Accuracy of freehand surgery, static and dynamic computer assisted surgery on zygomatic implant placement: A systematic review and meta-analyses.

Real-time surgical navigation systems (dynamic computer-aided surgery, d-CAIS) and static guided surgery (static computer-aided surgery, s-CAIS) have been shown to enhance the accuracy of zygomatic implant (ZI) placement. The objective of this systematic review was to evaluate and compare the accuracy and risk of complications associated with d-CAIS and s-CAIS in ZI placement. A systematic review of published studies involving more than 4 patients was conducted to assess and compare the accuracy of d-CAIS and s-CAIS in zygomatic implant placement. Only one study included freehand ZI placement as a control. The primary outcomes measured were the accuracy of implant placement relative to preoperative planning, with a secondary focus on evaluating any potential complications. Out of 903 screened studies, 14 met the inclusion criteria. Freehand zygomatic implant placement was used as a control in only 1 study. The results revealed a mean apex deviation of 2.07 mm (95% CI: 2.01 to 2.13; I ²  = 83.14%) for d-CAIS, 1.29 mm (95% CI: 1.15 to 1.43; I ²  = 94.5%) for s-CAIS, and 4.98 mm (95% CI: 3.59 to 6.37; I ²  = not assessable) for freehand placement. Reported complications included mucositis, reversible bilateral sinusitis, oroantral fistula, unspecified reversible postoperative complications, and fracture of the anterior wall of the zygoma. Both CAIS systems demonstrated high accuracy and safety in ZI placement, with a nearly 99% success rate at 6 months of follow-up. These findings suggest that both d-CAIS and s-CAIS are reliable methods for improving the precision and reducing the risks associated with ZI procedures.
Competing Interests: Declaration of competing interest The authors declare no conflict of interest related to this article. However, the authors would like to state the following conflicts outside the submitted work: Dr. Rui Figueiredo reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare, personal fees from Geistlich Pharma AG (Wolhusen, Switzerland), BioHorizons Iberica (Madrid, Spain), Araguaney Dental (Barcelona, Spain), Septodont (Saint-Maur-des-fossés, France), and Laboratorios Silanes (Mexico City, Mexico) outside the submitted work. Dr. Figueiredo has also participated as a principal investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK) and in another clinical trial as a sub-investigator for Menarini Richerche (Florence, Italy). Dr. Eduard Valmaseda-Castellón reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Inibsa Dental (Lliçà de Vall, Spain) Dentaid SL (Cerdanyola del Vallés, Spain) and personal fees from BioHorizons Iberica (Madrid, Spain) and Laboratorios Silanes (Mexico City, Mexico) outside the submitted work. Dr. Eduard Valmaseda-Castellón has also participated as a principal investigator in a randomized clinical trial sponsored by Geistlich Pharma AG (Wolhusen, Switzerland) and in another clinical trial as a sub-investigator for Mundipharma (Cambridge, UK). The remaining authors report no conflicts of interest. Dr. Octavi Camps-Font reports grants and non-financial support from Inibsa Dental (Lliçà de Vall, Spain) and Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare, and Avinent SLU outside the submitted work.
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