NAVIGATION SYSTEMS

IN IMPLANTOLOGY
By,Dr.Sruneerdha .T ,3rd year PG,
Department of prosthodontics
INTRODUCTION
MECHANICAL DRILL /LAB FABRICATED STENT

Waxing up
Visualization
patient’s
to the
teeth
template in
impression, Transfer the reality
interactive
planning of
implants
from 2D and
3D
 DRAWBACKS

Lack of interactive control

during
implant placement

High chance of errors

Technique sensitive
 GUIDED IMPLANT SURGERY

Accuracy and precision

for placement ● Reduced patient ● Second-stage implant
morbidity surgery can be
Minimally invasive
avoided.
● Avoid damage to
less treatment time critical anatomic ● surgical stents -
structures immediate loading
possible

● correct positioning
CLASIFICATION
 DYNAMIC NAVIGATION

3D planning with (CBCT) exploration

Prosthetic analysis before the surgical procedure.

Special instruments and a specific software

Bone drilling and the implant placement

Tracked Real time in a 3D software.

 STATIC NAVIGATION

Static surgical templates -bone implant drilling

Transmit the info- pre-surgical prosthetic and

surgical planning to the patient.

Bone drilling and the implant placement

 MUCOSA-SUPPORTED GUIDE

Flapless approach-first choice in partially or fully

edentulous patients

Partially edentulous patients, a combination of

mucosa and tooth/crown

Fully edentulous cases, supported by buccal

and lingual mucosal flanges palatal mucosa
 BONE-SUPPORTED GUIDE

surgical guide- Supported by the bone surface

Requires reflection of a fullthickness flap.

Bone deficiencies
2
 TOOTH/CROWN SUPPORTER GUIDE

Remaining teeth or crowns are used

Partially edentulous patients

Mucosa or bone support can be applied

simultaneously as well
 Stereolithographic or Rapid prototyping technology.

Remaining teeth- supporting complete edentulous patients Higher chance of inaccuracy.

To support guides
 HALF-GUIDED (HG)

Prosthetic and pre-surgical planning with CBCT

Cast-model planning (3D).

HALF-GUIDED (HG)-PILOT-DRILL GUIDED

It has also been termed first-drill guided surgery.

This technique only requires the surgical guide during the pilot drilling
bone sequence.

Thus, after the pilot drill is used, the surgical guide is removed
HALF-GUIDED (HG)-DRILLING GUIDED

A surgical guide is used during all drilling bone sequence.

Once the implant is placed, the surgical guide is then removed

HALF-GUIDED (HG)-NON-COMPUTER

Template is used during the bone drilling phase

This surgical stent is produced from the 3D planning,

Thermoplastic radiological stent that will be converted into a

surgical stent
 FREE HAND GUIDED
Conventional surgery and mental or brain-guided
surgery.

May not involve CBCT exploration.

Surgical templates are not used

 Free hand drilling

Significantly more error compared with

navigation methods.
 Static System

Have workflow time and cost considerations.

Cost of the software and CT- guide stent

 Dynamic Navigation

Time-effective ,Less placement error.

.

Computer system,arrays,patient specific clips.

.
 STATIC vs. DYNAMIC

The implant position is

The implant position is dependent on navigation
dependent on the stent system

No intraoperative position Intraoperative position

changes of implant changes of implant ,Size,shape.

No real-time visualization Real-time visualization

 Fundamental step

11

(CBCT) scanning

Fabricaion of surgical drilling guides

Surgical procedure
3D images-preoperatively via CBCT

Low-dose and relatively less expensive

It analyzes

(1) available bone volume,

(2) mucosal thickness,

(3) adjacent teeth structures,

(4) maxillary sinus position

(5) identifying the position of mandibular

canal, incisive canal, and mental foramen.
 Fundamental step

(CBCT) scanning
Software program execution

Fabrication of surgical drilling guides

Surgical procedure
Software program execution

EasyGuide

Biohorizons

Nobel Biocare

InVivo5

Simplant

The 3D images- (DICOM) format.

Size of the implants is chosen- virtually

Transactional view to visualize cortical

and trabecular bone.
 Fundamental step

Fabrication of drilling guides

Fabrication of surgical drilling guides

Surgical procedure
 Stereolithographic or Rapid prototyping technology.

Remaining teeth- supporting complete edentulous patients Higher chance of inaccuracy.

To support guides
Design of sleeves in the surgical guide. (a) Metallic sleeve; (b) non-metallic sleeve; (c) customized open
sleeve

Metallic sleeves :

Inadequate space for the salline

irrigation into target site

Cause overheating

Non metallic sleeves :

Less M-D space needed

Salline fall on the drill directly.

 Fundamental step

(CBCT) scanning
Surgical procedure

Fabrication of surgical drilling guides

STATIC DYNAMIC
Proper placement of stereolithographic guide using index in static-guided approach STATIC

1.Surgical guide is fitted in the mouth.

2.A flap or flapless approach is followed.

3.1FULLY GUIDED:
Osteotomy preparation + surgical guides or
templates

3.2 PARTIALY GUIDED:

Osteotomy preparation - using surgical

templates

Implants placed in a freehand manner.

A.(CBCT) scan (green lines);

(C,D) virtual template design according

to the planned virtual dental implant
placement;

(E) Manufactured stereolithography

template - placed over the partially
edentulous upper jaw models.
PROCESS OF STATIC NAVIGATION

A)The design of the implant optimal

position.

B) The surgical guide template was

inserted and controlled for stability of the
implant position.

C) Using the drill to preparation.

D) Implant placement
DYNAMIC
Thermoplastic stent attaches with the remaining
teeth in the arch using the radiographic marker. Preoperative planning;

Digital planning
 Preoperative planning

Digital planning

Postoperative image after implant placement

PROCESS OF DYNAMIC
. NAVIGATION

A)The registration device was

fixed onto the operating arch with
a silicone elastomer when taking
the CBCT scanning.

B)The optimal 3D implant position

was planned in the dental implant
navigation system software.

C) Matching the reference device

PROCESS OF DYNAMIC
.
NAVIGATION
D) Matching the registration plate with
the handpiece.

E) matching the registration plate in the

software.

F) The process of drilling under

navigation.

G)The view of real-time tracking under

navigation in the software.

H) Oral image of implant placement

Dynamic navigation :

Requires precise and continuous coordination of the patient, the image data, and the surgical instrumentation.

Consists of stereovision with natural light cameras .

It uses either passive or active arrays of optical technologies.

The arrays use reflected light emitted from a light source, tracking to the stereo cameras for imaging the surgical
procedure.

The fiducial markers are used as an index for a surgical guide and implant placement.

The surgical site is recorded using cameras, with arrays positioned extraorally.

This allows stereo camera to control the real time movements of the drill and implant placement through patient 3D
imaging.
The main components of a dynamic navigation system

-Patient jaw attachment

-Handpiece attachment

-System consisting of a camera

-Overhead-positioned emitting light, computer, and sensor.

The whole surgery involves direct vision on the computer screen, thereby controlling the direction and depth of implant
placement This provides real motion tracking effect of the surgery
 PRINCIPLE OF
GUIDANCE IN DYNAMIC

1. Calibration: 2. Registration 3. Tracking

 INDICATIONS OF DYNAMIC SYSTEMS
Direct visualization
Implants same day 1 5
is difficult

Limited mouth
2 6 Accuracy
opening

Implants in tight Uncooperative

interdental spaces 3 7 patients

In cases where
Safety during
static guides cant 4 8 surgery
be used
 ADVANTAGES OF DYNAMIC SYSTEMS
CT -planning and Ability to moidify
surgery in single 1 5 the plan during
day surgery

Reduced harm to Low pre-procedure

2 6
the patient cost

No damage to the
Reduced risk of
anatomical 3 7 bone damage
structures

Increased Elimination of
predictability 4 8 static guides
 DISADVANTAGES OF DYNAMIC NAVI

They are sensitive to reactions

and interference with sensors and
the cameras.

More expensive.

Increased presurgical planning.

Significant learning curve

The navigation systems commonly used are :

DenX Image Guided Implantology

X-Guide Dynamic 3D Navigation

Navident

Inliant.
FULLY GUIDED
THANK YOU