Accuracy of dynamic computer-assisted implant surgery among novice operators using three different patient registration methods: an in-vitro study

INTRODUCTION: Accurate implant placement with computer-assisted implant surgery (CAIS) is critical to ensuring long-term success. Dynamic computer-assisted implant surgery (d-CAIS) enhances surgical precision through real-time feedback; however, its accuracy and procedural efficiency when used by novice operators remain insufficiently investigated. This study evaluated how different registration methods in d-CAIS influence implant placement accuracy and procedural time when performed by novice operators. MATERIALS AND METHODS: In this in vitro study, three registration methods were assessed (surface-based registration: ND, marker-based registration: XC, and pair-point registration: XM groups). Five novice operators, defined as dentists with less than five years of implant experience, placed 25 implants per group (75 total) in partially edentulous maxillary models. Postoperative cone-beam computed tomography scans were used to measure deviations at the implant entry point, apex, vertical depth, and angle. Statistical analyses were performed to compare group differences. RESULTS: Mean three-dimensional deviations at the implant entry point were 0.97 mm (ND), 0.68 mm (XC), and 0.72 mm (XM); at the apex: 1.33 mm, 0.78 mm, and 0.90 mm, respectively. Vertical depth deviations at the apex were comparable across groups: 0.62 mm (ND), 0.51 mm (XC), and 0.54 mm (XM). Angular deviation was highest in the ND group (3.16°) compared to the XC (1.18°) and XM (0.97°) groups, with significant differences observed between ND and both XC and XM. Average procedural time was longest in the ND group and shortest in the XM group, with statistically significant differences between ND and the other two groups. CONCLUSIONS: In novice operators, d-CAIS enabled stable control of implant entry point position and insertion depth regardless of the registration method used. In contrast, angular accuracy and procedural efficiency were influenced by registration strategies and system-related characteristics. These findings suggest that selection of appropriate registration methods may play an important role in optimizing accuracy and workflow efficiency during the early learning phase of d-CAIS.