Surgical navigation for implant placement using transtomography.

OBJECTIVES To present a new guidance technique using transtomography in the operating room and to test the accuracy of this surgical protocol. MATERIAL A new concept of operating room, integrating when necessary this imagery to secure flapless procedures by intraoperative control, is described. This operating room concept, including X ray protection of the operators, is explained in addition to the transport system of the panoramic machine for its transfer to the patient who remains seated on his surgical chair. METHODS Twenty-five single-tooth edentulous patients were treated by implant placement with a flapless or a minimally invasive procedure using transtomographic navigation. The surgical protocol is explained: after the first limited drill through mucosa and bone, intraoperative transtomography is performed with a custom-made titanium guide inserted into the bone. Images show the drilling axis in three dimensions. This form of navigation allows rectifying the drill axis. We explain how this protocol respects asepsis. RESULTS The mean angular deviation was 2.04 degrees in the mesiodistal direction (range: 0 degrees -4.8 degrees, variance: 2.88) and 2.71 degrees in the buccal or the palatolingual direction (range: 0 degrees -5.4 degrees; variance: 2.63). Implant tip deviation was calculated: the mean mesiodistal tip deviation was 0.42 mm, and the mean buccal or palatolingual tip deviation was 0.5 mm. The maximum tip mesiodistal deviation was 1.08 mm and the maximum vestibular or palatolingual tip deviation was 1.22 mm. CONCLUSION This protocol appears to be as accurate as other guided or navigation systems. The advantages and limitations of this technique are explained, followed by future prospects with the new 3D cone beam computed tomography developed with the same panoramic machine.