Safe and Accurate Immediate Implant Placement in the Posterior Maxilla: The Role of Dynamic Navigation in Transcrestal Sinus Augmentation

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This PhD thesis investigates the safety, accuracy, and clinical feasibility of dynamic computer-assisted implant surgery (dCAIS) in immediate implant placement combined with transcrestal sinus augmentation in the posterior maxilla. The work addresses a major clinical challenge in implant dentistry, where limited residual bone height, sinus pneumatization, and anatomical variability complicate precise implant positioning and increase the risk of Schneiderian membrane perforation. Two complementary clinical studies form the basis of the thesis. First, a case report introduces a novel workflow integrating dynamic navigation with osseodensification-assisted transcrestal sinus augmentation, demonstrating technical feasibility, atraumatic membrane elevation, and successful immediate implant placement with stable osseointegration. Second, a prospective randomized split-mouth clinical trial compares dynamic navigation with the conventional freehand technique in 28 patients (62 implants) undergoing indirect sinus lift and immediate implantation. Primary outcomes included angular deviation and linear deviations at the entry point and apex, while secondary outcomes assessed procedural time and patient satisfaction. Dynamic navigation showed significantly superior accuracy, with markedly reduced angular and linear deviations compared with freehand placement (p < 0.0001), while maintaining comparable procedural efficiency and slightly higher patient satisfaction. No sinus membrane perforations were observed in either group. The results demonstrate that dynamic navigation substantially improves three-dimensional implant placement accuracy in the posterior maxilla without compromising clinical workflow. When combined with osseodensification, the approach provides enhanced control during sinus elevation and reliable primary stability. This thesis concludes that dynamic navigation represents a safe and effective adjunct for complex implant procedures in the posterior maxilla, particularly in immediate placement with transcrestal sinus augmentation, and supports its broader clinical adoption in anatomically demanding cases.

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