Mekhdieva Elina, Del Fabbro Massimo, Alovisi Mario, Scotti Nicola, Comba Allegra, Berutti Elio, Pasqualini Damiano
Department of Surgical Sciences, Dental School, Endodontics and Operative Dentistry, University of Turin, 10124 Torino, Italy.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20133 Milan, Italy.
J Clin Med. 2023 Sep 8;12(18):5845. doi: 10.3390/jcm12185845.
(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity () was estimated. < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time ( < 0.00001) and less angular ( ≤ 0.0001) and linear deviation ( ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery ( = 0.65, and < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator's experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS.
(1) 背景：动态导航系统（DNS）是一种创新工具，有助于复杂牙髓病病例的处理。尽管这种方法有诸多优点和局限性，但与牙髓病传统方法相比，尚无基于证据的关于其效率的信息。(2) 目的：我们旨在探究DNS的任何有益效果，并比较DNS与徒手（FH）方法在非手术和显微手术牙髓病治疗中的结果。(3) 方法：于2023年8月进行文献检索，以确定将DNS与FH方法进行比较的随机、实验性、非手术和显微手术牙髓病研究。记录并分析操作时间（ΔT，秒）、物质损失（ΔV，毫米）、角度偏差（ΔAD，度）、冠部/平台线性偏差（ΔLD_C，毫米）和根尖线性偏差（ΔLD_A，毫米）。根据体外研究质量评估工具进行质量和偏倚风险评估。对每个结果使用均值差和标准差进行荟萃分析，并估计异质性（）。<0.05被认为具有统计学意义。(4) 结果：经过重复剔除后确定了146项研究，其中9项纳入系统评价和荟萃分析。总体偏倚风险被分类为低。发现DNS比FH方法更准确、更高效，手术时间显著缩短（<0.00001），角度（≤0.0001）和线性偏差更小（≤0.01）。对于物质损失，DNS的优势仅在显微手术中显著（非手术和显微手术程序的分别为=0.65和<0.005）。对于专家和新手操作者，使用DNS均观察到医源性失败风险降低。(5) 结论：无论操作者经验如何，DNS似乎对非手术和显微手术牙髓病治疗有益。然而，需要适当的培训和经验才能充分利用DNS提供的优势。
