The accuracy and learning curve of active and passive dynamic navigation-guided dental implant surgery: An in vitro study

Infrared dynamic navigation systems can be categorized into active and passive based on whether the surgical instruments can emit or only reflect light. This in vitro study aimed to compare the accuracy of implant placement and the learning curve of both active and passive dynamic navigation systems, using different registration methods.Implants (n = 704) were placed in 64 sets of models and divided into active (Yizhime, DCARER, Suzhou, China) and passive (Iris-Clinic, EPED, Kaohsiung, China) dynamic navigation groups. Both marker point-based registration (M-PBR) and feature point-based registration (F-PBR) were employed for the two groups. Based on preoperative and postoperative cone-beam computed tomography imaging, the coronal, midpoint, apical, and angular deviations were analyzed from 2D and 3D views. The operation time was recorded for each group.The active dynamic navigation group exhibited significantly higher accuracy than the passive dynamic navigation group (angular deviation, 4.13 ± 2.39° versus 4.62 ± 3.32°; coronal global deviation, 1.48 ± 0.60 versus 1.86 ± 1.12 mm; apical global deviation, 1.75 ± 0.81 versus 2.20 ± 1.68 mm, respectively). Significant interaction effects were observed for both registration methods and four quadrants with different dynamic navigation systems. Learning curves for the two dynamic navigation groups approached each other after 12 procedures, and finally converged after 27 procedures.The accuracy of active dynamic navigation system was superior to that of passive dynamic navigation system. Different combinations of dynamic navigation systems, registration methods, and implanted quadrants displayed various interactions.Our findings could provide guidance for surgeons in choosing an appropriate navigation system in various implant surgeries. Furthermore, the time required by surgeons to master the technique was calculated. Nevertheless, there are certain limitations in this in vitro study, and therefore further research is required.