The Use of Dynamic Navigation for the Placement of Zygoma Implants: A Cadaver Study to Compare Accuracy
This study aimed to compare the angular, platform, and apical deviation of zygoma implants placed with the aid of a dynamic navigation (DN) device compared with the implants placed freehand. Eight cadaver heads were used for the study. Preoperative cone beam computerized tomography (CBCT) scans were made for the heads, and an implant-planning software was used to plan zygoma implants bilaterally in each scanned head. A total of 16 zygoma implants were placed using each surgical technique. Postimplant CBCT scans were merged with the preoperative plan to evaluate and compare the accuracy of the implants using each technique. Angular and linear deviations of the implants were measured and compared. The effect of implant length and position on the deviation was also investigated. The results showed a mean angular deviation of 2.44° ± 1.10° for implants placed using DN compared with 6.63° ± 4.81° for implants placed freehand. The mean apical deviation for implants placed using DN and for implants placed freehand was 2.14 ± 1.02 mm and 3.80 ± 2.49 mm, respectively. Finally, the mean platform deviation for implants placed using DN and for implants placed freehand was 1.66 ± 0.9 mm and 2.81 ± 2.1 mm, respectively. The analysis showed a significant difference between the two techniques in angular and apical deviation (p = .001 and .029, respectively). Zygoma implants placed with a DN device resulted in less apical and angular deviation than implants placed freehand.
Three-dimensional reconstruction of cone beam computerized tomography scan of a cadaver head showing 3 bone screws inserted in the maxillary bone.
Digital plan for bilateral zygoma implants. Each side was assigned to a different surgical technique.
(a) Handpiece tracker. (b) Probe tool tracker. (c) Patient tracker. (d) Patient tracker arm.
Patient tracker arm attached to the anterior maxilla via bone screws.
Pilot drill length measurement step during dynamic navigation–guided surgery.
Zygoma drill length measurement step during dynamic navigation guided surgery.
Screenshot of X-Guide system screen during zygoma implant osteotomy.
Clinical view of 4 zygoma implants placed along with the patient tracker arm assembly attached to the anterior maxilla.
Three-dimensional reconstruction of cone beam computerized tomography scan of a cadaver head after bilateral zygoma implant placement.
(a) Three-dimensional cone beam computerized tomography reconstruction of preoperative planned implants and postoperative placed implants aligned in the software. (b) Cross-section of preoperative planned implants and postoperative placed implants aligned in the software; purple circles represent planned implants.
(a) Illustration of angular deviation measurement. (b) Illustration of apical and platform deviation measurement.
(a through c) Plots of the measurements of the angular, platform, and apical deviations, respectively, for the zygoma implants placed using dynamic navigation–guided technique and freehand technique.
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