Comparison of marker-based and marker-free registration techniques in dynamic navigation-guided implant surgery for fully and partially edentulous patients: A systematic review and meta-analysis

Abstract

Objectives: To compare the accuracy of marker-based and marker-free registration methods in the context of dynamic navigation guided implant surgery for patients with partial or complete tooth loss. Methodology: The review includes research articles written in English and Mandarin Chinese published between January 2013 and May 2025, from databases such as MEDLINE/PubMed, Scopus, Cochrane, Embase, China National Knowledge Infrastructure (CNKI) and Web of Science. Both laboratory-based and clinical investigations were taken into account. Thirteen studies, met the specified criteria for inclusion and underwent meta-analysis. Sub-analyses were performed to compare various registration modalities. The assessment of collective evidence was conducted using the GRADE system. Results: No statistically significant differences were observed between registration methodologies i.e; marker based and marker free. Subgroup analysis highlighted a preference for marker-based methods, specifically those utilizing U-shaped markers and bone markers, especially in the lower jaw. No notable variations were noted in terms of time efficiency. Marker-free registration was favored for outcomes reported by patients. Conclusion: Both marker-free and marker-based registration strategies are considered feasible options. Selection should be made based on factors such as practicality, cost, efficiency, clinician preference, and patient-reported outcomes. The results should be interpreted with caution due to the considerable variability among studies, underscoring the necessity for more consistent and dependable data. PROSPERO Registration Number: CRD42024504573.