Anyone entering navigated implantology today will encounter essentially three dynamic navigation systems in Europe: Falcon, Navident and X-Nav. In the third episode of the podcast trilogy on computer-assisted implantology from Queens & Sons of Dentistry, an implantologist who runs all three systems in parallel in his practice reports with unusual openness on their strengths, weaknesses and areas of application – and on what really matters when making a choice.
Three systems, three areas of application
According to his own account, the practitioner today uses the Falcon system above all for limited situations, such as three or four implants or half a jaw. The reason lies in the camera guidance: if the position of the device or of the markers changes, the camera has to be turned – with full-arch restorations this can lead to complicated situations. In return, the device is considerably easier to move and to operate in everyday practice than its stationary competitors.
Navident was the implantologist's first navigation system. The decisive factor for the purchase was the possibility of connecting instruments to a piezo device and thus carrying out navigated bone harvesting – a building block of his vision of computer-assisted bone augmentation, which is why the system is still in use today. In terms of hardware quality, however, he sees Navident somewhat behind the two competitors: the components are said to be slightly mobile, which affects the quality of transmission during the procedure and therefore the accuracy.
X-Nav is currently the best system for the practitioner in terms of software and during surgery, particularly in extensive full-arch cases. He describes the sensor above the head, which sees everything throughout the entire procedure, as an enormous advantage. The drawback is the size: the unit is very large and tall, stands stationary in one room and is hardly suitable for being moved around the practice for two or three implants. For full arch, however, he describes the system as today's standard.
One user's software ranking
In terms of software, the implantologist places X-Nav in first position: the imaging and the quality of the navigation are elegantly solved, and the manufacturer also has a great deal of experience. Second place goes to Falcon – whose further development he says he contributed to on a small scale. A great deal has happened there; the software is by now easy to apply in everyday work. Navident comes third: the experience and the interface are somewhat less mature than with the other two systems.
What matters when making a choice
After three years of experience with all three systems, the practitioner names clear criteria in the conversation. In first place stands hardware quality: if something on the system moves during the operation, the entire transmission is no longer correct – the surgeon loses control. In second place follows handling during the procedure: is the camera position a hindrance? Does the sensor sit above the head or on the micromotor? Is it comfortable to work from the right, from the left, in front of or behind the patient? A system that looks down on the practitioner from above he considers advantageous here. As a third criterion he names – quite seriously – the fun factor: such a system is not bought primarily in order to be more productive; the device and the interface have to be enjoyable, rather like a good navigation system in a car.
Added to this is the compatibility of the individual components. What matters is a continuous path from the planning software through to the implant, without complicated interfaces and USB sticks – realistically possible only if a single supplier controls the entire chain. With the Falcon system this was a disaster at first; by now almost everything runs seamlessly through to the 3D printer. The closed chain from Smilecloud via the AXS cloud to the printer works very reliably. Technical support also plays a role: the implantologist appreciates being able to explore new systems calmly on his own at first – for instance with a practice model with markers, as Navident offered and as Falcon now also provides. If a system crashes, however, which happens rarely, an accessible hotline becomes all the more important.
Where the systems are heading
All three systems are in motion, in the practitioner's assessment. With the Falcon system a point has been reached at which a great deal could happen – what Straumann makes of it remains to be seen. At X-Nav, work is under way on a robotic arm mounted on the ceiling that is intended to enable semi-automatic implant placement: the robot prevents incorrect movements. Navident, in turn, comes from a small, extremely innovative Canadian company that constantly brings out something new – not always successful, but occasionally with really good ideas.
A look beyond Europe is revealing as well: a great deal is currently happening in Asian countries in particular. Almost identical copies of Falcon and X-Nav exist there; since the suppliers in those markets are not subject to the same regulations as MDR and FDA, they are able to develop more quickly. Anyone wishing to gain an impression of the next stage of development, as the podcast points out, could take a look at these systems in Bangkok, for example.
Conclusion: no single system for every case
There is therefore no universal system: the choice depends on the treatment spectrum – from the mobile, everyday-capable Falcon for manageable procedures through to the stationary X-Nav for extensive full-arch restorations. A structured comparison of hardware quality, handling during the procedure, a closed system chain and support leads to the device that suits the individual practice.