The use of computer-guided surgery via a partially guided protocol does not completely compensate for the level of operator experience in implant placement

Purpose: There is always a tension between allowing novice trainees to place implants
independently and the need to achieve accurate functional and esthetic outcomes. We aimed to
measure the influence of surgeon experience on the accuracy of implants placed using a teethsupported
surgical guide via a partially guided surgical protocol in a clinical setting.
Materials and Methods: Twenty partially edentulous patients were randomly allocated
to expert and novice surgeon groups. Implant drilling and placement for the two groups were
performed through a flapless surgical technique using surgical guides following a partially guided
surgical protocol. The study primary independent variable was the surgeon experience, while
the outcome variable was the accuracy, which was measured based on the differences in implant
angulations pre- and postoperatively. Two-way analysis of variance (ANOVA) was applied to find
the influence of surgeon experience, implant size, and the interactive effect of surgeon experience
and implant size on the angular deviation.
Results: A total of 40 implants were inserted in 7 males and 13 females. There was no significant
difference (p = 0.453) in the mesio-distal deviation between the expert and novice groups. In a
bucco-lingual direction, the expert group performed more accurate implant placement (3.7 ± 3.35)
compared with the novice surgeons (8.5 ± 6.3). There was no effect for implant size and/or the
interaction effect on the degree of angular deviations.
Conclusion: The level of surgeon experience affects the accuracy of implants placed using a
teeth-supported surgical guide in a bucco-lingual direction; therefore, the use of computer-guided
surgery via a partially guided protocol does not completely compensate for the level of operator
experience. However, such surgical guide might be used in a whole task training of novice surgeons,
as it can bridge a gap between simulation training in vitro and free-hand surgery in a clinical setting.