The manufacturing method and guidance system affects the accuracy of implant placement by inexperienced clinicians: a comparative study

Objectives: This study evaluates the accuracy of dental implant placements performed by inexperienced clinicians with surgical guides manufactured at different orientation (0°, 45°, and 90°) using three systems: Fully-guided (FG), pilot-guided (PG), and freehand (FH). The research aims to determine whether these clinicians can achieve precise implant placements in artificial mandibles. Methods: Three dentistry students with four years of general clinical experience placed a total of 270 implants in 45 modified mandibular models. Each student placed 30 implants using FG, PG, and FH methods with surgical guide manufactured at 0°, 45°, and 90° angulations. Virtual implant planning was conducted using 3Shape software, and accuracy was evaluated by comparing post-placement scans to baseline plans. Statistical analysis included two-way ANOVA to assess the impact of placement method and printing angulation on the implant deviation angle, followed by Tukey post hoc testing for significant differences. Results: The findings indicate that the FG system yields the highest accuracy with the minimum angle error of 0.12°, followed by the PG and FH systems. Additionally, 3D-printed surgical guides manufactured at a 0° angulation demonstrated superior placement accuracy compared to those at 45° and 90°. Conclusions: These results have significant implications for clinical practice and training, suggesting that FG systems are preferable for novice clinicians and that optimal printing orientation enhances implant placement accuracy. A statement of clinical relevance: This in vitro study highlights the importance of printing orientation in the fabrication of surgical guides, as it significantly affects guide accuracy and implant placement precision. Furthermore, the findings suggest that incorporating surgical guide use into pre-clinical training may enhance the performance of novice clinicians and improve surgical outcomes.