Dental implant therapy has become a predictable and widely accepted treatment modality for the rehabilitation of partially and completely edentulous patients. Its clinical success is commonly associated with osseointegration, prosthetic function, esthetic integration, and long-term stability of peri-implant hard and soft tissues.

Accurate three-dimensional implant placement is a fundamental prerequisite for predictable and successful outcomes (Buser 2004). An ideal implant position supports favorable prosthetic space for emergence profile, minimizes biomechanical complications, protects adjacent teeth and vital anatomical structures, and contributes to the maintenance of peri-implant tissue health (Tarnow 2000). Although experienced clinicians may achieve acceptable outcomes by using freehand techniques, conventional freehand placement remains highly dependent on surgical expertise, tactile perception, and intraoperative judgment, which varies among dentists. This dependence introduces the possibility of angular, coronal, and apical deviations from the planned implant position, particularly in anatomically complex or advanced edentulous cases (Bover-Ramos 2018; Colombo 2017; Raico Gallardo 2017).

Computer-assisted implant surgery (CAIS) has emerged as a clinical approach designed to transfer the virtual implant plan accurately to the surgical field to enhance accuracy, efficiency and safety (Choi 2017; D'haese 2017). The development of cone-beam computed tomography (CBCT) has enabled the, three-dimensional evaluation of alveolar bone morphology, anatomical risk structures, and the available bone volume as well as the condition of the surrounding teeth (Rios 2017). When combined with intraoral scanning and implant-planning software, CBCT allows clinicians to perform virtual prosthetically driven implant placement prior to surgery. This digital workflow supports the integration of restorative planning with surgical execution, thereby improving the predictability of implant positioning and reducing the risk of intraoperative complications (Siqueira 2020).

CAIS can generally be classified into static computer-assisted implant surgery (sCAIS) and dynamic computer-assisted implant surgery. Dynamic CAIS has further evolved into navigated CAIS and robotic assisted systems, incorporating advances in automation technology and artificial intelligence (Fig. 1).

Static CAIS uses prefabricated surgical guides, manufactured through CAD/CAM milling or printing, to guide the osteotomy during drilling and implant placement. This technique is well established and can assist clinicians, including less experienced operators, in achieving acceptable implant positioning. Nevertheless, limitations such as impaired instrumentation of the surgical field and the additional cost or time required for guide fabrication have driven the dental industry to develop alternative technologies to overcome such challenges.

Navigated computer-assisted implant surgery (nCAIS) was developed and introduced to overcome several limitations of sCAIS. Instead of using a physical template, dynamic navigation uses optical tracking systems, reference markers, and navigation software to monitor the real-time position of the surgical hand-piece, drill, implant, and patient’s jaw in relation to the preoperative CBCT-based virtual plan. The clinician receives continuous visual feedback on a monitor, allowing real-time correction of drilling direction, depth, and angulation. Dynamic navigation offers several clinical advantages, including preservation of surgical-field visibility, improved irrigation access, flexibility for intraoperative plan modification, and can be applied in patients with a limited mouth opening. It is also potentially valuable in complex procedures such as posterior implant placement with limited access, sinus-related surgery, pterygoid or zygomatic implant placement, endodontic microsurgery, and oral and maxillofacial procedures.

Despite these advantages, nCAIS remains operator-sensitive. The procedure is still performed freehand and therefore is influenced by the operator’s hand stability, experience, visual-motor coordination, and familiarity with the navigation interface. Recent figures from scientific evidence have significantly increased the discussion about the utilization and accuracy of navigated dental treatment. However, there are few reviews that provide comprehensive clinical guidance with the implementation of nCAIS are scarce.

The aim of this article is to provide an encyclopedic overview of the knowledge for nCAIS in dentistry, with particular emphasis on implantology. In addition, this review seeks to address details of clinical procedures for achieving optimal accuracy when operating using nCAIS. The potential sources of error associated with nCAIS will further be identified in the form of practical tips. By critically evaluating current applications and challenges, the review offers practical insights that may assist dental practitioners in the optimal integration and utilization of dynamic navigation technology in clinical practice. Ultimately, broader acceptance and implementation of this technology across diverse areas of dental treatment may contribute to improved procedural accuracy, enhanced patient safety, and ultimate overall treatment outcomes.