Comparison of the accuracy of static and dynamic computer-assisted implant surgery in extraction sockets, encased healed sites, and distal extension: an in vitro study.

Abstract

Objectives: This study compared the accuracy of static and dynamic computer-assisted implant surgery (CAIS) by measuring the magnitudes and directions of coronal, apical, and angular deviations across three experimental scenarios.

Methods: An in vitro study was conducted on 33 maxillary models per group, using static (s-CAIS) or dynamic CAIS (d-CAIS). Each model included three experimental conditions: Extraction Socket (#21), Encased Healed Site (#23), and Distal Healed Site (#26). A total of 198 implants were placed (3 per model). Postoperative deviations were assessed using 3D superimposition. Three-way ANOVA compared deviation magnitudes; directional deviations were analysed using Student's t-test or Wilcoxon test.

Results: d-CAIS demonstrated significantly higher accuracy than s-CAIS. Mean 3D deviations for s-CAIS versus d-CAIS were 0.74 ± 0.32 mm compared to 0.65 ± 0.33 mm at the platform, 1.33 ± 0.54 mm versus 0.69 ± 0.37 mm at the apex, and 3.45 ± 1.14° versus 1.27 ± 1.05° angularly. The Extraction Socket Site showed the largest deviations for both systems (p < 0.001). For the Distal Healed Site, d-CAIS exhibited significantly higher accuracy than s-CAIS (p < 0.001). Platform deviation showed no significant difference between techniques (p = 0.44). Directional analysis revealed consistent buccal deviations in extraction sockets for both systems and vestibular-mesial-apical deviation for s-CAIS in distal sites.

Conclusions: The current in vitro study indicated that d-CAIS exhibited superior accuracy to static s-CAIS across all tested conditions. While both techniques remained within clinically acceptable deviation thresholds, anatomical challenges, particularly in extraction sockets and distal regions, significantly influenced the magnitude and direction of deviations.

Clinical significance: In this in vitro setting, both static and dynamic CAIS achieved deviations within clinically acceptable limits, supporting their reliability in clinical practice. Extraction sockets represented the most challenging sites for both systems. In distal sites, the directional deviations observed with s-CAIS indicated a bending effect of the cantilevered guide, emphasising the need for improved distal support or reinforcement.