Comparison of the accuracy of implant placement using different drilling systems for static computer-assisted implant surgery: A simulation-based experimental study

Background Different designs of surgical drilling systems have been developed for the purpose of static Computer-Assisted Implant Surgery (sCAIS), but there is at present little understanding of how design principles affect the accuracy of implant placement. Purpose The aim of this in vitro study was to compare the accuracy of implant placement among five drilling systems of sCAIS in a controlled experimental setting. Materials and Methods Twenty-five 3D printed models with two edentulous bilateral premolar spaces were allocated to five different drilling systems: group A: sleeve-in-sleeve, group B: sleeve-in-sleeve with self-locking, group C: mounted sleeve-on-drill, group D: integrated sleeve-on-drill with metal sleeve in the guide, group E: integrated sleeve-on-drill without metal sleeve. Models were scanned with CBCT and optical scanner. All implants were digitally planned and 10 implants placed with sCAIS in each group. Postoperative 3D deviation of placed vs planned position was measured by means of platform, apex and angular deviation. Data was analyzed using Kruskal-Wallis test (P <= .05). Pairwise comparisons were tested with Dunn's test with adjusted P values. Results The overall platform deviation ranged from 0.42 +/- 0.12 mm (group B) to 1.18 +/- 0.19 mm (group C). The overall apex deviation ranged from 0.76 +/- 0.22 mm (group B) to 1.95 +/- 0.48 mm (group D). The overall angular deviation ranged from 2.50 +/- 0.89 degree (group B) to 5.30 +/- 1.04 degree (group E). Group A and B showed significantly less angular deviation than groups D and E (P < .05). There was no statistically significant differences in all parameters between group A and B, as well as between group D and E (P > .05). Conclusions Significant differences were found with regards to accuracy among the five sCAIS systems tested, suggesting that the drilling protocol, the devices used and the design principles of the guides could influence the accuracy of implant placement.