title: Impact of operator experience on the accuracy of implant placement with stereolithographic surgical templates: an in vitro study.
abstract: BACKGROUND
  To achieve functional and esthetic results, implants must be placed accurately. However, little information relating to the effect of operator experience on implant placement accuracy is available.
  
  
  OBJECTIVE
  The objective of this investigation was to measure the accuracy of dental implant placement with a bone-supported stereolithographic surgical template created from a virtual implant plan and to determine the effect of operator experience on implant placement accuracy.
  
  
  METHODS
  Twenty photopolymer resin edentulous mandibles were scanned with cone beam computerized tomography (CBCT). Five implants were planned virtually for each mandible, and a stereolithographic surgical template was made. Four operators placed a total of 100 implants (25 per operator). Two of the operators were experienced in implant placement and 2 operators had limited prior implant placement experience. A CBCT scan of the postimplant placement mandibles was performed, and the images were superimposed on the preimplant placement images containing the virtual implant plans. The amount of angular, horizontal, and vertical deviation of the placed implants from the virtually planned implants at the apex and platform was calculated, and statistically significant differences were detected between the operator groups by using a multivariate analysis of variance (MANOVA) (α=.05).
  
  
  RESULTS
  For the experienced operators, the mean error of angular deviation was 2.60 ±1.25 degrees, of horizontal deviation at the apex 0.34 ±0.15 mm, of horizontal deviation at the platform 0.63 ±0.28 mm, of vertical deviation at the apex 0.59 ±0.12 mm, and of vertical deviation at the platform 0.16 ±0.11 mm. For the inexperienced group, the mean error of angular deviation was 3.96 ±1.64 degrees, of horizontal deviation at the apex 0.42 ±0.19 mm, of horizontal deviation at the platform 0.77 ±0.33 mm, of vertical deviation at the apex 0.62 ±0.13 mm, and of vertical deviation at the platform 0.15 ±0.11 mm. The MANOVA showed a statistically significant difference between the experienced and inexperienced groups for angular and horizontal error at the implant apex and platform (P<.05).
  
  
  CONCLUSIONS
  The results of this in vitro investigation revealed that the experience level of the operator placing the implants contributes to the accuracy of implant placement, with more experienced operators placing more implants accurately.
authors.affiliation: United States Air Force, Wilford Hall Medical Center, Lackland AFB, San Antonio, Texas, USA.
authors.forename: Sarra E
authors.initials: SE
authors.lastname: Cushen
authors.forename: Ilser
authors.initials: I
authors.lastname: Turkyilmaz
mesh_terms: D002983:Clinical Competence; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000592:standards*; D015921:Dental Implants; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007575:Jaw, Edentulous / Q000601:surgery; D008334:Mandible / Q000601:surgery; D008953:Models, Anatomic; D010027:Osteotomy / Q000295:instrumentation / Q000592:standards; D010347:Patient Care Planning; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D014584:User-Computer Interface
chemical_list: D015921:Dental Implants