Dynamic Computer-Assisted Surgery in Oral Surgery: A Systematic Review.

Abstract

Background/Objectives: Dynamic computer-assisted surgery (dCAS) has emerged as a promising tool, particularly in implantology, enabling real-time procedural adjustments through 3D image-based tracking. However, their application in other areas of oral surgery remains limited. This systematic review aims to evaluate the advantages, limitations, clinical implications, and complications associated with the use of dCAS in oral surgery (excluding implants or miniscrew insertion) beyond implant placement, in comparison to conventional freehand (FH) techniques. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. A focused PICO question was developed, and a comprehensive literature search was performed in PubMed, Scopus, and the Cochrane Library between February and March 2025, and supplemented by manual screening. The risk of bias of the included studies was evaluated using the Cochrane Risk of Bias tool (RoB 2) for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized controlled trials (NRCTs). Data were summarized in tables and analyzed through qualitative synthesis. Results: Ten studies evaluating dCAS in several oral surgical procedures, including complex tooth extractions and endodontic surgery, were included. A substantial improvement was observed in accuracy of endodontic procedures. Operator experience was a key factor in surgical outcomes. Regarding postoperative complications, no significant differences were observed, although the trend indicated an equal or lower risk in comparison with conventional FH techniques. Conclusions: dCAS may significantly improve accuracy and efficiency in endodontic surgery and reduce operative time in complex mandibular third molar (M3M) extractions. The complication rate is comparable to that of conventional FH techniques. However, current evidence remains limited, heterogeneous, and mainly experimental. Further studies are recommended to validate the benefits of dCAS in clinical settings.