Influence of clinician experience with a static computer-assisted implant surgery workflow on implant-placement accuracy across three surgical-guide designs: a clinical trial.
Abstract
Objectives
Although static computer-assisted implant surgery (sCAIS) is widely used, the influence of operator experience with guided workflows-distinct from general implant experience-remains unclear. This trial compared placement accuracy between experienced and novice operators in the sCAIS workflow across three surgical-guide designs: bilateral tooth-supported, unilateral tooth-supported, and mucosa-supported.
Methods
This parallel-arm clinical trial enrolled 39 patients receiving 85 implants, stratified by guide design (n = 18, 35, and 32, respectively). Within each stratum, patients were randomly allocated to an experienced (≥500 guided implants) or novice (≤20 guided implants, ≥1 year conventional implant experience) operators. Cone-beam computed tomography and intraoral scans were merged for prosthetically driven planning, and digital light processing -printed templates were fabricated. Accuracy was quantified by superimposing postoperative scan-body-based intraoral scans onto the virtual plan. Angular deviation was the primary outcome; coronal global, apical global, and vertical deviations were the secondary outcomes.
Results
Four experienced and five novice operators participated. In mixed-effects models accounting for clustering within patients and operators, experienced and novice operators showed no significant differences in any deviation for bilateral or unilateral tooth-supported guides. For mucosa-supported full-arch guides, novice operators showed greater angular deviation (7.02° ± 4.52° vs. 4.68° ± 1.68°; P = 0.018) and greater variability (Levene P = 0.041), although this did not survive correction for multiple comparisons (adjusted P = 0.22).
Conclusions
Operator experience with the sCAIS workflow was not associated with significant accuracy differences for tooth-supported guides. For mucosa-supported full-arch guides, novice operators showed greater angular deviation and variability. CLINICAL
Significance
For well-supported tooth-borne guides, novice and experienced operators achieved comparable accuracy. For the more demanding mucosa-supported full-arch scenario, greater deviation and variability among novices suggest that experience with the guided workflow remains relevant, and such cases may warrant additional caution or supervision. CLINICAL TRIAL REGISTRY https://clinicaltrials.gov/study/NCT07112664.