Study shows dynamic navigation superiority in complex maxillary implant cases

Dental implantologists routinely face challenges when placing implants in the posterior maxilla. The anatomy of this region—limited bone height, proximity to the maxillary sinus, and variable bone quality—increases the risk of complications such as sinus perforation, implant malposition, and compromised long-term outcomes. Traditional freehand implant placement relies heavily on the clinician’s experience and manual dexterity, which can result in significant deviations from the planned implant position, especially during complex procedures like indirect sinus lift and immediate implant placement.

To address these limitations, implantologists needed a technology that could provide real-time, intraoperative guidance, improving accuracy and reducing the risk of complications.

The American Academy of Oral and Maxillofacial Radiology (AAOMR) recommends CBCT imaging before sinus floor elevation procedures. CBCT provides a detailed view of the surgical site, allowing for precise surgical planning and the early identification of potential risks or pathology. It enables accurate measurement of alveolar bone height and width, as well as visualization of surrounding vital structures, including the maxillary sinus.

Recently, computer-aided implant surgery (CAIS) has been developed to reduce the differences between the planned virtual implant position and the actual placement during surgery.

There are two main types of CAIS systems:

1. Static computer-aided implant surgery (sCAIS):
This method uses pre-made stereolithographic surgical guides, which are templates supported by teeth, bone, or mucosa. These guides are placed in the patient’s mouth during drilling and implant insertion to direct the surgical instruments according to the preoperative plan.

2. Dynamic computer-aided implant surgery (dCAIS):
This approach uses real-time tracking technology. Optical markers attached to the surgical instruments allow the system to track the drill and implant position during surgery. The system continuously compares the instrument’s real-time location with the three-dimensional preoperative virtual plan (based on CBCT imaging), providing immediate feedback to the clinician.

Both methods aim to improve surgical accuracy, but dCAIS, a dynamic navigation system, offers the advantage of intraoperative flexibility and real-time guidance.

Dynamic navigation enables surgeons to track the position of surgical instruments in real-time relative to the patient’s anatomy, utilizing computer-guided visual feedback. dCAIS specifically refers to the application of this technology to implant surgery, integrating preoperative planning with intraoperative navigation for enhanced precision and safety.

Despite the availability of dynamic navigation and dCAIS, there was limited evidence comparing their accuracy and safety to traditional freehand techniques, particularly in complex procedures such as indirect sinus lift with immediate implant placement. Clinicians require robust data to guide their adoption of these advanced technologies and to understand their clinical benefits.

The authors designed a split-mouth study to directly compare the accuracy, safety, procedural time, and patient satisfaction between dynamic navigation (dCAIS) and freehand implant placement in the posterior maxilla. The study focused on indirect sinus lift and immediate implant placement, two procedures where precision is critical.

Over two years, 28 patients requiring bilateral indirect sinus lifts with immediate implant placement were enrolled. Each patient received implants on both sides of the maxilla: one side using dynamic computer-assisted implant surgery (dCAIS) and the other using freehand placement. A total of 62 implants were included in the final analysis. The researchers measured angular deviation, deviation at entry, and apex deviation for each implant.

The study found statistically significant differences between the two groups. For the dCAIS group, mean angular deviation was 2.768°, compared to 11.094° in the freehand group. Entry deviation was 1.510 mm (dCAIS) versus 2.687 mm (freehand), and apex deviation was 2.719 mm (dCAIS) versus 3.913 mm (freehand). These results indicate that dCAIS significantly improves accuracy in implant placement.

The authors concluded that real-time dynamic navigation in implant surgery offers greater accuracy and safety compared to freehand techniques, particularly in complex procedures such as indirect sinus lift and immediate implant placement. The technology significantly reduces deviations, enhancing clinical outcomes.

The integration of dynamic navigation and dCAIS into implantology practice will set a new standard for precision, especially in anatomically challenging regions like the posterior maxilla. By minimizing deviations and reducing the risk of complications, these technologies enable more predictable and successful implant outcomes. Clinicians can confidently adopt dCAIS to improve patient safety and satisfaction, marking a measurable advancement over traditional freehand techniques in dental implantology.

The study, titled “Accuracy and safety of dynamic navigation vs. freehand approach in indirect sinus lift and immediate implant placement: A split mouth clinical study”, was published online on 29 May 2025 in the Journal of Dentistry (ahead of print issue: volume 160, September 2025).

Citation: Jain S, Nagy K, Bhalerao A. Accuracy and safety of dynamic navigation vs. freehand approach in indirect sinus lift and immediate implant placement: A split mouth clinical study. J Dent. 2025 May 29;160:105866. doi: 10.1016/j.jdent.2025.105866. Epub ahead of print. PMID: 40449828.

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