Accuracy and patient‐centered results of marker‐based and marker‐free registrations for dynamic computer‐assisted implant surgery: A randomized controlled trial

Abstract Objectives To compare implant placement accuracy and patient‐centered results between the dynamic computer‐assisted implant surgeries (d‐CAISs) using marker‐based and marker‐free registration methods. Materials and Methods A double‐armed, single‐blinded randomized controlled trial was conducted, in which 34 patients requiring single implant placement at the esthetic zone were randomly assigned to the marker‐based ( n = 17) or marker‐free ( n = 17) groups. The marker‐based registration was performed using a splint containing radiopaque markers, while the marker‐free registration used natural teeth. The primary outcome assessed implant positioning accuracy via angular and linear deviations between preoperative and postoperative implant positions in CBCT. Patients were also surveyed about the intraoperative experience and oral health impact profile (OHIP). Results The global linear deviations at the implant platform (0.82 ± 0.28 and 0.85 ± 0.41 mm) and apex (1.28 ± 0.34 and 0.85 (IQR: 0.64–1.50) mm) for the marker‐based and marker‐free groups respectively showed no significant difference. However, the angular deviation of the marker‐free group (2.77 ± 0.92) was significantly lower than the marker‐based group (4.28 ± 1.58). There was no significant difference in the mean postoperative OHIP scores between the two groups ( p = .758), with scores of 2.74 ± 1.21 for marker‐based and 2.93 ± 2.18 for marker‐free groups, indicating mild oral health‐related impairment in both. Notably, patients in the marker‐free group showed significantly higher satisfaction ( p = .031) with the treatment procedures. Conclusions D‐CAIS with a marker‐free registration method for single implantation in the anterior maxilla has advantages in improving implant placement accuracy and patients' satisfaction, without generating a significant increase in clinical time and expenses.