Accuracy and Self-Confidence Level of Freehand Drilling and Dynamic Navigation System of Dental Implants: An In Vitro Study.

Abstract

The impact of the experience of the clinician on learning a new skill or equipment was still an intriguing subject. The goal of this research is to determine the accuracy level of a dynamic navigation system to that of freehand drilling by expert and novice practitioners with varied levels of experience. Additionally, the duration of the surgical procedure and the self-confidence level of the surgeons were also evaluated. An analogimpression of the patient was used to make 20 polyurethane simulation models of the maxilla. Five expert and five inexperienced surgeons prepared the site and placed the implants at random on ten models each. Two different techniques were used to insert dental implants: freehand and dynamic navigation systems. Dental implants were placed in Group 1 utilizing a computer-assisted dynamic navigation device. The implants in Group 2 were secured using free-hand drilling. The dental implants were inserted first in the maxillary right first molar, then in the maxillary right lateral incisor, and the maxillary left second premolar. Preoperative and postoperative CBCT scans were superimposed by employing the Evalunav software and contrasted. The coronal 3-D, apex 3-D, apex vertical depth, and angular deviations for both procedures were evaluated. A pre-tested self-confidence questionnaire was also administered to assess the self-confidence of the practitioners. The duration of the surgical time was also documented for each strategy. The t-test was used to measure the difference in accuracy and confidence levels between freehand and dynamic navigation systems among expert and novice surgeons using SPSS software (IBM Corp., Armonk, NY, USA). A total of 60 implants were used (three insertion sites, two methods, and 10 practitioners). Each of the five expert and novice clinicians implanted 15 implants (five models each). Except for entry 3-D, there was a statistically significant difference between the two approaches in all of the primary outcome variables. The apex 3-D (5.89±1.08 mm) and apex vertical (2.08±1.27 mm) dimensions of the dynamic navigation system were significantly smaller than those of the freehand drilling approach (p<005). Dynamic navigation and freehand drilling had angular deviations of 7.16±1.76ᵒ and 9.06±2.18ᵒ, respectively (p=0.0004). The apex vertical deviation was reduced in the navigation technique (2.07±1.5 mm) than in the freehand drilling (2.86±1.4 mm) by experienced practitioners (p=0.04). The difference in time between the two procedures was determined to be statistically highly significant (p<0.001) by both expert and novice surgeons. Furthermore, when contrasting with experienced practitioners, novice practitioners had an overall increase in surgery time (p<0.001) for both approaches. The current in vitro study found that the dynamic navigation system enables more accurate implant placement than the freehand drilling technique, irrespective of the experience of the surgeons. However, this technique appears to benefit novice practitioners more, as they can profoundly minimize their deviations while accomplishing results comparable to those of expert surgeons.