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. 2025 May;36(5):555-565.
doi: 10.1111/clr.14403. Epub 2025 Jan 21.

Evaluation of the Accuracy, Surgical Time, and Learning Curve of Freehand, Static, and Dynamic Computer-Assisted Implant Surgery in an In Vitro Study

Joscha Gabriel Werny  1 , Shengchi Fan  1   2 , Leonardo Diaz  3 , Bilal Al-Nawas  1 , Keyvan Sagheb  1 , Matthias Gielisch  1 , Eik Schiegnitz  1
Affiliations

Evaluation of the Accuracy, Surgical Time, and Learning Curve of Freehand, Static, and Dynamic Computer-Assisted Implant Surgery in an In Vitro Study

Joscha Gabriel Werny et al. Clin Oral Implants Res. 2025 May.

Abstract

Objectives: This experimental study compared the accuracy of implant insertion using the free-hand (FH) technique, static computer-aided surgery (S-CAIS), or dynamic computer-assisted surgery (D-CAIS) and to evaluate the correlation of learning curves between surgeons' experience and surgical time.

Materials and methods: Thirty-six models were randomly assigned to three groups (FH, n = 12; S-CAIS, n = 12; D-CAIS, n = 12). Each model was planned to receive four implants in the maxillary anterior and posterior regions. Twelve participants, six experienced surgeons, and six dental students were included in this study. The primary outcome was the deviation between the planned and final implant placement from each group. Secondary outcomes were each technique's learning curve regarding surgical time.

Results: The average deviation at implant platform, apex and gradual deviation with FH technique were 1.31 ± 0.88 mm, 1.75 ± 0.9 mm and 6.67° ± 3.70°, respectively. The average deviation of implant platform, apex and angular in S-CAIS were 0.67 ± 0.32 mm, 1.00 ± 0.39 and 2.66° ± 1.77°, respectively. The average deviation of implant platform, apex and angular in D-CAIS were 1.14 ± 0.70 mm, 1.23 ± 0.58 and 3.20° ± 2.16°, respectively. Significant discrepancies at the implant platform, implant apex, and angular deviation were found between all surgical methods (p < 0.016). Learning curves were evident after multiple implant insertions using both freehand and S-CAIS.

Conclusion: The findings indicate that computer-assisted implant insertion leads to a more precise implant alignment than implants inserted freehand in an experimental set-up.

Keywords: computer‐aided implant surgery; implant accuracy; learning curve; surgeon‐reported outcome; surgical time.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Implant bed preparation with static CAIS.
FIGURE 2
FIGURE 2
Implant bed preparation with dynamic CAIS.
FIGURE 3
FIGURE 3
Drafted comparison of the degree's planned and final implant positions, the 3D deviation at platform and apex in mm, and surgical time. Behind the description, average measurements are shown. The blue implant represents the digitally planned position, and the grey implant represents the final implant position. The yellow dots represent the center of the apex and platform, while the line indicates the axis of the implant.
FIGURE 4
FIGURE 4
Comparison of the planned and final implant positions. The blue implant is the digital planning, while the red one shows the final position.
FIGURE 5
FIGURE 5
The scatter plot illustrating the direction of deviation for each group. (a) Buccolingual and mesiodistal planes at implant platform. (b) Mesiodistal and apicocoronal planes at implant platform. (c) Buccolingual and apicocoronal planes at implant platform. (d) Buccolingual and mesiodistal planes at implant apex. (e) Mesiodistal and apicocoronal planes at implant apex. (f) Buccolingual and apicocoronal planes at implant apex.
FIGURE 6
FIGURE 6
(a–d) Boxplots showing the difference between surgeons with a high level of experience and students with a low level of experience in implant dentistry in terms of implant deviation at apex, platform, angular and surgical time.
FIGURE 7
FIGURE 7
The learning curves of the freehand, static CAIS, and dynamic CAIS methods during repeated implant insertion with the same preparation technique defined by the surgical time.
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