Master of Science in Dentistry
Dr. Janina Golob Deeb
Purpose: The objective of this study was to compare the exposure/uncovery of palatally impacted canines via the use of dynamic navigation guidance to the traditional freehand approach. Outcomes evaluated include the time to plan and perform exposure, area/size of initial access to locate the impacted tooth and the final size of the osteotomy to completely uncover the impacted tooth.
Methods: In order to simulate various frequently encountered clinical scenarios, three different model types were used. Six plastic models of each model type were fabricated from epoxy resin. Each model contained 2 bilaterally, palatally impacted canines, that were randomly embedded in the models, in the canine region. Impacted canines were exposed by either a traditional approach, or guided by dynamic navigation randomly assigned to the right and left side of the same model. Time to plan/prepare, drill, and sizes of the initial and final osteotomy to expose the impacted teeth were measured and compared for the two methods.
Results: Bilaterally, palatally impacted canines were exposed either with the freehand or with guided navigation approach in 18 models, a total of 36 sites evenly distributed. The time to prepare for the procedure was significantly longer for the guided navigation experiments (p3 (adjusted p=.0097). The difference on the left side of the models was not significant (1.86mm3, p=.9933). The total volume removed did not differ significantly between the two methods (78.9 vs 77.4 mm3; p=.7793) or on the side of the model (79.1 vs 77.2 mm3, p=.7175).
Conclusion: Within the limitations of this study, dynamic navigation methods require more time to prepare prior to initiation of surgery, as well as to locate the impacted canine on the left side of the palate, for a right handed operator. Initial access volume was significantly smaller with dynamic navigation on the right side, but the benefit was not seen on the opposite side. No significant differences were seen in the time to finalize the osteotomy or the final size. Dynamic navigation could add significant value to a surgeon in certain clinical presentations, such as proximity to vital structures and adjacent roots, despite the increased time for preparation.
© Daniel Hall, DMD
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