Authors : Reddy Sudhakara Reddy, Sai Susmitha Gollu, Satyanarayana Raju Mantena, Jyothirmai Koneru, Veera Kumari Merneedi, Rama Laxmi Koruprolu, Sindhuja Yerrapragada, Anitha Reddy Rangasamudram
DOI : 10.1177/23202068251407432
Volume : 0
Issue : 1
Year : 2026
Page No : Nil
Background: Endodontic microsurgery requires precise osteotomy and root-end resection to enhance healing. Freehand approaches are operator-dependent, while static guides limit flexibility. Dynamic navigation systems (DNS) provide real-time guidance, enabling smaller osteotomies, consistent bevel orientation, and improved bone preservation, while reducing variability across different operator skill levels. Aim: To assess the accuracy and efficiency of DNS in osteotomy and root-end resection compared with freehand, static, robotic, and augmented reality techniques. Materials and Methods: A comprehensive search of PubMed, TRIP, LILACS, Google Scholar, and gray literature identified in vitro and cadaveric studies comparing DNS with freehand, static, robotic, or augmented reality in endodontic microsurgery. Reported outcomes included linear and angular deviations, osteotomy diameter, bevel orientation, and operative time. Study quality was appraised using the QUIN 12-item tool, with findings synthesized descriptively due to heterogeneous reporting. The protocol was registered in https://www.crd.york.ac.uk/PROSPERO/view/CRD420251084335 . Results: A total of nine in vitro studies were included. DNS was consistently compared with freehand, static, robotic, and augmented reality methods. Despite variations in design and outcome measures, DNS demonstrated superior accuracy, efficiency, and reproducibility. Additional benefits included reduced osteotomy size, improved bevel orientation, and minimized operator variability. Robotic and augmented reality approaches showed potential but remain in early evaluation. Risk of bias was generally low, but methodological heterogeneity limited the possibility of conducting a meta-analysis. Conclusion: DNS showed superior performance compared with conventional methods, offering accurate, efficient, and adaptable guidance for osteotomy and root-end resection. With most studies demonstrating a low risk of bias, the evidence supports DNS as a reliable approach in guided endodontic microsurgery.