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Comparison of marker-based and marker-free registration techniques in dynamic navigation-guided implant surgery for fully and partially edentulous patients: A systematic review and meta-analysis

Evidence-Based Dentistry volume 26, page 158 (2025)Cite this article

Subjects

Abstract

Objectives

To compare the accuracy of marker-based and marker-free registration methods in the context of dynamic navigation guided implant surgery for patients with partial or complete tooth loss.

Methodology

The review includes research articles written in English and Mandarin Chinese published between January 2013 and May 2025, from databases such as MEDLINE/PubMed, Scopus, Cochrane, Embase, China National Knowledge Infrastructure (CNKI) and Web of Science. Both laboratory-based and clinical investigations were taken into account. Thirteen studies, met the specified criteria for inclusion and underwent meta-analysis. Sub-analyses were performed to compare various registration modalities. The assessment of collective evidence was conducted using the GRADE system.

Results

No statistically significant differences were observed between registration methodologies i.e; marker based and marker free. Subgroup analysis highlighted a preference for marker-based methods, specifically those utilizing U-shaped markers and bone markers, especially in the lower jaw. No notable variations were noted in terms of time efficiency. Marker-free registration was favored for outcomes reported by patients.

Conclusion

Both marker-free and marker-based registration strategies are considered feasible options. Selection should be made based on factors such as practicality, cost, efficiency, clinician preference, and patient-reported outcomes. The results should be interpreted with caution due to the considerable variability among studies, underscoring the necessity for more consistent and dependable data.

PROSPERO Registration Number

CRD42024504573.

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Fig. 1
Fig. 2: Meta-analysis comparing deviations between marker-based and marker-free dynamic Navigation Guided implant surgery (D-NGIS).
Fig. 3: Subgroup analysis based on registration methods comparing deviations between marker-based and marker-free dynamic navigation-assisted implant surgery.
Fig. 4: Subgroup analysis based on arch location of registration comparing deviations between marker-based and marker-free dynamic navigation-assisted implant surgery.
Fig. 5: Subgroup analysis based on saddle condition comparing deviations between marker-based and marker-free dynamic navigation-assisted implant surgery.
Fig. 6: Subgroup analysis based on study design comparing deviations between marker-based and marker-free dynamic navigation-assisted implant surgery.
Fig. 7: Meta-analysis comparing time efficiency between marker-based and marker-free dynamic navigation-assisted implant surgery.

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Data availability

The data supporting this article can be made available by the corresponding author upon request.

References

  1. Jain S, Sayed ME, Ibraheem WI, Ageeli AA, Gandhi S, Jokhadar HF, et al. Accuracy comparison between robot-assisted dental implant placement and static/dynamic computer-assisted implant surgery: a systematic review and meta-analysis of in vitro studies. Medicina. 2023;60:11.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wang J, Ge Y, Mühlemann S, Pan S, Jung RE. The accuracy of dynamic computer assisted implant surgery in fully edentulous jaws: A retrospective case series. Clin Oral Implants Res. 2023;34:1278–88.

    Article  CAS  PubMed  Google Scholar 

  3. Schnutenhaus S, Edelmann C, Knipper A, Luthardt RG. Accuracy of dynamic computer-assisted implant placement: a systematic review and meta-analysis of clinical and in vitro studies. J Clin Med. 2021;10:704.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Feng Y, Yao Y, Yang X. Effect of a dynamic navigation device on the accuracy of implant placement in the completely edentulous mandible: An in vitro study. J Prosthet Dent. 2023;130:731–7.

    Article  PubMed  Google Scholar 

  5. Jorba-García A, González-Barnadas A, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Accuracy assessment of dynamic computer-aided implant placement: a systematic review and meta-analysis. Clin Oral Investig. 2021;25:2479–94.

    Article  PubMed  Google Scholar 

  6. Wei SM, Zhu Y, Wei JX, Zhang CN, Shi JY, Lai HC. Accuracy of dynamic navigation in implant surgery: A systematic review and meta-analysis. Clin Oral Implants Res. 2021;32:383–93.

    Article  PubMed  Google Scholar 

  7. Pomares-Puig C, Sánchez-Garcés MA, Jorba-García A. Dynamic and static computer-guided surgery using the double-factor technique for completely edentulous patients: A dental technique. J Prosthet Dent. 2022;128:852–7.

    Article  PubMed  Google Scholar 

  8. Knipper A, Kuhn K, Luthardt RG, Schnutenhaus S. Accuracy of dental implant placement with dynamic navigation-investigation of the influence of two different optical reference systems: a randomized clinical trial. Bioengineering. 2024;11:155.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Emery RW, Merritt SA, Lank K, Gibbs JD. Accuracy of dynamic navigation for dental implant placement-model-based evaluation. J Oral Implantol. 2016;42:399–405.

    Article  PubMed  Google Scholar 

  10. Eggers G, Mühling J, Marmulla R. Image-to-patient registration techniques in head surgery. Int J Oral Maxillofac Surg. 2006;35:1081–95.

    Article  CAS  PubMed  Google Scholar 

  11. Kang SH, Kim MK, Kim JH, Park HK, Lee SH, Park W. The validity of marker registration for an optimal integration method in mandibular navigation surgery. J Oral Maxillofac Surg. 2013;71:366–75.

    Article  PubMed  Google Scholar 

  12. Wang XY, Liu L, Guan MS, Liu Q, Zhao T, Li HB. The accuracy and learning curve of active and passive dynamic navigation-guided dental implant surgery: an in vitro study. J Dent. 2022;124:104240.

    Article  PubMed  Google Scholar 

  13. D’Haese J, Ackhurst J, Wismeijer D, De Bruyn H, Tahmaseb A. Current state of the art of computer-guided implant surgery. Periodontol 2000. 2017;73:121–33.

    Article  PubMed  Google Scholar 

  14. Gargallo-Albiol J, Barootchi S, Salomó-Coll O, Wang HL. Advantages and disadvantages of implant navigation surgery. A systematic review. Ann Anat. 2019;225:1–10.

    Article  PubMed  Google Scholar 

  15. Aydemir CA, Arisan V. Accuracy of dental implant placement via dynamic navigation or the freehand method: A split-mouth randomized controlled clinical trial. Clin Oral Implants Res. 2020;31:255–63.

    Article  PubMed  Google Scholar 

  16. Wei SM, Li Y, Deng K, Lai HC, Tonetti MS, Shi JY. Does machine-vision-assisted dynamic navigation improve the accuracy of digitally planned prosthetically guided immediate implant placement? A randomized controlled trial. Clin Oral Implants Res. 2022;33:804–15.

    Article  CAS  PubMed  Google Scholar 

  17. Stefanelli LV, Mandelaris GA, DeGroot BS, Gambarini G, De Angelis F, Di Carlo S. Accuracy of a Novel Trace-Registration Method for Dynamic Navigation Surgery. Int J Periodont Restorat Dent. 2020;40:427–35.

    Article  Google Scholar 

  18. Jorba-García A, Bara-Casaus JJ, Camps-Font O, Sánchez-Garcés M, Figueiredo R, Valmaseda-Castellón E. Accuracy of dental implant placement with or without the use of a dynamic navigation assisted system: A randomized clinical trial. Clin Oral Implants Res. 2023;34:438–49.

    Article  PubMed  Google Scholar 

  19. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  21. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021;12:55–61.

    Article  PubMed  Google Scholar 

  22. Sheth VH, Shah NP, Jain R, Bhanushali N, Bhatnagar V. Development and validation of a risk-of-bias tool for assessing in vitro studies conducted in dentistry: The QUIN. J Prosthet Dent. 2024;131:1038–42.

    Article  CAS  PubMed  Google Scholar 

  23. Al-Jarsha MY, Almezyad O, AlOtaibi N, Naudi KB, Robertson DP, Ayoub AF. The Accuracy of intraoral registration for dynamic surgical navigation in the edentulous maxilla. Int J Oral Maxillofacial Implants. 2024;https://doi.org/10.11607/jomi.10531.

  24. Jorba-García A, Bara-Casaus JJ, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. The influence of radiographic marker registration versus a markerless trace registration method on the implant placement accuracy achieved by dynamic computer-assisted implant surgery. An in-vitro study. J Dent. 2024;146:105072.

    Article  PubMed  Google Scholar 

  25. Ma FF, Wei T, Sun F, Ma Y. [Accuracy of two different registration methods of dynamic navigation system for dental implant placement]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2022;57:1225–9.

    CAS  PubMed  Google Scholar 

  26. Mohagheghi S, Ahmadian A, Yaghoobee S. Accuracy assessment of a marker-free method for registration of CT and stereo images applied in image-guided implantology: a phantom study. J Craniomaxillofac Surg. 2014;42:1977–84.

    Article  PubMed  Google Scholar 

  27. Pei X, Liu X, Iao S, Ma F, Li H, Sun F. Accuracy of 3 calibration methods of computer-assisted dynamic navigation for implant placement: An in vitro study. J Prosthet Dent. 2024;131:668–74.

    Article  PubMed  Google Scholar 

  28. Wei T, Ma F, Sun F, Ma Y. Assessment of the accuracy of two different dynamic navigation system registration methods for dental implant placement in the posterior area: an in vitro study. J Pers Med. 2023;13:139.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ruiz-Romero V, Jorba-Garcia A, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Accuracy of dynamic computer-assisted implant surgery in fully edentulous patients: an in vitro study. J Dent. 2024;149:105290.

    Article  PubMed  Google Scholar 

  30. Ekram A, Ekram K, El Maghraby M, Elmorsy AK, Bayome M. 3D Registration accuracy of a novel marker-free technique for double-scan protocol. Int J Oral Maxillofac Implants. 2022;37:473–8.

    Article  PubMed  Google Scholar 

  31. Ma F, Sun F, Wei T, Ma Y. Comparison of the accuracy of two different dynamic navigation system registration methods for dental implant placement: A retrospective study. Clin Implant Dent Relat Res. 2022;24:352–60.

    Article  PubMed  Google Scholar 

  32. Pozzi A, Carosi P, Laureti A, Mattheos N, Pimkhaokham A, Chow J, et al. Accuracy of navigation guided implant surgery for immediate loading complete arch restorations: Prospective clinical trial. Clin Implant Dent Relat Res. 2024;26:954–71.

    Article  PubMed  Google Scholar 

  33. Zhu J, Sun W, Li L, Li H, Zou Y, Huang B, et al. Accuracy and patient-centered results of marker-based and marker-free registrations for dynamic computer-assisted implant surgery: A randomized controlled trial. Clin Oral Implants Res. 2024;35:101–13.

    Article  CAS  PubMed  Google Scholar 

  34. Wu Y, Wang F, Huang W, Fan S. Real-time navigation in zygomatic implant placement: workflow. Oral Maxillofac Surgery Clin North Am. 2019;31:357–67.

    Article  Google Scholar 

  35. Fitzpatrick JM, West JB, Maurer CR Jr. Predicting error in rigid-body point-based registration. IEEE Trans Med Imaging. 1998;17:694–702.

    Article  CAS  PubMed  Google Scholar 

  36. West JB, Fitzpatrick JM, Toms SA, Maurer CR Jr., Maciunas RJ. Fiducial point placement and the accuracy of point-based, rigid body registration. Neurosurgery. 2001;48:810–6.

    CAS  PubMed  Google Scholar 

  37. Wu Y, Tao B, Lan K, Shen Y, Huang W, Wang F. Reliability and accuracy of dynamic navigation for zygomatic implant placement. Clin Oral Implants Res. 2022;33:362–76.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Metzger MC, Rafii A, Holhweg-Majert B, Pham AM, Strong B. Comparison of 4 registration strategies for computer-aided maxillofacial surgery. Otolaryngol Head Neck Surg. 2007;137:93–9.

    Article  PubMed  Google Scholar 

  39. Luebbers HT, Messmer P, Obwegeser JA, Zwahlen RA, Kikinis R, Graetz KW, et al. Comparison of different registration methods for surgical navigation in cranio-maxillofacial surgery. J Cranio-Maxillo-Facial Surg. 2008;36:109–16.

    Article  Google Scholar 

  40. Widmann GMD, Stoffner RD, Bale RMD. Errors and error management in image-guided craniomaxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:701–15.

    Article  PubMed  Google Scholar 

  41. Seginer A. Rigid-body point-based registration: The distribution of the target registration error when the fiducial registration errors are given. Med Image Anal. 2011;15:397–413.

    Article  CAS  PubMed  Google Scholar 

  42. Lan K, Tao B, Wang F, Wu Y. Accuracy evaluation of 3D-printed noninvasive adhesive marker for dynamic navigation implant surgery in a maxillary edentulous model: An in vitro study. Med Eng Phys. 2022;103:103783.

    Article  PubMed  Google Scholar 

  43. Woo HW, Mai HN, Lee DH. Comparison of the accuracy of image registration methods for merging optical scan and radiographic data in edentulous jaws. J Prosthodont. 2020;29:707–11.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Bahria University Dental College, Bahria University of Health sciences Campus, Karachi, Pakistan

    Meisha Gul

  2. Second Dental Center, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Meisha Gul, Baoxin Tao, Wenjie Zhou, Feng Wang & Yiqun Wu

  3. College of Stomatology, Shanghai Jiao Tong University, Shanghai, China

    Baoxin Tao, Wenjie Zhou, Feng Wang & Yiqun Wu

  4. National Center for Stomatology, Shanghai, China

    Baoxin Tao, Wenjie Zhou, Feng Wang & Yiqun Wu

  5. National Clinical Research Center for Oral Diseases, Shanghai, China

    Baoxin Tao, Wenjie Zhou, Feng Wang & Yiqun Wu

  6. Shanghai Key Laboratory of Stomatology, Shanghai, China

    Baoxin Tao, Wenjie Zhou, Feng Wang & Yiqun Wu

  7. Shanghai Research Institute of Stomatology, Shanghai, China

    Baoxin Tao, Wenjie Zhou, Feng Wang & Yiqun Wu

  8. Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China

    Baoxin Tao, Wenjie Zhou, Feng Wang & Yiqun Wu

Authors
  1. Meisha Gul
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  2. Baoxin Tao
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  4. Feng Wang
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Contributions

Meisha Gul: Data curation, Formal analysis, Investigation, Software, Visualization, Writing - original draft. Baoxin Tao: Data curation, Investigation, Writing - review & editing. Wenjie Zhou: Conceptualization, Methodology, Writing - review & editing. Feng Wang: Conceptualization, Methodology, Supervision, Writing - review & editing. Yiqun Wu: Conceptualization, Methodology, Supervision, Writing - review & editing.

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Correspondence to Meisha Gul.

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Gul, M., Tao, B., Zhou, W. et al. Comparison of marker-based and marker-free registration techniques in dynamic navigation-guided implant surgery for fully and partially edentulous patients: A systematic review and meta-analysis. Evid Based Dent 26, 158 (2025). https://doi.org/10.1038/s41432-025-01171-2

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