Comparison of Accuracy and Operator Confidence between Freehand and Dynamic Navigation Systems in the Socket-Shield Technique: An In Vitro Model Study
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Updated: Nov 6, 2026
Dynamic Navigation for Dental Implant Placement
Published on: September 13, 2022
Zhongyi Sun1, Xuzhu Wang2, Zepeng Cao3
1Department of Stomatology,Sijing Hospital;Songjiang Stomatological Hospital, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Prevention and Control Institute for Oral Diseases, Songjiang District, Shanghai, China.
Objectives:
To evaluate whether dynamic navigation (DN) improves preparation accuracy and operator confidence compared with freehand (FH) in the socket shield technique among novices, and to explore DN as a training tool.
Methods:
Eight novice dentists performed freehand (FH) and dynamic navigation (DN) socket shield preparations on standardized models (crossover). Outcomes included Dice similarity coefficient (DSC), perforation rate, length deviation, and confidence scores. An exploratory phase with four operators (two experienced FH, two novice DN) prepared five maxillary anterior teeth. Due to unbalanced experience and technique and a limited sample size, this phase was analyzed descriptively without inferential testing.
Results:
In the main experiment, the DN group showed significantly higher DSC (78.0% vs. 63.5%) and lower length deviation (1.12 mm vs. 2.68 mm), with higher self-reported confidence scores (all P<0.01) than FH. Apical perforation occurred in 5/24 FH preparations (20.8%) and 0/24 DN preparations. Attempt number did not significantly affect DSC. In the exploratory phase, novice DN showed a DSC of 72.7% and a length deviation of 1.59 mm, whereas experienced FH showed values of 66.9% and 1.97 mm, respectively. The novice DN observations showed lower dispersion in the two-metric PCA space.
Conclusions:
Within the limitations of this in vitro study, DN was associated with greater geometric conformity to the planned preparation, lower length deviation, a lower observed laboratory perforation frequency, and higher operator confidence. The exploratory validation phase showed descriptively similar patterns across different anterior tooth anatomies, although preparation technique and operator experience could not be disentangled. These findings support further investigation of DN as an adjunct to initial technical training and should not be interpreted as evidence of clinical safety or therapeutic efficacy.
Clinical Significance:
DN may facilitate novice training by providing real-time guidance in vitro; translation to skill acquisition and patient outcomes requires longitudinal and clinical validation.