BackgroundTo compare the accuracy of implant placement using the conventional freehand method and a dynamic navigation system; to assess the role of the surgeon’s experience in implant placement using these two methods.Material and MethodsA randomized in-vitrostudy was conducted. Six resin mandible models and 36 implants were used. Two researchers with differing clinical experience (novice and experienced) placed implants using either the Navident dynamic navigation system (navigation group) or the conventional freehand method (freehand group). Accuracy was measured by overlaying the real position in the postoperative CBCT on the virtual presurgical placement of the implant in a CBCT image. Descriptive and bivariate analyses of the data were performed.ResultsThe navigation group showed significantly higher accuracy for all the variables studied except 3D entry and depth deviation. This system significantly enhanced the accuracy of the novice professional in several outcome variables in comparison with the freehand implant placement method. However, when the implants were placed by the experienced clinician the dynamic navigation system only improved angulation deviation. Significant differences were found between the 2 professionals when the freehand method was employed. Similar deviations were observed for the implants placed with the navigation system.ConclusionsDynamic computer assisted surgery systems allow more accurate implant placement in comparison with the conventional freehand method, regardless of the surgeon’s experience. However, this system seems to offer more advantages to novice professionals, since it allows them to reduce their deviations significantly and achieve similar results to those of experienced clinicians. Key words:Computer guided surgery, dynamic computer guided surgery, implant navigation system, dental implants.

Objectives To assess the accuracy of dynamic computer-aided implant surgery (dCAIS) systems when used to place dental implants and to compare its accuracy with static computer-aided implant surgery (sCAIS) systems and freehand implant placement. Materials and Methods An electronic search was made to identify all relevant studies reporting on the accuracy of dCAIS systems for dental implant placement. The following PICO question was developed: "In patients or artificial models, is dental implant placement accuracy higher when dCAIS systems are used in comparison with sCAIS systems or with freehand placement? The main outcome variable was angular deviation between the central axes of the planned and final position of the implant. The data were extracted in descriptive tables, and a meta-analysis of single means was performed in order to estimate the deviations for each variable using a random-effects model. Results Out of 904 potential articles, the 24 selected assessed 9 different dynamic navigation systems. The mean angular and entry 3D global deviations for clinical studies were 3.68°(95% CI: 3.61 to 3.74; I 2 = 99.4%) and 1.03 mm (95% CI: 1.01 to 1.04; I 2 = 82.4%), respectively. Lower deviation values were reported in in vitro studies (mean angular deviation of 2.01°(95% CI: 1.95 to 2.07; I 2 = 99.1%) and mean entry 3D global deviation of 0.46 mm (95% CI: 0.44 to 0.48 ; I 2 = 98.5%). No significant differences were found between the different dCAIS systems. These systems were significantly more accurate than sCAIS systems (mean difference (MD): −0.86°; 95% CI: −1.35 to −0.36) and freehand implant placement (MD: −4.33°; 95% CI: −5.40 to −3.25). Conclusion dCAIS systems allow highly accurate implant placement with a mean angular of less than 4°. However, a 2-mm safety margin should be applied, since deviations of more than 1 mm were observed. dCAIS systems increase the implant placement accuracy when compared with freehand implant placement and also seem to slightly decrease the angular deviation in comparison with sCAIS systems. Clinical Relevance The use of dCAIS could reduce the rate of complications since it allows a highly accurate implant placement.

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