Primary stability of dental implants placed by novice surgeons: an ex vivo study across two implant systems in a porcine mandible model

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Abstract
Purpose: Dental implant placement is a technically demanding procedure in which surgical experience is considered a key determinant of outcome. Primary stability, as measured by the implant stability quotient (ISQ) via resonance frequency analysis (RFA), is a critical predictor of successful osseointegration. This study aimed to quantify the influence of surgical experience on primary implant stability in a standardized porcine mandible model. Methods: Dental students with no prior implant experience and experienced oral surgeons placed implants using two commercially available systems (Straumann Standard Plus and Astra Tech EV). Primary stability was assessed by RFA immediately after insertion at four standardized measurement positions. ISQ values were analyzed using a linear mixed-effects model with surgical experience, implant system, and measurement position as fixed factors and a random intercept for implant to account for the non-independence of the four measurements obtained per implant. Results: A total of 760 ISQ measurements were included in the analysis. Experienced surgeons achieved significantly higher ISQ values (M = 75.72, SD = 5.22) than students (M = 68.68, SD = 11.61; p < 0.001), with an overall mean difference of approximately 7 ISQ points. Within the Straumann Standard Plus, the difference was 8.14 ISQ points ( p = 0.028); within the Astra Tech EV, the difference was 5.42 ISQ points ( p < 0.001). Variability was markedly greater in the student group across both systems. Conclusions: Surgical experience significantly influences primary implant stability within both implant systems investigated. Novice operators achieve lower and less consistent ISQ values, which may have clinical implications for the selection of loading protocols. These findings suggest that structured training may help improve primary stability among less-experienced operators, a hypothesis that warrants prospective clinical evaluation. Clinical trial number: Not applicable.
Funding Information
  • Universitätsklinikum Schleswig-Holstein - Campus Kiel

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