Accuracy of zygomatic dental implant placement using computer-aided static and dynamic navigation systems compared with a mixed reality appliance. An in vitro study.

Background: Analyze and compare the accuracy of zygomatic dental implant placement carried out using a static navigation surgery, a dynamic navigation surgery and an augmented reality appliance.

Material And Methods: Eighty (80) zygomatic dental implants were randomly assigned to one of four study groups: A: static navigation implant surgery (n = 20) (GI); B: dynamic navigation implant surgery (n = 20) (NI); C: augmented reality appliance implant placement (n = 20) (ARI) and D: free hand technique (n = 20) (FHI). A preoperative cone-beam computed tomography (CBCT) scan of the existing situation was performed to plan the surgical approach for the computer assisted implant surgery study groups. Four zygomatic dental implants were placed in anatomical-based polyurethane models (n = 20) manufactured by stereolithography, and a postoperative CBCT scan was taken. Subsequently, the preoperative planning and postoperative CBCT scans were uploaded to dental implant software to analyze the coronal global, apical global, and angular deviations. Results were analyzed using linear regression models with repeated measures to assess the differences according to the group, according to the position, and the interaction between both variables. If statistically significant differences were detected, 2-to-2 comparisons were made between the groups/positions.

Results: The results did not show statistically significant differences between the coronal global deviations of GI (5.54 ± 1.72 mm), NI (5.43 ± 2.13 mm), ARI (5.64 ± 1.11 mm) and FHI (4.75 ± 1.58 mm). However, showed statistically significant differences between the apical global deviations of FHI (3.20 ± 1.45 mm) and NI (4.92 ± 1.89 mm) ( = 0.0078), FHI and GI (5.33 ± 2.14 mm) ( = 0.0005) and FHI and ARI (4.88 ± 1.54 mm) ( = 0.0132). In addition, the results showed also statistically significant differences between the angular deviations of FHI (8.47º ± 4.40º) and NI (7.36º ± 4.12º) ( = 0.0086) and between GI (5.30º ± 2.80º) and ARI (9.60º ± 4.25º) ( = 0.0005).

Conclusions: Free-hand technique provides greater accuracy of zygomatic dental implant placement than computer-assisted implant surgical techniques, and zygomatic dental implants placed in the anterior region are more accurate than in the posterior region. However, it is an study and further clinical studies must be conducted to extrapolate the results to the clinical setting. Implantology, computer assisted implant surgery, image-guided surgery, augmented reality, navigation surgery, zygomatic implants.