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Volume 15
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Article

Comparative Evaluation of Two Dynamic Navigation Systems vs. Freehand Approach and Different Operator Skills in Endodontic Microsurgery: A Cadaver Study

by
Umberto Gibello
1,2,†,
Elina Mekhdieva
1,*,†,
Mario Alovisi
1,
Luca Cortese
1,
Andrea Cemenasco
1,
Anna Cassisa
3,
Caterina Chiara Bianchi
1,
Vittorio Monasterolo
4,
Allegra Comba
1,
Andrea Baldi
1,
Vittorio Fenoglio
5,
Elio Berutti
1 and
Damiano Pasqualini
1
1
Department of Surgical Sciences, Dental School, University of Turin, Via Nizza 230, 10126 Turin, Italy
2
Department of Mechanical and Aerospace Engineering—DIMEAS, Polytechnic University of Turin, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
3
Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy
4
Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy
5
Department of Surgical Sciences, Dental School, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to the work.
Appl. Sci. 2025, 15(21), 11405; https://doi.org/10.3390/app152111405
Submission received: 22 September 2025 / Revised: 15 October 2025 / Accepted: 22 October 2025 / Published: 24 October 2025
(This article belongs to the Special Issue Endodontics and Restorative Dentistry: Advanced Materials, Methods and Technologies)
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Abstract

Background/Objectives: The purpose of the study is to determine and compare the accuracy and efficiency of two dynamic navigation systems (DNS)—Navident (ClaroNav, Canada) and X-Guide (Nobel Biocare, Switzerland)—vs. a free-hand (FH) approach in performing endodontic microsurgery (EMS) on human cadavers. Methods: a total of 119 roots of six cadavers were randomly divided into three groups (Navident/X-Guide/FH). The cadavers’ jaws were scanned pre-operatively with computed tomography. The DICOM data were uploaded and digitally managed with software interfaces for registration, calibration, and virtual planning of EMS. Osteotomy was performed under DNS control and using a dental operating microscope (FH control group). Post-operative scans were taken with same settings as preoperative. Accuracy was then determined by comparing pre- and post-scans of coronal and apical linear, angular deviation, angle, length, and depth of apical resection. Efficiency was determined by measuring the procedural time of osteotomy, apicectomy, retro-cavity preparation, the volume of substance, and cortical bone loss, as well as iatrogenic complications. Outcomes were also evaluated in relation to different operators’ skill levels. Descriptive statistics and inferential analyses were conducted using R software (4.2.1). Results: DNS demonstrated better efficiency in osteotomy and apicectomy, second only to FH in substance and cortical bone loss. Both DNS approaches had similar accuracy. Experts were faster and more accurate than non-experts in FH, apart from resection angle, length and depth, and retro-cavity preparation time, for which comparison was not statistically significant. The Navident and X-guide groups had similar trends in increasing efficiency and accuracy of EMS. All complications in the FH group were performed by non-experts. The X-guide group demonstrated fewer complications than the Navident group. Conclusions: Both DNS appear beneficial for EMS in terms of accuracy and efficacy in comparison with FH, also demonstrating the decreasing gap of skill expertise between experts and novice operators. Through convenient use X-guide diminishes the level of iatrogenic complications compared to Navident.
Keywords: endodontic microsurgery; dynamic navigation endodontic microsurgery; dynamic navigation

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MDPI and ACS Style

Gibello, U.; Mekhdieva, E.; Alovisi, M.; Cortese, L.; Cemenasco, A.; Cassisa, A.; Bianchi, C.C.; Monasterolo, V.; Comba, A.; Baldi, A.; et al. Comparative Evaluation of Two Dynamic Navigation Systems vs. Freehand Approach and Different Operator Skills in Endodontic Microsurgery: A Cadaver Study. Appl. Sci. 2025, 15, 11405. https://doi.org/10.3390/app152111405

AMA Style

Gibello U, Mekhdieva E, Alovisi M, Cortese L, Cemenasco A, Cassisa A, Bianchi CC, Monasterolo V, Comba A, Baldi A, et al. Comparative Evaluation of Two Dynamic Navigation Systems vs. Freehand Approach and Different Operator Skills in Endodontic Microsurgery: A Cadaver Study. Applied Sciences. 2025; 15(21):11405. https://doi.org/10.3390/app152111405

Chicago/Turabian Style

Gibello, Umberto, Elina Mekhdieva, Mario Alovisi, Luca Cortese, Andrea Cemenasco, Anna Cassisa, Caterina Chiara Bianchi, Vittorio Monasterolo, Allegra Comba, Andrea Baldi, and et al. 2025. "Comparative Evaluation of Two Dynamic Navigation Systems vs. Freehand Approach and Different Operator Skills in Endodontic Microsurgery: A Cadaver Study" Applied Sciences 15, no. 21: 11405. https://doi.org/10.3390/app152111405

APA Style

Gibello, U., Mekhdieva, E., Alovisi, M., Cortese, L., Cemenasco, A., Cassisa, A., Bianchi, C. C., Monasterolo, V., Comba, A., Baldi, A., Fenoglio, V., Berutti, E., & Pasqualini, D. (2025). Comparative Evaluation of Two Dynamic Navigation Systems vs. Freehand Approach and Different Operator Skills in Endodontic Microsurgery: A Cadaver Study. Applied Sciences, 15(21), 11405. https://doi.org/10.3390/app152111405

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