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Dynamic navigation: Invention, innovation, revelation, revolution

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ClaroNav’s dynamic navigation in use. (Photo: ClaroNav)

Mon. 25 April 2022

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Fifty years ago, Apollo 11, after a computer-guided voyage of 250,000 miles, orbited the moon. Neil Armstrong, avoiding house-sized boulders and dangerously steep inclines, was able to safely fly the lunar lander onto Tranquility Base assisted by AGC computers.

In the field of endodontics, the accuracy of dento-osseous freehand navigation has been heightened by the magnification and illumination capabilities of microscopes and the spatial plane coordinates of cone-beam computed tomography. Minimally invasive access penetration and osteotomies have mitigated unnecessary structural removal. The preservation of the tooth framework ensures its capacity to sustain adverse functional stresses.

The fundamental concern with the use of freehand navigation is that, at its best, the axis angulation can be as off as much as 2.0 mm, which is inconsistent with diminished structure removal.

3-D printers and intraoral scanners have definitively altered the procedural landscape of endodontics. Static navigation stents are used to enhance the accuracy of access preparation and trephine dedicated microsurgery.

Although stents are an effective evolution in procedural protocols, there are limitations to their use. Stents are cumbersome and bulky. Their use can be restricted by insufficient interocclusal space in posterior and anterior regions and minimal space for microsurgical access. Their fit can be compromised by fabrication inadequacies, and of greatest significance, the predetermined pathway is unalterable.

Dynamic navigation is used extensively in neurosurgery, spinal and orthopedic surgery. Endodontics is embracing this technology as an integral part of a new triad: CBCT, dynamic navigation and laser/sound/fluid dynamic irrigation.

Estimates place the global population older than age 65 at 615 million. Years of dentate and periodontal disease can have an impact on the pulp, the periapex and peri-radicular tissues. With longevity will come the need for targeted accuracy as increasing numbers of complex endodontic procedures occur.

Dynamic navigation facilitates real-time computer guidance technology using a CBCT dataset. This is analogous to the use of GPS and satellite navigation.

Trace and Place (TaP), which has been developed by the Canadian company ClaroNav, eliminates the need for a fiducial stent, thus reducing the workflow time as well as the need for an extra registration scan. This also eliminates the concern of needing the fiducial positioned in exactly the same position during the surgery as it was during the scan.

A stereoscopic camera tracks tags connected to the patient’s jaw and to the instrument specific to the procedure. A navigation screen shows the instrument’s movement on the CBCT as it follows the planned pathway.

Dynamic navigation is invaluable in tracking MB2 canals, middle mesial canals and C shaped canals. Removal of fibre posts is simplified, the use of piezotomes facilitates guided cortical window procedures, and 6mm trephines can create a minimal crypt and resect the apex. It has been demonstrated in vitro that dynamic navigation technology can be used to track ultrasonic tips.

Innovation in dentistry occurs when there is a willingness to explore and improve both diagnosis and treatment. The challenge is to cohesively marry the equipment and materials to new software applications.

Safer and less invasive protocols are the direction of dentistry’s future. Dynamic navigation is proving to be the pilot. Improvement in stereoscopic cameras, the resolution of computer screens, optical markers and the reference array to the patient and the instrumentation used will herald an unprecedented level of accuracy in all patient-centric dental procedures.

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