Accuracy Assessment of Dynamic Vs. Static Navigation Implant Placement Protocols (Randomized Controlled Trial)
Phase: PHASE4
Conditions: Healthy Adults, Dental Implant, Accuracy
Sponsor: Ain Shams University

Accuracy Assessment of Dynamic Vs. static navigation 
implant placement protocols 
(Randomized controlled trial with radiographic assesment) 
 
A protocol submitted to Department of Oral Medicine, 
Periodontology, Oral Diagnosis and Radiology, Faculty of 
Dentistry, Ain Shams University, in partial fulfilment of the 
requirements of the Doctoral’s Degree in Oral Periodontology. 
 
By 
Salma Nabil Ahmed Lotfy Mobarek 
BDS Faculty of Dentistry, Ain Shams University 2014 
MDS Faculty of Dentistry, Ain Shams University 2021 
 
Supervisors 
 
Prof. Dr. Hala Kamal Abdel Gaber 
Professor of Oral Medicine, Periodontology and Oral Diagnosis Faculty of 
Dentistry, Ain Shams University 
Dr. Mohamed Wagdy Bissar 
Lecturer of Oral Medicine, Periodontology and Oral Diagnosis Faculty of 
Dentistry, Ain Shams University 
 
Faculty of dentistry 
Ain shams university 
2022

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Introduction  
Restoration of missing teeth with dental implants has been 
widely recognized as one of the treatment options (1). Proper 
surgical diagnosis is essential, to prevent any complications or 
injury to  vital anatomic structures, to help in the prosthetic driven 
approach and to formerly evaluate the available bone quality and 
quantity. 
The concept of ‘Dynamic navigation’ implantology was born 
after the use of ‘Static navigation’ or ‘Guided implant surgery’, 
offering remarkable changes in the treatment plan and aiding 
clinicians in proper implant rehabilitation (2).  
In static navigation, the full digital workflow has been shown 
to lead to many inaccuracies, starting from the intraoral position 
of the template and it’s fixation. Some claimed the inaccuracy of 
tooth supported templates was less than mucosa supported ones 
showing greater deviations than the proposed plan, but these were 
refuted by Raico Gallardo et al. in their meta-analysis. 
One of the main drawbacks of fully-guided static navigation is 
the fact that there’s no intraoperative evaluation and change in 
treatment plan. 
Implant surgeons can evaluate a patient, plan the implant 
position after scanning and perform the implant surgery all in the 

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same day. Without the need for a static surgical guide, thus 
reducing both time and cost of fabrication (3). 
While both dynamic and static image navigation systems are 
quite efficient, dynamic navigation technologies offer the 
following advantages: 
1. The patient can be scanned, scheduled for, and operated on  
the same day. 
2. Plans can be changed during surgery if clinical 
circumstances necessitate it. 
3. The full field is easily visible. 
4. The accuracy may be evaluated at any time (4). 
One of the main advantages of Dynamic Navigation (DN) is 
that it aids the surgeon to confirm accuracy at all times, unlike the 
Static Navigation using guide (SN), which may include errors if 
the stent was not properly seated over the teeth (3). 
The present (DN) approach necessitates getting a 3D scan 
using a consistently repeatable fiducial marking system, virtual 
planning of the implant, alignment and identification of fiducial 
markers and implant drills, last is implant osteotomy preparation 
and implant placement in line with the 3D constructed image 
present on the navigation screen (3). 
The workflow may be entirely digital. Dependency on the 
system employed maybe anticipated when assessing the accuracy 

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reached here. Because of the difficult surgical implementation, 
the success of the dynamically guided insertion necessitated 
extensive training. More clinical research is needed to compare 
dynamic navigation approaches to static navigation (5). 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Aim of the study 
Primary objective: 
Deviations in :  
- Platform position 
- Apical position  
- Angular deviation 
 
Of the placed implant when compared with the planned one. 
 
Secondary objective: 
Patient satisfaction questionnaire and operating time for each 
technique. 
 
 
 
 
 
 
 
 
 
 
 
 

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Study Methodology 
The proposal will be reviewed by the Faculty’s research ethics 
committee. 
❖ Patient Selection: 
• Selection of 20 patients will be made in the outpatient clinic 
of the Oral Medicine, Periodontology, Diagnosis and 
Radiology Department at the faculty of dentistry, Ain Shams 
University. 
• The procedure will be explained to all patients and an 
informed consent will be signed before their inclusion in the 
study. 
❖ Inclusion Criteria: 
• Healthy patients at least 22 years old. 
• At least one missing tooth to be restored using an implant 
in the upper jaw from the maxillary right 2nd premolar to 
the maxillary left 2nd premolar. 
• At least six residual teeth in the affected jaw (5). 
• Minimum of 5 mm available bone. 
 
❖ Exclusion Criteria: 
• Medical condition or medication that would impair bone 
healing. 
• Poor oral hygiene 
• Inadequate bone width or height that may need bone 
augmentation. 

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• Alcohol users.  
• Smoking more than 10 cigarettes per day. 
• History of head and neck radiotherapy. 
• Pregnant females. 
• Uncontrolled hypertensive or diabetic patient. 
• Vulnerable group; prisoners, pregnant women, orphans…etc 
 
 
❖ Groups: 
o Group 1 : 10 patients Static Navigation 
o Group 2 : 10 patients Dynamic Navigation 
❖ Patient Preparation: 
Static Guidance: 
• CBCT is taken prior to implant surgery to allow for proper 
planning of the prosthetic driven implant placement and 
an impression is taken to allow for proper guide design 
and fabrication. 
 
 
 
 
 
Dynamic Guidance: 
• Thermoplastic stent preparation to fix the radiopaque 
fiducial marker on the arch that needs to be treated. 

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• Cone Beam Computed Tomography taken with a stent 
in the mouth. 
• Implant planning using prosthetic driven approach. 
• Guided placement of implant, with the stent holding 
an optical marker mounted on the arch to provide a 
coordinate reference frame during surgery. 
❖ Surgical Procedure: 
Static Guidance: 
• Infiltration anesthesia will be administered to the 
missing area to be restored. 
• Placement of the guide with it’s proper orientation on 
the teeth. 
• Guided implant drilling and placement is achieved. 
• Placement of healing abutment of the proper size. 
Dynamic Guidance: 
• Infiltration anesthesia will be administered to the 
missing area to be restored. 
• Calibration using the fiducial marker for accuracy. 
• When looking in a screen, implant drilling and 
placement is performed. 
• Placement of healing abutment of the proper size. 
 
 
❖ Post-operative instructions: 
1. Antibiotics will be prescribed for each patient; 
Amoxicillin and clavulanic acid (1gm every 12 hours 

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for 5 days) or Clindamycin (600 mg every 8 hours for 
5 days). 
2. Non-steroidal anti-inflammatory drug (300 mg twice 
daily for 3-5 days). 
3. Chlorhexidine solution 0.12% twice daily. 
4. Following a soft diet for three days. 
5. Stopping mechanical removal of plaque at the surgical 
site for two weeks. 
 
❖ Follow up visits: 
• A CBCT will be taken on the day of the surgery after 
implant placement. 
• A patient’s expectations questionnaire is filled a week 
after implant placement in terms of pain and 
expectations from the treatment. 
 
 
 
 
 
 
❖ Accuracy assessment: 
Superimposition of the planned CBCT and the 
immediately post-operative CBCT will be done to assess the 

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accuracy of implant placement according to the technique 
used, in terms of : 
o Angular Deviation 
o Deviation of the Implant Platform : Mesiodistal, 
Buccolingual and Apicocoronal. 
o Deviation of the Implant Apex: Mesiodistal, Buccolingual 
and Apicocoronal. 
 
❖ Operating time 
 
o Operating time will be recorded for each procedure to 
be compared. 
 
 
❖ Patient satisfaction 
o Patient will fill a survey to compare the patient’s 
satisfaction between the surgical guide and the dynamic 
navigation. 
 
 
 
Statistical analysis 
All data will be collected, tabulated and statistically analyzed.