Implementation of Navigated Computer-assisted Implant Surgery (nCAIS) in Daily Clinical Practice: A Narrative Review

Abstract

Computer-assisted implant surgery (CAIS) has emerged as a clinical approach designed to transfer the virtual implant plan accurately to the surgical field to enhance accuracy, efficiency and safety. While various types of CAIS have been utilized and discussed, navigated computer-assisted implant surgery (nCAIS) has matured into a clinically reliable modality that uses real-time motion tracking of the patient's jaw and surgical handpiece against a CBCT-based virtual plan, allowing intraoperative visualization and adjustment without a physical surgical template. This review focuses on introducing the fundamental concept and knowledge of this dynamic navigated system by its corresponding pros and cons when compared with freehand surgery, static CAIS, and robotic CAIS. The accuracy of nCAIS was analyzed by comparing different surgical approaches as well as the commercial brands currently available. Clinical protocols and tips for accuracy when performing nCAIS are described in detail for better adoption by clinicians. Furthermore, the diverse clinical applications of nCAIS are discussed to optimize its utilization and accuracy, extending beyond implant therapy to fields such as endodontics and major head and neck surgery. The transition toward robotic CAIS has been driven by the major limitations of nCAIS such as surgeon-dependent drilling stability. However, robotic CAIS remains in a preliminary stage and is limited for clinical use. Ultimately, the real-time feedback feature of nCAIS may serve as a foundational element to be integrated with additional technologies such as augmented reality (AR), virtual reality (VR), mixed reality (MR), artificial intelligence (AI) and automation, to evolve into the future generations of computer-assisted surgery for the benefit of all patients.