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Completed

NCT Number: NCT06028750

Dynamic Navigation vs. the Freehand Method

The purpose of the study is to evaluate in novice surgeons the accuracy of the X-Guide® navigation system (X-Guide®, X-Nav Technologies®, Pennsylvania, USA) in implant placement compared to freehand implant placement.

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Key information

Conditions

Dental Implants

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University of Barcelona

L'Hospitalet de Llobregat, Catalonia, 08903, Spain

About this study

Randomized clinical trial with 2 parallel treatment groups. Eligible patients will be randomized with a 1:1 ratio to one of 2 possible parallel treatment groups:

  • Group 1: Nobel Replace Conical Connection® placed freehand.
  • Group 2: Nobel Replace Conical Connection® placed using the X-Guide guided surgery system (X-Nav Technologies®, Pennsylvania, USA).

PRIMARY OBJECTIVE:

  • To evaluate in novice surgeons the accuracy of the X-Guide® Navigation System (X-Guide®, X-Nav Technologies®, Pennsylvania, USA) in implant placement compared to freehand implant placement.

SECONDARY OBJECTIVES:

  • To evaluate overall surgical time with the X-Guide® Navigation System (X-Guide®, X-Nav Technologies®, Pennsylvania, USA) compared to freehand implant placement in inexperienced surgeons.
  • To evaluate Patient Reported Outcomes Measures (PROMs) during implant treatment with navigation systems performed by novice surgeons.
  • To assess the association between SURG-TLX-SP scores and preoperative anxiety, self-perceived surgical difficulty, assistant-observed stress, and surgical duration in novice surgeons.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Subjects who agree to voluntarily sign the informed consent before performing any action related to the study.
  • Men or women at least 18 years old.
  • Single edentulous spaces or edentulous sections located in maxilla or mandible with a healing period longer than 12 weeks to rehabilitate with implant-supported fixed crowns ≤3 units.
  • O'Leary plaque and/or bleeding on probing index ≤25%.

Exclusion criteria

  • Systemic diseases that may interfere with dental implant placement.
  • Any contraindications for oral surgical procedures.
  • History of head and neck radiotherapy.
  • Patients smoking >20 cigarettes/day or tobacco equivalents.
  • History of substance abuse (drugs or alcohol) or any other factor (e.g., severe psychiatric illness) that, in the opinion of the investigator, could interfere with the patient's ability to cooperate and comply with the study.
  • Patients who have participated in a clinical trial within the last 30 days.
  • Pregnant or lactating women.
  • Patients with poor or unmotivated oral hygiene.
  • Probing depth with bleeding of ≥4 mm in one of the teeth adjacent to the edentulous space or tract.
  • Need to perform guided bone regeneration procedures simultaneous to implant placement.
  • Cases where the use of transepithelial abutments is not recommended (reduced prosthetic space, high esthetic demand associated with thin gingival biotypes, etc.).

Treatment and study plan

Dynamic Computer Assisted Surgery

Procedure

Surgical navigation system (X-Guide guided surgery system) Navigation system X-Guide

Other names: Dynamic Navigation, Navigated surgery

Freehand

Procedure

Freehand implant placement

Primary outcomes

  1. To evaluate in novice surgeons the accuracy of the X-Guide® navigation system (X-Guide®, X-Nav Technologies®, Pennsylvania, USA) in implant placement compared to freehand implant placement.

    Time frame: Through study completion, an average of 1 year.

    The accuracy of placement of Nobel Replace Conical Connection® implants (Nobel Biocare) will be evaluated by superimposing the two cone-beam computed tomography (CBCT) (pre- and post-surgical) and calculating the deviations from the pre-operative planning and the final implant position. The superimposition of both CBCTs will be performed using X-Guide Standalone Planning Software (Nobel Biocare).

    The following variables will be analyzed for each implant: Angular deviation, Lateral platform deviation (2D), Global platform deviation (3D), Lateral apex deviation (2D), Apex depth deviation and Global apex deviation (3D).

Secondary outcomes

  1. To evaluate overall surgical time with the X-Guide® Navigation System (X-Guide®, X-Nav Technologies®, Pennsylvania, USA) compared to freehand implant placement in inexperienced surgeons.

    Time frame: During the surgical procedure.

    Duration of the operation from the moment of anesthesia to the last suture point. In seconds (s).

  2. Comparison of Patient Reported Outcomes Measures (PROMs) between navigated and freehand surgery, using the Oral Health Impact Profile questionnaire, in addition to a PROMs questionnaire designed.

    Time frame: The OHIP-14 will be performed just before starting the surgery and at the 7-day postoperative control. The PROMs questionnaire will be performed by the patient just after finishing the implant surgery and having explained the postoperative instructions.

    A questionnaire has been designed to evaluate the PROMs of patients treated with dynamic guided surgery and compare it with the PROMs of patients treated freehand:

    • Prior to surgery the patient will complete the oral health impact profile questionnaire (OHIP-14sp).
    • Immediately after the surgery and after explaining the postoperative instructions, the patient will fill in the questionnaire designed to evaluate PROMs.
    • At 7 postoperative days, the patient will again complete the OHIP-14sp.

  3. Comparison of postoperative pain between navigated and freehand surgery, using a questionnaire designed with a visual analog scale (VAS).

    Time frame: The postoperative pain will be evaluated immediately after the surgery with a VAS questionnaire and during the 7 days following surgery.

    A questionnaire has been designed to evaluate the postoperative pain of patients treated with dynamic guided surgery and compare it with patients treated freehand:

    • Immediately after the surgery the patient will complete the VAS questionnaire.
    • Another VAS questionnaire will be given to assess postoperative pain during the 7 days following surgery.
    • The VAS questionnaire consists of a 100 mm visual analog scale (VAS). In the VAS questionnaire given for the 7 postoperative days there will be a VAS for each day and the analgesics and anti-inflammatory drugs consumed by the patient will be recorded.
    • The VAS is formed by the value "No pain" to the left of the 100 mm straight line and by the value "Worst pain imaginable" to the right of the 100 mm straight line.

  4. Assessment of correlations between perceived surgical workload and preoperative anxiety, self-perceived surgical difficulty, assistant-observed stress, and surgical duration in novice surgeons

    Time frame: From immediately before surgery to immediately after completion of the surgical procedure.

    Correlations between perceived surgical workload and other perioperative variables will be assessed during implant placement procedures performed by novice surgeons. Perceived surgical workload will be measured using the Spanish version of the Surgery Task Load Index questionnaire (SURG-TLX-SP; total score and domain scores). Preoperative anxiety will be assessed immediately before surgery using the State-Trait Anxiety Inventory-State questionnaire (STAI-S; score). Self-perceived surgical difficulty will be assessed immediately after surgery using a 100 mm visual analog scale (VAS; mm). Assistant-observed operator stress will be evaluated immediately after surgery using a 100 mm VAS completed by the surgical assistant (mm). Surgical duration will be recorded in minutes from the beginning of the incision to placement of the last suture (minutes). Correlations between SURG-TLX-SP scores and each variable will be analyzed.

Sponsors and collaborators

Lead sponsor

University of Barcelona

Other

Registry information

Official study title

Accuracy of Dental Implant Placement Using Dynamic Navigation or the Freehand Method: a Randomized Controlled Clinical Trial in Novice Operators

Important dates

Study start
2023
Primary completion
2024
Study completion
2024
First posted
Sep 8, 2023
Registry last updated
May 18, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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