Dynamic Navigation in Endodontic Surgery: A Systematic Review.

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.