To create and to spread a new interactive multimedia instrument, based upon virtual reality technologies, that allows both the running simulation of machines and equipment and the reproduction via Web of complex three-dimensional (3D) anatomical models such as the skull. There were two main aspects of the project, one of design engineering and the other biomedical engineering, for the creation of "artificial" and anatomical objects. The former were made with 3D Studio Max R4 by Autodesk, San Rafael, CA, while the latter were created starting from real bones scanned with a CT system or a surface scanner and elaborated with different programs (3D Studio Max R4, Scenebuilder by Viewpoint, New York, NY and Spinfire by Actify, San Francisco, CA). The 3D models were to be integrated into web modules and had to respect file limits while preserving a sufficient definition. Two systems of evaluation were used, a questionnaire on a selected sample and an external evaluation by a different university. The Viewpoint format offers the best interactivity and size reduction (up to 96% from the original 3D model). The created modules included production of radiological images, rapid prototyping, and anatomy. The complete "3D Distant Learning Prototype" is available at www.webd.etsii.upm.es. The software currently available permits the construction of interactive modules. The verification on the selected sample and the evaluation by the University of Naples show that the structure is well organized and that the integration of the 3D models meets the requirements.

Background/Objectives: The purpose of the study is to determine and compare the accuracy and efficiency of two dynamic navigation systems (DNS)—Navident (ClaroNav, Canada) and X-Guide (Nobel Biocare, Switzerland)—vs. a free-hand (FH) approach in performing endodontic microsurgery (EMS) on human cadavers. Methods: a total of 119 roots of six cadavers were randomly divided into three groups (Navident/X-Guide/FH). The cadavers’ jaws were scanned pre-operatively with computed tomography. The DICOM data were uploaded and digitally managed with software interfaces for registration, calibration, and virtual planning of EMS. Osteotomy was performed under DNS control and using a dental operating microscope (FH control group). Post-operative scans were taken with same settings as preoperative. Accuracy was then determined by comparing pre- and post-scans of coronal and apical linear, angular deviation, angle, length, and depth of apical resection. Efficiency was determined by measuring the procedural time of osteotomy, apicectomy, retro-cavity preparation, the volume of substance, and cortical bone loss, as well as iatrogenic complications. Outcomes were also evaluated in relation to different operators’ skill levels. Descriptive statistics and inferential analyses were conducted using R software (4.2.1). Results: DNS demonstrated better efficiency in osteotomy and apicectomy, second only to FH in substance and cortical bone loss. Both DNS approaches had similar accuracy. Experts were faster and more accurate than non-experts in FH, apart from resection angle, length and depth, and retro-cavity preparation time, for which comparison was not statistically significant. The Navident and X-guide groups had similar trends in increasing efficiency and accuracy of EMS. All complications in the FH group were performed by non-experts. The X-guide group demonstrated fewer complications than the Navident group. Conclusions: Both DNS appear beneficial for EMS in terms of accuracy and efficacy in comparison with FH, also demonstrating the decreasing gap of skill expertise between experts and novice operators. Through convenient use X-guide diminishes the level of iatrogenic complications compared to Navident.