Di Spirito Federica, Gasparro Roberta, Di Palo Maria Pia, De Benedetto Giuseppina, Giordano Francesco, Amato Massimo, Bramanti Alessia
Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy.
Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy.
Healthcare (Basel). 2025 Aug 28;13(17):2151. doi: 10.3390/healthcare13172151.
While widely investigated in implantology and nonsurgical endodontics, evidence on the application of dynamic navigation systems (DNSs) in endodontic surgery remains limited. This systematic review aimed to assess their accuracy and reliability based on two-dimensional and three-dimensional virtual deviations, osteotomy parameters, as well as procedural duration, the impact of the dentist's level of expertise, endodontic surgery healing outcomes, complications, and dentist- and patient-reported feedback. Following the PRISMA guidelines, an electronic search was conducted across the PubMed/MEDLINE, Scopus, Web of Science, and PROSPERO (CRD420251056347) databases up to 23 April 2025. Eligible studies involved human subjects (cadaveric or live) undergoing endodontic surgery with dynamic navigation. Extracted data focused on accuracy metrics such as platform/apical depth deviation and angular deflection. Fourteen studies involving 240 roots were included. DNSs showed high accuracy, with mean platform and apical deviations of 1.17 ± 0.84 mm and 1.21 ± 0.99 mm, respectively, and angular deflection of 2.29° ± 1.69°, as well as low global deviations, averaging 0.83 ± 0.34 mm at the platform and 0.98 ± 0.79 mm at the apex. Root-end resections averaged 3.02 mm in length and 7.49° in angle deviation. DNS-assisted steps averaged 5.6 ± 2.56 min. Healing outcomes were favorable and complications were infrequent. DNSs demonstrated satisfactory accuracy and efficiency and, in the included studies, were linked to favorable healing outcomes and a low occurrence of intra- and postoperative complications. Nevertheless, the current evidence is still limited by the small number of available studies, and the heterogeneity in study designs and outcome measures, highlighting the need for further studies to define the clinical implications of DNSs in endodontic surgery.
虽然动态导航系统（DNS）在种植学和非手术牙髓病学中得到了广泛研究，但关于其在牙髓手术中的应用证据仍然有限。本系统评价旨在基于二维和三维虚拟偏差、截骨参数、手术持续时间、牙医专业水平的影响、牙髓手术愈合结果、并发症以及牙医和患者报告的反馈来评估其准确性和可靠性。按照PRISMA指南，截至2025年4月23日，在PubMed/MEDLINE、Scopus、Web of Science和PROSPERO（CRD420251056347）数据库中进行了电子检索。符合条件的研究涉及接受动态导航牙髓手术的人类受试者（尸体或活体）。提取的数据集中在准确性指标上，如平台/根尖深度偏差和角度偏转。纳入了14项涉及240颗牙根的研究。DNS显示出较高的准确性，平台平均偏差和根尖偏差分别为1.17±0.84毫米和1.21±0.99毫米，角度偏转为2.29°±1.69°，整体偏差也较低，平台平均为0.83±0.34毫米，根尖平均为0.98±0.79毫米。根尖切除术平均长度为3.02毫米，角度偏差为7.49°。DNS辅助步骤平均为5.6±2.56分钟。愈合结果良好，并发症较少。DNS显示出令人满意的准确性和效率，在所纳入的研究中，与良好的愈合结果和较低的术中和术后并发症发生率相关。然而，目前的证据仍然受到可用研究数量少以及研究设计和结果测量的异质性的限制，这突出表明需要进一步研究来确定DNS在牙髓手术中的临床意义。
