Computer-aided implant navigation

Based on the robotic and navigation systems proven in neurosurgical and orthopedic practice over decades, a surgical system for dental implantology has now been developed which optimally fulfills the requirements with regard to precision, functionality, and especially safety for surgeons and their patients.

Because all components focus on the work area of the oral cavity, the system is optimally integrated in the implantological-prosthetic treatment program.

Minimally invasive surgical procedures
From the patient's point of view, the advantage of the robotic technique include: The oral surgeon can place the implants precisely in the optimal positions from a surgical and prosthetic point of view. In many cases, the surgical opening and later suturing of the oral mucosa can be eliminated.
Precise placement of the implants in the optimal location can shorten the implant healing time. In certain cases the dental prosthesis can be immediately attached to the implants.
The ultimate in stability and esthetics is thus achieved.
At the implant locations, only a small hole hole is punched after a local anesthetic is administered. Postoperative stress on the patient is reduced to a minimum.
The duration of treatment and recovery from the implant surgery is shorter in comparison to conventional surgery, and precision is significantly increased as well.

The Robodent® navigation system was developed as part of an extensive research project at the Charité University Clinic in Berlin by the team under the direction of Dr. Lüth and Dr. Bier (Department of Navigation and Robotics). It is now
standardized and used professionally in our practice.

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Anatomische Strukturen wie Nerven,Gefäße,Kieferhöhle oder Nasenboden werden am Computermonitor markiert umd vom Navigationssystem später bei der Operation vor unbeabsichtigten Verletzungen geschützt.
Durch das gezielte operative Vorgehen ist nur ein sehr kleiner Zugang zum OP-Gebiet notwendig und dadurch bedingt ist eine wesentlich geringere Traumatisierung (Schädigung) des Weichgewebe. Das postoperative Beschwerdebild des Patienten ist deutlich verringert.

Die Implantatauswahl erfolgt aus einer Datenbank, die nahezu alle Hersteller zahnärztlicher Implantate erfasst. Eine besondere Erleichterung bei der Planung wie auch der eigentlichen Operation ist das automatisch berechnete 3-D-Modell des Patientenkiefers in das automatisch die Implantatachsen der zu setzenden Implantate gezeichnet werden. Das 3-D Modell kann virtuell gedreht und gewendet werden.

Ablauf während der OP
Ein optischer Sensor vermisst hochpräzise die Lage von Patient und Bohreinheit. Das Navigationssystem zeigt dem Operateur über intuitiv zu erfassende Farbmarkierungen die korrekte Lage seines Bohrers in Bezug auf das zu setzende Implantat an.

Das Verfahren basiert auf Infrarotlicht, das an kleinen, leichten und ergonomisch angebrachten Reflektorkörpern an Bohreinheit und Patient gespiegelt wird. Ähnlich der Wirkungsweise der menschlichen Augen werden die Reflektionsprismen von 2 Infrarotkameras beobachtet und durch Stereovision die räumliche Lage exakt bestimmt. Es befinden sich keine Kabel am Patienten, dadurch wird die Handhabung wesentlich erleichtert.

Anatomical structures such as nerves, blood vessels, the oral cavity of the sinus floor are marked on the computer monitor and protected by the navigation system from unintentional injury during the operation.
The precisely targeted surgical procedure means that only very limited access to the operating field is required, thus causing considerably less damage to the soft tissue. The patient's postoperative pain is substantially reduced.

The implant is selected from a database that contains nearly all of the manufacturers of dental implants. A particular advantage in planning as well as in the actual operation is the automatically calculated 3D model of the patient's jaw in which the implant axes of the implants to be placed are automatically drawn. The 3D model can be virtually rotated as you wish.

Surgical procedure
An optical sensor measures the position of the patient and drilling unit with extreme precision. Via intuitive colored markers, the navigation system shows the surgeon the correct position of his drill related to the implant to be placed.

The process utilizes infrared light which is reflected on small, light-weight and ergonomically placed reflectors on the drill and the patient. Similar to the function of the human eye, the reflective prisms are observed by two infrared cameras and the spatial position is precisely determined using stereovision. No cables are attached to the patient, which makes system handling considerably easier.

During the operation, the deviation between the instrument and the planned implant axis is displayed to the surgeon with an accuracy of one-tenth of a millimeter and documented for purposes of quality control. The navigation system automatically recognizes the length of the mounted drill and independently identifies the particular implant to be drilled.
The surgeon can track the depth of the drill in the bone on a scroll bar on the monitor. An acoustic signal sounds as soon as the exact depth is reached.

In the pre-operative planning phase, the patient is positioned in the CT or DVT unit.
A spiral CT of the jaw is then produced in high-resolution thin sections. The entire examination, including patient positioning, takes approximately 2 to 3 minutes. The record of the jaw then undergoes further processing with the reconstruction parameters.
This information is saved on a CD-ROM for the patient and is then available to the surgeon.