Accuracy and Efficacy of a 3D Dynamic Navigation System for Endodontic Retreatment: A Systematic Review and...

The objective of this systematic review was to evaluate the accuracy of the dynamic navigation system (DNS) versus the freehand (FH) technique in nonsurgical endodontic retreatment, focusing on tooth structure loss, linear and angular deviations, iatrogenic errors, procedural time, and mishaps. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, an extensive literature search was conducted across several major databases, including PubMed, Scopus, the Cochrane Database of Systematic Reviews, and Web of Science, covering all available records from each database's inception through August 2025. In addition, a search of the open gray literature was conducted, and relevant studies were identified through hand searching, yielding a total of 2,154 articles. After screening, 10 studies were included that compared DNS and FH in nonsurgical endodontic retreatment procedures, such as post space preparation and post removal. Among these, two studies focused on post space preparation, five on post removal, one on second mesiobuccal canal location, one on file retrieval, and one was a case report. The Quality Assessment Tool for In Vitro Studies (QUIN tool) was used to evaluate bias, indicating a moderate overall risk. Meta-analysis was performed on five studies: two on post space preparation and three on post removal. The DNS significantly reduced procedural time compared to the FH technique in both applications (p < 0.00001), although heterogeneity was high (I² = 95% and 59%, respectively). Compared to FH, DNS demonstrated better accuracy with less angular deviation (p < 0.0001 and p = 0.83; I² = 94% and 0%), coronal deviation (p = 0.06 and p = 0.12; I² = 72% and 59%), and apical deviation (p < 0.02 and p = 0.55; I² = 81% and 0%).