A Real-Time Inertial Sensor-Based Diagnostic Support System for Improving Angular Accuracy in Dental Implant Placement: Preclinical Experimental Validation in a 3D Haptic Simulation Model

Background: Accurate three-dimensional positioning of dental implants is critical for ensuring biomechanical stability, prosthetic passivity, and long-term clinical success. While computer-assisted navigation systems achieve high precision, their complexity and cost often limit accessibility. This study presents the development and preclinical experimental validation of a low-cost prototype designed to enhance angular accuracy in dental implant placement within a controlled 3D haptic simulation environment. Methods: A preclinical experimental design was implemented using a 3D haptic simulator (Virteasy, Montpellier, France). The prototype incorporated high-precision inertial measurement units (IMUs) and an Extended Kalman Filter (EKF) for real-time angular feedback. Ninety-seven simulated implant placements were performed—both freehand and with prototype assistance—under identical virtual conditions by a single experienced operator. Angular deviations in mesiodistal and buccolingual planes were recorded, combined into a composite 3D index, and analyzed using paired t-tests and linear mixed-effects models. The study was conducted in a controlled simulation environment, which does not fully replicate clinical conditions. Results: The prototype significantly reduced angular deviation from 13.49° to 2.99° in the mesiodistal plane (−77.8%) and from 13.56° to 5.59° in the buccolingual plane (−58.8%), achieving an overall 67% improvement in three-dimensional orientation (p < 0.001; Cohen’s d = 1.47). Agreement with an optical reference system (OptiTrack) was excellent (bias = +0.36°, RMSE = 0.39°). Intra-operator reliability exceeded 0.95 (ICC), confirming strong reproducibility and measurement stability. Conclusions: The proposed inertial sensor-based prototype achieved angular accuracy within the range reported for computer-guided systems while maintaining advantages of portability, low cost, and usability. Its integration into haptic simulators provides a valid tool for both educational and preclinical applications, offering real-time feedback that enhances spatial perception and psychomotor learning. Future clinical studies should validate its performance in cadaveric and patient-based contexts to determine its practical impact on surgical precision and implant success.