitro Study

Area of Science:

• Oral and Maxillofacial Surgery
• Dental Implantology
• Surgical Navigation Technology

Background:

• Zygomatic implants (ZIs) are a viable solution for patients with significant maxillary bone loss.
• Surgical navigation systems can potentially improve the accuracy and safety of ZI placement.
• Evaluating novel navigation systems is crucial for advancing implant dentistry.

Purpose of the Study:

• To compare the accuracy of a new dynamic surgical navigation system with a minimally invasive registration guide against a conventional navigation approach for zygomatic implant placement.
• To assess deviations in implant position and angulation between the two navigation systems.

Main Methods:

• An in vitro study using 10 3D-printed models based on CBCT scans of edentulous patients.
• Placement of 40 zygomatic implants using a split-mouth design, testing both the new system (test group) and a gold standard (control group).
• Comparison of planned versus placed implant positions using offset basis, offset apical, and angular deviation measurements after CBCT analysis.

Main Results:

• Both navigation systems demonstrated comparable accuracy in zygomatic implant placement, with no significant differences in deviations (offset basis, offset apical, angular deviation).
• The test group achieved an offset basis of 1.43 ± 0.55 mm, offset apical of 1.81 ± 0.68 mm, and angular deviation of 2.32 ± 1.59 degrees.
• The control group showed similar results: 1.48 ± 0.57 mm (offset basis), 1.76 ± 0.62 mm (offset apical), and 2.57 ± 1.51 degrees (angular deviation).

Conclusions:

• Dynamic surgical navigation systems, even with minimally invasive registration, provide acceptable accuracy for zygomatic implant placement.
• The novel system eliminates the need for pre-interventional radiologic imaging and invasive fiducial markers, simplifying the procedure.
• This technology offers a promising advancement for accurate and less invasive zygomatic implant surgery.