Operator experience on robotic and dynamic computer-assisted implant surgery (CAIS): an in vitro controlled study

To evaluate the influence of operator experience on implant placement accuracy and primary implant stability in dynamic and robotic computer-assisted implant surgery (d-CAIS and r-CAIS).

This controlled in vitro study evaluated three levels of operator experience: postgraduate students without previous CAIS experience (G1), implant dentistry experts without prior experience in either d-CAIS or r-CAIS (G2), and implant dentistry experts with more than 10 years of experience using both systems (G3). Coronal, apical, and angular deviations between planned and final implant positions were assessed using inspection software (Geomagic X Control, 3D Systems, Rock Hill, SC, USA). Primary implant stability was evaluated by resonance frequency analysis (Osstell AB, Gothenburg, Sweden). Data were analyzed using a two-way ANOVA followed by Tukey post hoc comparisons (α = 0.05). To facilitate interpretation of the results, empirical, non-validated clinical relevance thresholds for each outcome were defined.

A total of 72 implants were placed in standardized resin models containing D3-type bone blocks (n = 12 per group). Both technology and operator experience significantly affected implant placement accuracy (p < 0.001). Compared with r-CAIS, d-CAIS resulted in higher coronal and apical deviations, with clinically relevant mean differences of 0.567 mm (95% CI: 0.396-0.738 mm) and 0.481 mm (95% CI: 0.310-0.652 mm), respectively. Clinically relevant effects of operator experience were observed only within the d-CAIS workflow, where G1 showed greater coronal (MD = 0.764 mm, 95% CI: 0.444-1.085 mm), apical (MD = 0.639 mm, 95% CI: 0.262-1.016 mm), and angular (MD = 1.502°, 95% CI: 0.737-2.267°) deviations than G3. Corresponding differences within the r-CAIS workflow did not reach predefined thresholds for clinical relevance. All groups achieved clinically acceptable ISQ values, with no clinically relevant differences attributable to the technology used or operator experience.

Under standardized in vitro conditions, r-CAIS achieved higher implant placement accuracy than d-CAIS. Although operator experience influenced implant placement accuracy in both workflows, differences were observed mainly within the d-CAIS workflow, while no differences were observed in primary implant stability.

r-CAIS achieved greater implant placement accuracy than d-CAIS and demonstrated a reduced influence of operator experience on the measured experimental outcomes.