Influence of experience on dental implant placement: an in vitro comparison of freehand, static guided and dynamic navigation approaches

Abstract

Purpose This study aimed to investigate the performance of novice versus experienced practitioners for placing dental implant using freehand, static guided and dynamic navigation approaches. Methods A total of 72 implants were placed in 36 simulation models. Three experienced and three novice practitioners were recruited for performing the osteotomy and implant insertion with freehand, surgical guide (pilot-drill guidance) and navigation (X-Guide, X-Nav technologies) approaches. Each practitioner inserted 4 implants per approach randomly with a 1-week gap to avoid memory bias (4 insertion sites × 3 approaches × 6 practitioners = 72 implants). The performance of practitioners was assessed by comparing actual implant deviation to the planned position, time required for implant placement and questionnaire-based self-confidence evaluation of practitioners on a scale of 1–30. Results The navigation approach significantly improved angular deviation compared with freehand (P < 0.001) and surgical guide (P < 0.001) irrespective of the experience. Surgical time with navigation was significantly longer compared to the freehand approach (P < 0.001), where experienced practitioners performed significantly faster compared to novice practitioners (P < 0.001). Overall, self-confidence was higher in favor of novice practitioners with both guided approaches. In addition, the confidence of novice practitioners (median score = 26) was comparable to that of experienced practitioners (median score = 27) for placing implants with the navigation approach. Conclusions Dynamic navigation system could act as a viable tool for dental implant placement. Unlike freehand and static-guided approaches, novice practitioners showed comparable accuracy and self-confidence to that of experienced practitioners with the navigation approach. Graphical Abstract

In vitro and in vivo accuracy of autonomous robotic vs. fully guided static computer‐assisted implant surgery

“…They all performed the same practice 10 times. The evaluation standard was able to complete freehand, fully guided static computer‐assisted, and autonomous robotic implant surgeries on models within 15 min each before the formal experiments, and the implants needed to be placed in the correct position, without immobility and damage to the adjacent dental regions under CBCT examination 6 . The models, implants (Straumann® bone level tapered 3.3 mm × 10 mm, Institute Straumann AG, Basel, Switzerland), and implant positions were the same in these two groups (Figure 1).…”

“…Both oral scanning data and 3D images of cone-beam computed tomography (CBCT) were used to generate standard tessellation language files of the maxilla, which were transferred for stereolithographical printing using the Form 3B printer (SLA-Laser Technology, Formlab, Somerville, MA, USA). The scanning parameters were set at 110 kV and 6 The models, implants (Straumann ® bone level tapered 3.3 mm  10 mm, Institute Straumann AG, Basel, Switzerland), and implant positions were the same in these two groups (Figure 1).…”

“…4 Therefore, digital technologies, including static guides and dynamic navigations, are applied to implant surgeries to diminish the inherent positional uncertainty of freehand implantations. [4][5][6] The fully guided static computer-assisted implant surgeries (sCAIS), with designed sleeves, are implemented to steer the steps of osteotomy and implantation according to the planned data, which combine the designed drills and implant drivers with depth stops. 7 3D digital implant guides are used to constrain the drill and implant to the planned position.…”

“…Short‐ or long‐term postoperative complications are likely to emerge because variations in the experience level of surgeons will eventually result in variability of implant positioning by freehand insertions 4 . Therefore, digital technologies, including static guides and dynamic navigations, are applied to implant surgeries to diminish the inherent positional uncertainty of freehand implantations 4–6 …”

A pilot clinical study to evaluate the accuracy of an autonomous dental implant robotic system in partially edentulism

“…The introduction of computed tomography into dentistry in 1988 and the development of a software program for virtual implant planning in 1993 led to the development of static and dynamic computerassisted implant surgery (CAIS) [4]. CAIS decreased the intraoperative variability in implant placement and allowed precise transfer of the planned implant positions to the surgical setting [4][5][6][7]. However, human error cannot be entirely eliminated and robotic surgery has the potential advantages of sustained precision, increased stability, and improved e ciency [8].…”