Implant Deviation Assessment in Static and Dynamic Guidance: An In Vitro Study

Purpose This in vitro study aims to assess implant placement positioning accuracy using static or dynamic guidance by measuring 3D, 2D, and volumetric deviations of 20 implants compared to the reference implant position obtained following preoperative implant planning. Methods A case of single-tooth edentulism was used to simulate the situation of single implant placement. A cone beam computed tomography (CBCT) scan (Orthophos SL 3D, Dentsply Sirona, Mölndal, Sweden) of the model was taken, and implant planning was done on the Blue Sky Plan (BSP) software (Blue Sky Bio, New York City, NY), generating an implant reference position. The 20 printed models were randomly divided into two equal groups, with both receiving implant placement using either static guidance using polymethylmethacrylate (PMMA)-printed templates (group 1) or dynamic guidance using the X-Guide^® (X-Nav Technologies, LLC, Lansdale, PA, USA) navigation system (group 2). A high-precision non-reflective abutment-level scan body was mounted on the implant directly after placement, and a surface scan was taken. The reference implant and placed implant standard tessellation language (STL) files were aligned using the Medit Link^® software (Medit, Seoul, South Korea). Three-dimensional and 2D deviations were assessed using the Geomagic^® Control X software (3D Systems, Rock Hill, SC), and volumetric deviation was assessed using the Blender™ software (Blender Foundation, Amsterdam, Netherlands). Statistical analysis was performed using RStudio version 2024.12.1 (Posit Software, Boston, MA). Results Twenty scans were obtained in total (n = 10 per group). The significance level was set at p ≤ 0.05. Statistical analysis revealed statistical significance in terms of 3D coronal deviation (p < 0.001), coronal linear deviation (CLD) (p = 0.036), coronal vertical deviation (CVD) (p < 0.001), and apical vertical deviation (AVD) (p = 0.001). However, 3D apical deviation (p = 0.131), apical linear deviation (ALD) (p = 0.945), angular deviation (p = 0.097), and accuracy percentage (p = 0.954) did not reach statistical significance. Conclusion Dynamic guidance showed higher coronal and vertical deviations compared to static guidance, while overall accuracy and global implant deviation remained comparable between the techniques. This in vitro study consisted of resin models lacking bone density or gingival tissue simulation, which limits the extrapolation of the findings to clinical practice. With that being said, further validation of these results through clinical studies involving a larger sample is required.