Accuracy of guided vs non-guided surgery in three-dimensional positioning of single implants: a rapid systematic review

Accuracy of guided vs non-guided surgery in three-dimensional positioning of single implants: a rapid systematic review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Accuracy of guided vs non-guided surgery in three-dimensional positioning of single implants: a rapid systematic review Paul Alexander Carrera Quizhpe, Carolina Endara Moreno, Mónica Roxana Mancheno Ponce, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9245128/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To synthesize the evidence on the use of guided surgery for the placement of single implants compared to non-guided surgery, evaluating the accuracy of the 3D position of the implant, implant location and the effect of guide fabrication. Methods A rapid systematic review was conducted. Publications were taken from Medline/PubMed, LILACS, Cochrane Library and Epistemonikos. A qualitative synthesis of the included articles was performed, and for the main outcomes (coronal, apical, and angular deviation) a meta-analysis of random effects was developed for the differences in means (DM), with a con 95% confidence interval, using RevMan5.0. Results A total of 1114 articles were identified, and 13 were included. The meta-analysis indicated a statistically significant reduction in the coronal, apical and angular deviations, favoring guided surgery. Coronal deviation: DM = -0,35 mm (IC 95%: -0,55 a -0,16; p = 0,0005). Apical deviation: DM = -0,78 mm (IC 95%: -1,06 a -0,51; p < 0,00001). Angular deviation: DM = -3,0º (IC 95%: -4,36º a -1,65º; p 80%), although the results were consistent and statistically significant. Conclusion Guided surgery in any modalities (static, dynamic, or mixed) is superior to non-guided surgery in terms of results and three-dimensional precision of the position of single dental implants, in adults with edentulism. Computer-Assisted Surgery Dental Implantation Oral surgery Partially Edentulous Rapid Systematic Review Ecuador Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background In the field of modern dentistry, guided surgery has been implemented to offer precision when placing implants. Nowadays, various software programs provide information for the creation of files that generate guides to be used as complementary methods of diagnosis and surgical procedure ( 1 , 2 ). These images are not only used in diagnosis but have also been implemented in treatment planning ( 3 ). Surgical guides function as a tool for the operator to position implants according to pre-surgical planning to avoid possible unplanned deviations and provide comfort to the patient ( 4 ). In this context, the computer-assisted implant planning and surgery, based on digital design tools, computer-aided design (CAD), offers clinicians the advantage of combining digital imaging and communication in medicine (DICOM) information from medical images with stereolithography (STL) files corresponding to three-dimensional models. The advantage of this integration into specialized software is that it’s possible to accurately determine the ideal position of the implants within the jaw, carefully considering the surrounding anatomical structures. Currently, the benefits of guided surgery allow the operator to understand each patient’s anatomical variants, such as remaining teeth, bone quality, and the presence of pathologies, which can influence the accuracy of guided or analog surgery. Therefore, further research in this area can identify better success factors for implant placement, in addition to optimizing surgical protocols to improve outcomes in these cases ( 3 ). The placement of dental implants is a procedure that requires precision to ensure both the functionality and aesthetics of the restoration. In recent decades, different ways of performing this process have emerged, the most common being guided by surgery and the manual or traditional technique. Although both aim to achieve good results, there is still debate over which offers greater precision and long-term benefits ( 4 ). The field lacks recent, well-designed studies that objectively compare the precision of both techniques across different clinical scenarios and at varying levels of operator experience. In addition, there is some resistance or disagreement among different dental specialties, such as implantologists and periodontists, regarding the adoption and application of guided surgery ( 5 ). This research aimed to provide concrete information to help to determine whether guided surgery is truly superior in terms of accuracy compared to the manual technique, evaluating the precision of the 3D position of the implant, the implant location, and the effect of guide fabrication, synthesizing the available evidence. Materials and methods We conducted a rapid systematic review using (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) (PRISMA) reporting guidelines ( 6 ). To answer the research question: What is the accuracy of three-dimensional positioning of single implants using guided versus non-guided surgery? using the PICO question strategy. Inclusion criteria (P) partially edentulous adult patients undergoing single implant treatment: (I) Guided surgery, (C) Conventional surgery, (O) Implant accuracy using CT scans, and the change in implant position between planning and final position. Exclusion criteria Randomized or non-randomized controlled clinical trials and comparative observational studies that included partially edentulous patients over 18 years of age who required single implant placement accuracy as an outcome were excluded, as were patients who, despite meeting these criteria, had not been evaluated for adequate bone quality and quantity, patients with periodontal defects, and patients with bruxism. In addition, studies that included patients with systemic diseases were excluded. Search strategy Studies were searched for in different databases, including Medline/PubMed, LILACS, Cochrane Library, and Epistemonikos. Key terms related to "single implants, “conventional surgery," and "guided surgery" were used. The search was restricted to publications in Spanish, English, and Portuguese. Additionally, a manual search was conducted of the reference lists in the included articles. Study selection and data extraction Two reviewers (PACQ and CEM) independently selected articles that met the eligibility criteria in two stages. In the first stage, the researchers selected articles based on their titles and abstracts. Subsequently, the researchers selected articles by reading the full texts of the preselected records. In case of discrepancies in the selection of studies, a third reviewer (JMPV) participated to reach a consensus. The article selection process was conducted out using Rayyan software. The PRISMA flow diagram, shown in Fig. 1 , was used to visualize the selection process. Two reviewers (PACQ and CEM) extracted data into a Microsoft Excel template, including author, year of publication, research design, age, gender, method of measurement of variables, comparison between the two methods, surgical procedure used, and region of implant placement related to guided surgery and conventional surgery and the relationship between them to determine accuracy and whether there are significant differences between the two surgical methods. In case of discrepancies in data extraction, a third reviewer (JMPV) participated in reaching an agreement. Quality assessment and risk of bias The risk of bias was assessed independently for each study by two reviewers (PC, CE). The Cochrane Risk of Bias (RoB) tool was applied. The results are presented in a traffic-light graphic format. Statistical analysis A qualitative synthesis was conducted to describe the methodological and clinical characteristics of the included studies. In addition, a random effects meta-analyses were performed for each primary outcome (coronal, apical, and angular deviation), expressing the results as mean differences (MD) with 95% confidence intervals. The mean values and standard deviations reported by each study were used, and heterogeneity was assessed using the I statistic. Results Result of literature search The search identified 1114 articles eligible based on their titles and abstracts, of which 582 came from PubMed, 10 from Epistemonikos, 120 from the Cochrane Library, 396 from Lilacs, and 6 were identified through manual search. A total of 165 were eliminated before screening due to duplicates. In the analysis by title and abstract, 907 articles were eliminated, leaving 42 for full-text download. Of these, 9 articles could not be retrieved, leaving only 33 articles were selected for evaluation. A total of 20 were eliminated for reporting that did not meet the objectives set or for their design. At the end of the screening process, 13 articles remained and were included in this rapid review. Table 1 shows the screening process. Table 1 Articles selected for the analyses Last name (year) Tittle Journal Country Design Total number of implants placed IMPLANTS – Guided group IMPLANTS - Unguided Type of guided surgery Surgical approach – Guided group Surgical approach – Unguided group (Control) Main results Conclusions Huang (2023) ( 7 ) Evaluation of the accuracy of implant placement by using implant positional guide versus freehand: a prospective clinical study International Journal of Implant Dentistry China Prospective Clinical Study - Non-randomized 48 24 24 Non-restrictive guide (position only) With flap With flap All deviations (coronal, apical, angular, vertical) were significantly lower with positional guidance. Implant positional guidance is a technique for performing digital oral implants, which can be a viable tool for dentists to place dental implants. Lops (2024) ( 9 ) Guided versus freehand single implant placement: A 3-year parallel randomized clinical trial Journal of Dentistry Italy Randomized clinical trial 60 30 30 Static guide With flap With flap Difference in MBL of 0.11 ± 0.22 mm, not significant. At 3 years, there were no significant differences in marginal bone remodeling (MBL) between implants placed with guided surgery and freehand surgery. Magrin (2020) ( 16 ) Clinical and tomographic comparison of dental implants placed by guided virtual surgery versus conventional technique: A split-mouth randomized clinical trial Jorurnal of Clinical Periodontology Brazil Randomized clinical trial 24 12 12 Static guide. Combined static+dynamic Without flap Full-thickness flap Angular deviation 2.2 ± 1.1° (guided) vs. 3.5 ± 1.6° (conventional), p = 0.042. Computer-guided surgery using stereolithographic guides showed a slight reduction in angular discrepancy compared to the conventional surgical technique. However, the differences in linear deviations at the coronal and apical levels, as well as in the results perceived by patients, were not statistically significant. Sancho (2019) ( 18 ) A Randomized Controlled Clinical Trial Comparing Conventional And Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 2: Patient Related Outcome Measures The International Journal of Periodontics & Restorative Dentistry Switzerland y Spain Randomized controlled clinical trial 73 47 26 Static With flap With flap Greater satisfaction in guided groups; similar morbidity. There were no significant differences between groups (control vs. guided) in intraoperative and postoperative quality of life parameters. The type of protocol (conventional or CAIPP) did not influence morbidity or comfort; the determining factors were surgical duration and complexity. Schneider (2019) ( 17 ) A Randomized Controlled Clinical Trial Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 4: Accuracy of Implant Placement The International Journal of Periodontics & Restorative Dentistry Switzerland Randomized controlled clinical trial 41 21 20 Static With flap With flap Angular deviation: T1 4.23°, T2 3.13% vs. control 7.36%; less deviation in shoulder and apex with guidance. Angular deviation: T1 4.23°, T2 3.13% vs. control 7.36%; less deviation in shoulder and apex with guidance. Guided surgery (CAIPP) demonstrated greater precision at the apex and in angulation compared to the conventional technique, although no significant differences were observed at the coronal level. Tooth-supported guides offered the highest levels of accuracy. Smitkarn (2019) ( 5 ) The accuracy of single-tooth implants placed using fully digital-guided surgery and freehand implant surgery Journal of Clinical Periodontology Thailand Randomized controlled clinical trial 60 30 30 Static Full-thickness flap Full-thickness flap Angular 2.8° vs 7.0°; apical 1.2 vs 2.2 mm; hombro 0.9 vs 1.3 mm; p < 0.05. Static guided surgery (CAIS) was more accurate than free placement in a single space: lower angular, coronal (3D), and apical deviations. Søndergaard (2021) ( 15 ) Fully versus conventionally guided implant placement by dental students: A randomized controlled trial Clinical Oral Implants Research Denmark Randomized clinical trial 26 14 12 Static Full-thickness flap Full-thickness flap Significant differences in apical and angular deviation in favor of FG; no differences in other areas. There is no significant difference in 5 of 7 deviation parameters between fully guided and conventional surgery. Fully guided surgery showed less angular and apical deviation in the buccolingual direction. mesiodistal (sagittal). Varga (2020) ( 13 ) Guidance means accuracy: A randomized clinical trial on freehand versus guided dental implantation Clinical Oral Implants Research Hungary Randomized clinical trial 104 49 55 Static Full-thickness flap Full-thickness flap Gradual improvement in accuracy with a higher degree of guidance; all guided protocols superior to FH. The greatest improvement is observed in angular deviation, with fully guided surgery being the most accurate. The authors suggest that guided surgery should be considered the gold standard when precision in implant positioning is required. Vercruyssen (2014) ( 14 ) Implant- and patient-centred outcomes of guided surgery, a 1-year follow-up: An RCT comparing guided surgery with conventional implant placement Journal of Clinical Periodontology Belgium Randomized clinical trial 314 212 102 Static Mucosa-supported flapless and bone-supported with flap Full-thickness flap MBL 0.04 mm (guiada) vs 0.01 mm (control) al año; sin diferencias clínicas relevantes; QoL mejoró en ambos. No differences were observed between guided and conventional surgery in terms of marginal bone loss, clinical parameters, or quality of life; all groups showed an improvement in their OHIP score. Guided surgery is presented as a valid and predictable alternative, with clinical and radiological results. Yotpibulwong (2023) ( 8 ) Accuracy of implant placement with a combined use of static and dynamic computer-assisted implant surgery in single tooth space: A randomized controlled Clinical Oral Implants Research Thailand Randomized clinical trial 120 90 30 Static+dynamic combination Full-thickness flap Full-thickness flap 3D deviation platform/apical/angle: SD < S ≈ D < FH (p < 0.001). The static+dynamic (SD) combination produced the highest accuracy in platform, apex, and angle, superior to static (S) and dynamic (D) guidance separately and to free surgery (FH). Younes (2019) ( 11 ) A randomized controlled study on the accuracy of free-handed, pilot-drill guided and fully-guided implant surgery in partially edentulous patients Journal of Clinical Periodontology Belgium Randomized clinical trial 71 45 26 Static Without flap Full-thickness flap AGD: FG 0.97 mm < PG 1.43 mm < FH 2.11 mm; more cemented in FH. Fully guided surgery was the most accurate (AGD ≈ 1 mm; maximum ≈ 2 mm), followed by pilot-drill (PG), and the least accurate was freehand (FH) (AGD ≈ 2.1 mm; maximum ≈ 4.8 mm). Several metrics (AD, CGD, ALD) confirmed the same order. Younes F (2018) ( 12 ) A randomized controlled trial on the efficiency of free-handed, pilot‐drill guided and fully‐guided implant surgery in partially edentulous patients Clinical Oral Implants Research Belgium Randomized clinical trial 47 21 26 Static guide Without flap Full-thickness flap FG more effective (AGD 0.97 mm) and more efficient (ICER €4.12/ % reduction in AGD). Fully guided surgery is the most efficient approach in terms of precision and cost-effectiveness, although it involves a higher absolute cost compared to pilot-drill and free-hand techniques. Younis (2024) ( 10 ) Accuracy of dynamic navigation compared to static surgical guides and the freehand approach in implant placement: a prospective clinical study Head & Face Medicine China Prospective clinical study with random assignment to three groups 65 42 23 94 64 30 Static (sCAIS) and Dynamic (dCAIS) Dynamic: with flap (soft-tissue reflection); Static: N/R on flap/flapless Basic characteristics of the included studies This rapid systematic review included 13 clinical studies published between 2014 and 2024 that compared the three-dimensional accuracy of guided surgery with that of traditional surgery in single implants in partially edentulous adult patients ( 5 , 7 – 18 ). Only 12 studies were used for the meta-analysis. One study was excluded because it investigated patients' perceptions of guided and unguided surgery and did not provide numerical data for quantitative analysis ( 18 ). Most of the articles were randomized clinical trials (5.8–18), with parallel or split-mouth designs, and only one was a prospective non-randomized study ( 7 ). The participating population consisted of 711 adult patients. In one study, they had total edentulism ( 14 ), and in the remaining studies, they had partial edentulism ( 5 , 7 – 13 , 15 – 18 ), without active periodontal disease, and underwent single-implant restorations in posterior or aesthetic areas. A total of 912 implants were placed, of which 659 were guided surgery, and 253 were 186 freehand conventional surgery. The patient’s age ranged from 18 to 65 years, and in 8 articles, women predominated ( 8 – 16 ). The type of guided surgery was static in 9 studies ( 5 , 9 , 11 – 15 , 17 , 18 ), a combination of static and dynamic guided surgery was used in two studies ( 8 , 16 ), and in 1 study, a non-restrictive, position-only guide was used ( 7 ). The surgical approach in guided surgery was a full-thickness flap in nine studies ( 5 , 7 – 10 , 13 , 15 , 17 , 18 ). Flapless surgery was performed in three studies ( 11 , 12 , 16 ), and in one study, the mucosa-supported flapless technique and bone-supported flap technique were used ( 14 ). In the non-guided surgery group, most studies reported the use of full-thickness flaps ( 2 , 7 – 9 , 11 – 18 ). The implant system brands were Astra Tech Implant System in four studies ( 11 , 12 , 14 , 15 ); Strauman in three studies ( 5 , 7 , 8 ); Neodent in one article ( 16 ), Anyridge, MegaGen Implant in another study ( 9 ); and MultiNeO, Alpha Bio in another ( 13 ). The following software was used for implant planning: coDiagnostiX (5.8); Dental slice ( 16 ); Simplant (12,14.15,17,18); SMART Guide ( 13 ); R2 Gate CAD software ( 9 ). A tooth-supported guide was used in 12 studies ( 5 , 7 – 13 , 15 – 18 ) and a mucosa-supported and bone-supported guide in one study ( 14 ). The guides were manufactured using 3D printing in most studies ( 5 , 7 – 9 , 11 , 13 ) The guide material was acrylic resin in three studies ( 9 , 15 , 16 ), model resin ( 7 ), light-curing resin ( 10 ), and postoperative cone beam computed tomography (CBCT) in most studies (5,7,8,10–13,15,116). Risk of bias assessment In the risk of bias assessment (Appendix 1), most of the included studies were of adequate methodological quality. In general, the domains of random sequence generation, allocation concealment, blinding, handling of incomplete data, and selective reporting of results were rated as low risk. Only one study, Huang et al. ( 7 ), showed a high risk in random sequence generation. Several studies raised concerns (uncertain risk) in domains related to allocation concealment and blinding of participants or evaluators, likely due to limitations inherent to the clinical design and type of surgical intervention. Overall, the assessment suggests that most studies have a low overall risk of bias. Data synthesis Coronal deviation of the implant in guided and non-guided surgery A random-effects meta-analysis was performed to assess coronal deviation in both study groups, as the I 2 statistic indicate high heterogeneity among the studies analyzed ( I 2 = 87%). (This is shown in Fig. 2 ). The statistical measure used the difference in means, with a 95% confidence interval. The overall mean difference was (–0.35 mm; IC 95%: − 0,55, − 0,16), with a p-value of 0,0005 and a negative effect direction, indicating that with guided surgery, the mean coronal deviation was significantly lower than with non-guided surgery. Overall, this analysis indicates that guided surgery reduces coronal deviation by approximately 0.35 mm on average compared to non-guided surgery, demonstrating its superiority surgery. The Z statistic = 3.49 indicates that these differences are not due to chance (p < 0,001). Three studies ( 7 , 11 , 12 ), carried the most weight in this meta-analysis, reporting significantly lower coronal deviations in the guided surgery groups (differences between − 0,33 and − 0,59 mm). Other studies show effects close to zero, with minimal differences ( 16 , 17 ), and one study reported a difference − 1,40 mm ( 14 ). Apical deviation of the implant in guided and non-guided surgery Following a similar procedure, a meta-analysis was performed to compare the apical deviation of implants with guided and non-guided surgery. The random effects model shows that the overall mean difference was − 0.78 mm (95% CI: -1.06 to 0.51), with a p-value < 0.001, and the effect was negative. The model shows high heterogeneity (1'= 94%). The Z statistic = 5.52, indicating that these differences are not due to chance (p = 0.001). Based on this, the meta-analysis indicates that guided surgery achieves a significant 1 reduction in implant apical deviation of 0.78 mm compared to non-guided surgery. Three articles reported a reduction in implant apical deviation with guided surgery > 1 mm ( 13 , 14 , 17 ), suggesting that digital guidance provides a significant improvement in reducing implant apical deviation. (See Fig. 3 ). Angular deviation of the implant in guided and non-guided surgery To compare the results in terms of angular deviation, another meta-analysis was conducted using the same statistical method as the previous analyses. As in these, heterogeneity was high ( I 2 = 97%). The overall mean difference in angular deviation between the two methods (guided and non-guided surgery) was − 3.0° (95% CI: -4.36–1.65), with a p-value < 0.001. This means that guided surgery achieves a significant reduction of up to 3° in angular deviation compared to non-guided surgery. The Z statistic = 4.33 indicates that these differences are not due to chance (p < 0.001). The greatest effects in this analysis were observed in the studies by Younes et al. ( 12 ) (-4.69°) and Vercruyssen et al. ( 14 ) (-6.10°), showing an advantage in guided surgery. (See Fig. 4 ). Publication bias and funnel plots The funnel plot for coronal deviation (Fig. 5 ) shows a reasonably symmetrical distribution of studies around the vertical line of mean effect, with a predominance of points at the top of the funnel, indicating high precision and low variance. One isolated study is in the lower left quadrant, representing a possible extreme effect associated with a smaller sample size, but without affecting the overall symmetry. This pattern is consistent with the results of the meta-analysis, which showed a mean difference of -0.35 mm (95% CI -0.55 to -0.16: p = 0.0005) in favor of guided surgery with moderate heterogeneity (I'= 87%). No clear evidence of asymmetry or selective accumulation of positive studies was observed, so it is considered that there is no relevant publication bias for this outcome. The funnel plot for apical deviation (Fig. 6 ) has a balanced conical shape a centralized distribution, suggesting the absence of systematic publication bias. The studies accumulation of positive studies was observed, so it is considered that there is no relevant publication bias for this outcome. Likewise, Fig. 6 shows a balanced, conical shape and a centralized distribution, suggesting the absence of systematic publication bias. The studies are mainly clustered around the overall effect line, with a leftward dispersion attributable to differences in sample size and methodological heterogeneity. The corresponding meta-analysis in Fig. 3 showed a mean difference of -0.78 mm (95% CI: -1.06 to -0.51; p < 0.001), indicating that guided surgery significantly reduces apical deviation compared to the non-guided technique. Although high heterogeneity was detected (1 = 94%), the graph does not show a systematic trend suggesting selective publication of studies with favorable results. Therefore, it can be inferred that there is no apparent influence of publication bias. In the case of angular deviation (Fig. 7 ), the funnel plot shows a slightly asymmetrical distribution, with a concentration of studies toward the left side of the central axis (effects more favorable to guided surgery and greater dispersion of small studies. This pattern could reflect both clinical and methodological heterogeneity across studies and the presence of small-study effects, without necessarily implying publication bias. The meta-analysis in Fig. 4 showed an overall mean difference of -3.00° (95% CI: -4.36 to -1.65, p < 0.001) in favor of guided surgery, with very high heterogeneity (I°=97%). Given the limited number of studies and the variability in angular measurement methods, the funnel plot should be interpreted with caution. Conclusions Guided surgery in any of its modalities (static, dynamic, or mixed) is superior to non-guided surgery in terms of results, in three-dimensional precision of the position of single dental implants in partially edentulous adults. The meta-analysis showed a statistically significant decrease in the average coronal, apical, and angular deviation of single implants in patients undergoing guided surgery compared to non-guided surgery. This is clinically relevant because it translates into optimized implant axis and depth, reduces anatomical damage, and greater prosthetic congruence. Abbreviations CAD Computer-aided design DICOM Digital imaging and communication in medicine STL Stereolithography CBCT Cone beam computed tomography Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding None. Author Contribution P.A.C.Q., and C.E.M., conceptualization; C.E.M., methodology; J.M.P.V., and M.R.M.P., management software; P.A.C.Q., and C.E.M., formal Analysis; P.A.C.Q., and C.E.M., writing original draft, writing review and editing, J.M.P.V., and M.R.M.P., supervision. Acknowledgement Staff of Universidad UTE. Availability of data and materials Data used in this study are publicly available. References Alexandre Oliveira N, Matos Garrido N, España López A, Jiménez Guerra A, Ortiz García I, Velasco Ortega E et al. Planificación de tratamiento con software para cirugía guiada en implantología oral. Av Odontoestomatol [Internet]. 1 de marzo de 2019 [citado 22 de octubre de 2025];35(2):59–68. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-12852019000200002&lng=es&nrm=iso&tlng=es Khourani W, Yamani A. Digital Implante Planning: A Brief narrative review. 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Disponible en: https://onlinelibrary.wiley.com/doi/ 10.1111/clr.13578 Vercruyssen M, van de Wiele G, Teughels W, Naert I, Jacobs R, Quirynen M. Implant- and patient‐centred outcomes of guided surgery, a 1‐year follow‐up: An RCT comparing guided surgery with conventional implant placement. J Clin Periodontol [Internet] 11 de diciembre de. 2014;41(12):1154–60. 10.1111/jcpe.12305 . Disponible en:. https://onlinelibrary.wiley.com/doi/ . Søndergaard K, Hosseini M, Storgård Jensen S, Spin-Neto R, Gotfredsen K. Fully versus conventionally guided implant placement by dental students: A randomized controlled trial. Clin Oral Implants Res [Internet]. 5 de septiembre de 2021;32(9):1072–84. Disponible en: https://onlinelibrary.wiley.com/doi/ 10.1111/clr.13802 Magrin GL, Rafael SNF, Passoni BB, Magini RS, Benfatti CAM, Gruber R et al. Clinical and tomographic comparison of dental implants placed by guided virtual surgery versus conventional technique: A split-mouth randomized clinical trial. J Clin Periodontol [Internet]. 14 de enero de 2020;47(1):120–8. Disponible en: https://onlinelibrary.wiley.com/doi/ 10.1111/jcpe.13211 Schneider D, Sancho-Puchades M, Mir-Marí J, Mühlemann S, Jung R, Hämmerle C. A Randomized Controlled Clinical Trial Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 4: Accuracy of Implant Placement. Int J Periodontics Restorative Dent [Internet]. julio de. 2019;39(4):e111-22. Disponible en: http://www.quintpub.com/journals/prd/abstract.php?iss2_id=1618&article_id=19557 Sancho-Puchades M, Alfaro F, Naenni N, Jung R, Hämmerle C, Schneider D. A Randomized Controlled Clinical Trial Comparing Conventional And Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 2: Patient Related Outcome Measures. Int J Periodontics Restor Dent [Internet] julio de. 2019;39(4):e99–110. Disponible en:. http://www.quintpub.com/journals/prd/abstract.php?iss2_id=1618&article_id=19554 . Floriani F, Jurado CA, Cabrera AJ, Duarte W, Porto TS, Afrashtehfar KI. Depth distortion and angular deviation of a fully guided tooth-supported static surgical guide in a partially edentulous patient: A systematic review and meta-analysis. J Prosthodont [Internet]. 1 de septiembre de 2024 [citado 9 de octubre de 2025];33(S1):10–24. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38992883/ Werny JG, Frank K, Fan S, Sagheb K, Al-Nawas B, Narh CT et al. Freehand vs. computer-aided implant surgery: a systematic review and meta-analysis—part 1: accuracy of planned and placed implant position. Int J Implant Dent [Internet]. 2 de mayo de. 2025;11(1):35. Disponible en: https://journalimplantdent.springeropen.com/articles/ 10.1186/s40729-025-00622-w Dutta D, Mohanty AK, Raut A, Pal D, Mahato M, Jain A et al. Comparison of Accuracy of Dental Implant Placement Between Freehand and Guided Implant Surgery-A Systematic Review and Meta-analysis. J Maxillofac Oral Surg [Internet]. 1 de agosto de 2025 [citado 15 de octubre de 2025];24(4):865 – 76. Disponible en: https://pubmed.ncbi.nlm.nih.gov/40756940/ Additional Declarations No competing interests reported. Supplementary Files Appendix1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9245128","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619416109,"identity":"5d59d361-73fd-4df2-bc75-44e9dae4b861","order_by":0,"name":"Paul Alexander Carrera Quizhpe","email":"","orcid":"","institution":"Universidad Tecnológica Equinoccial","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"Alexander Carrera","lastName":"Quizhpe","suffix":""},{"id":619416116,"identity":"2fcf3e1f-f637-4ac6-b4e6-384ccb1e6835","order_by":1,"name":"Carolina Endara Moreno","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYLCCBwYQWgKI5SBMNgJaEpC0GENUE9TCgNCS2EBIC3/72YcPEgruyDOw9x688XOPXfqG+80HGD6UHWbgZz+AVYvEmXRjgwSDZ4YNPOeSLXueJeduOMaWwDjj3GEGyZ4ErFoMGNLYJBIMDjM2SOSYSfAcYAZq4TFg5m07zGBwA7vDDPifgbXYN8i/MZP8c6A+3eAY/wfmv0At9ri0SEBsSWyQ4DGT5jlwOMHgGA8DMyPIFgnsWiRuPGMG+uVwchtPjrG1zIHjhjOPpRkc7DmXziNxBrtf+PvTGB98+HPYtp/9jOHNNweq5fkOH3744EeZtRx/O/YQgwOUiACp5cGvfhSMglEwCkYBPgAAkH9aT6EVRzsAAAAASUVORK5CYII=","orcid":"","institution":"Universidad Tecnológica Equinoccial","correspondingAuthor":true,"prefix":"","firstName":"Carolina","middleName":"Endara","lastName":"Moreno","suffix":""},{"id":619416118,"identity":"4f772bd2-ca20-4b43-9cd9-2952d81e3593","order_by":2,"name":"Mónica Roxana Mancheno Ponce","email":"","orcid":"","institution":"Universidad Tecnológica Equinoccial","correspondingAuthor":false,"prefix":"","firstName":"Mónica","middleName":"Roxana Mancheno","lastName":"Ponce","suffix":""},{"id":619416120,"identity":"2cf54d16-dd76-4d84-8d86-fa18c2ae98a2","order_by":3,"name":"Juan Marcos Parise Vasco","email":"","orcid":"","institution":"Universidad Tecnológica Equinoccial","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Marcos Parise","lastName":"Vasco","suffix":""}],"badges":[],"createdAt":"2026-03-27 13:24:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9245128/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9245128/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106870115,"identity":"d5814211-0b0c-4d0a-8359-dc0069908f62","added_by":"auto","created_at":"2026-04-14 09:41:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":158961,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA diagram for articles selection\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/43f87290636e4b7d88f6cd1c.png"},{"id":106869792,"identity":"8bf8b4d3-bb65-48a0-a4ac-75740f2a8fa7","added_by":"auto","created_at":"2026-04-14 09:40:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":124790,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCoronal deviation. Guided and Non-Guided Surgery. Forest plot\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/e77a5d71ef5e97e32e34af1c.png"},{"id":106869903,"identity":"53e6317e-d08e-43b8-9990-56df2e449fb0","added_by":"auto","created_at":"2026-04-14 09:41:05","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":96001,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eApical deviation of the implant in guided and non-guided surgery. Forest plot.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/6554436aab6c3a015d9b9c2b.png"},{"id":106869908,"identity":"c2244662-5f2f-4ae2-964c-38a0522bdd74","added_by":"auto","created_at":"2026-04-14 09:41:06","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":96934,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAngular deviation of the implant in guided and non-guided surgery. Forest plot.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/982fa4119e3851f3646a9006.png"},{"id":106869881,"identity":"1f059fff-57df-4f3c-8e03-40f123bdb0d0","added_by":"auto","created_at":"2026-04-14 09:41:04","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":17923,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCoronal deviation. Funnel graph.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/93b12280f405c017ed60c5ca.png"},{"id":106870319,"identity":"07adb1e3-4f40-473a-9d6d-2c980c06265f","added_by":"auto","created_at":"2026-04-14 09:42:05","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":14778,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eApical deviation. Funnel graph.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/5b90f2010130f424a6c89590.png"},{"id":106869872,"identity":"6e779df8-ca23-45d4-a7f6-a88c1d636c74","added_by":"auto","created_at":"2026-04-14 09:41:02","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":17518,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/9db29d89050563ffaa0c4ea9.png"},{"id":107062281,"identity":"8d2bfd12-bd3e-4dac-b6b6-22cf61916bae","added_by":"auto","created_at":"2026-04-16 10:27:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1756402,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/08b7bef9-9bce-46bb-ab4a-9ff0e6b01098.pdf"},{"id":106869791,"identity":"46c86e7f-7395-4fea-9475-6687f69bed5d","added_by":"auto","created_at":"2026-04-14 09:40:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23084,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9245128/v1/320ff476494f6778f8cd1fa4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Accuracy of guided vs non-guided surgery in three-dimensional positioning of single implants: a rapid systematic review","fulltext":[{"header":"Background","content":"\u003cp\u003eIn the field of modern dentistry, guided surgery has been implemented to offer precision when placing implants. Nowadays, various software programs provide information for the creation of files that generate guides to be used as complementary methods of diagnosis and surgical procedure (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). These images are not only used in diagnosis but have also been implemented in treatment planning (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Surgical guides function as a tool for the operator to position implants according to pre-surgical planning to avoid possible unplanned deviations and provide comfort to the patient (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, the computer-assisted implant planning and surgery, based on digital design tools, computer-aided design (CAD), offers clinicians the advantage of combining digital imaging and communication in medicine (DICOM) information from medical images with stereolithography (STL) files corresponding to three-dimensional models. The advantage of this integration into specialized software is that it\u0026rsquo;s possible to accurately determine the ideal position of the implants within the jaw, carefully considering the surrounding anatomical structures.\u003c/p\u003e \u003cp\u003eCurrently, the benefits of guided surgery allow the operator to understand each patient\u0026rsquo;s anatomical variants, such as remaining teeth, bone quality, and the presence of pathologies, which can influence the accuracy of guided or analog surgery. Therefore, further research in this area can identify better success factors for implant placement, in addition to optimizing surgical protocols to improve outcomes in these cases (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe placement of dental implants is a procedure that requires precision to ensure both the functionality and aesthetics of the restoration. In recent decades, different ways of performing this process have emerged, the most common being guided by surgery and the manual or traditional technique. Although both aim to achieve good results, there is still debate over which offers greater precision and long-term benefits (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe field lacks recent, well-designed studies that objectively compare the precision of both techniques across different clinical scenarios and at varying levels of operator experience. In addition, there is some resistance or disagreement among different dental specialties, such as implantologists and periodontists, regarding the adoption and application of guided surgery (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis research aimed to provide concrete information to help to determine whether guided surgery is truly superior in terms of accuracy compared to the manual technique, evaluating the precision of the 3D position of the implant, the implant location, and the effect of guide fabrication, synthesizing the available evidence.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eWe conducted a rapid systematic review using (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) (PRISMA) reporting guidelines (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). To answer the research question: What is the accuracy of three-dimensional positioning of single implants using guided versus non-guided surgery? using the PICO question strategy.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003e(P) partially edentulous adult patients undergoing single implant treatment: (I) Guided surgery, (C) Conventional surgery, (O) Implant accuracy using CT scans, and the change in implant position between planning and final position.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eRandomized or non-randomized controlled clinical trials and comparative observational studies that included partially edentulous patients over 18 years of age who required single implant placement accuracy as an outcome were excluded, as were patients who, despite meeting these criteria, had not been evaluated for adequate bone quality and quantity, patients with periodontal defects, and patients with bruxism. In addition, studies that included patients with systemic diseases were excluded.\u003c/p\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eStudies were searched for in different databases, including Medline/PubMed, LILACS, Cochrane Library, and Epistemonikos. Key terms related to \"single implants, \u0026ldquo;conventional surgery,\" and \"guided surgery\" were used. The search was restricted to publications in Spanish, English, and Portuguese. Additionally, a manual search was conducted of the reference lists in the included articles.\u003c/p\u003e\n\u003ch3\u003eStudy selection and data extraction\u003c/h3\u003e\n\u003cp\u003eTwo reviewers (PACQ and CEM) independently selected articles that met the eligibility criteria in two stages. In the first stage, the researchers selected articles based on their titles and abstracts. Subsequently, the researchers selected articles by reading the full texts of the preselected records. In case of discrepancies in the selection of studies, a third reviewer (JMPV) participated to reach a consensus. The article selection process was conducted out using Rayyan software. The PRISMA flow diagram, shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, was used to visualize the selection process.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTwo reviewers (PACQ and CEM) extracted data into a Microsoft Excel template, including author, year of publication, research design, age, gender, method of measurement of variables, comparison between the two methods, surgical procedure used, and region of implant placement related to guided surgery and conventional surgery and the relationship between them to determine accuracy and whether there are significant differences between the two surgical methods. In case of discrepancies in data extraction, a third reviewer (JMPV) participated in reaching an agreement.\u003c/p\u003e\n\u003ch3\u003eQuality assessment and risk of bias\u003c/h3\u003e\n\u003cp\u003e The risk of bias was assessed independently for each study by two reviewers (PC, CE). The Cochrane Risk of Bias (RoB) tool was applied. The results are presented in a traffic-light graphic format.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eA qualitative synthesis was conducted to describe the methodological and clinical characteristics of the included studies. In addition, a random effects meta-analyses were performed for each primary outcome (coronal, apical, and angular deviation), expressing the results as mean differences (MD) with 95% confidence intervals. The mean values and standard deviations reported by each study were used, and heterogeneity was assessed using the I statistic.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eResult of literature search\u003c/h2\u003e \u003cp\u003eThe search identified 1114 articles eligible based on their titles and abstracts, of which 582 came from PubMed, 10 from Epistemonikos, 120 from the Cochrane Library, 396 from Lilacs, and 6 were identified through manual search. A total of 165 were eliminated before screening due to duplicates. In the analysis by title and abstract, 907 articles were eliminated, leaving 42 for full-text download. Of these, 9 articles could not be retrieved, leaving only 33 articles were selected for evaluation. A total of 20 were eliminated for reporting that did not meet the objectives set or for their design. At the end of the screening process, 13 articles remained and were included in this rapid review. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the screening process.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eArticles selected for the analyses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast name\u003c/p\u003e \u003cp\u003e(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTittle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDesign\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal number of implants placed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIMPLANTS \u0026ndash; Guided group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIMPLANTS - Unguided\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eType of guided surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSurgical approach \u0026ndash; Guided group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurgical approach \u0026ndash; Unguided group (Control)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMain results\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eConclusions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuang\u003c/p\u003e \u003cp\u003e(2023) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluation of the accuracy of implant placement by using implant positional guide versus freehand: a prospective clinical study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternational Journal of Implant Dentistry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProspective Clinical Study - Non-randomized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNon-restrictive guide (position only)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWith flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eWith flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAll deviations (coronal, apical, angular, vertical) were significantly lower with positional guidance.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eImplant positional guidance is a technique for performing digital oral implants, which can be a viable tool for dentists to place dental implants.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLops\u003c/p\u003e \u003cp\u003e(2024) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuided versus freehand single implant placement: A 3-year parallel randomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal of Dentistry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic guide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWith flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eWith flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eDifference in MBL of 0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22 mm, not significant.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eAt 3 years, there were no significant differences in marginal bone remodeling (MBL) between implants placed with guided surgery and freehand surgery.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagrin\u003c/p\u003e \u003cp\u003e(2020) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical and tomographic comparison of dental implants placed by guided virtual surgery versus conventional technique: A split-mouth randomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJorurnal of Clinical Periodontology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic guide. Combined static+dynamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWithout flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAngular deviation 2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u0026deg; (guided) vs. 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u0026deg; (conventional), p\u0026thinsp;=\u0026thinsp;0.042.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eComputer-guided surgery using stereolithographic guides showed a slight reduction in angular discrepancy compared to the conventional surgical technique. However, the differences in linear deviations at the coronal and apical levels, as well as in the results perceived by patients, were not statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSancho\u003c/p\u003e \u003cp\u003e(2019) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA Randomized Controlled Clinical Trial Comparing Conventional And Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 2: Patient Related Outcome Measures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe International Journal of Periodontics \u0026amp; Restorative Dentistry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSwitzerland y Spain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWith flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eWith flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGreater satisfaction in guided groups; similar morbidity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eThere were no significant differences between groups (control vs. guided) in intraoperative and postoperative quality of life parameters.\u003c/p\u003e \u003cp\u003eThe type of protocol (conventional or CAIPP) did not influence morbidity or comfort; the determining factors were surgical duration and complexity.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchneider\u003c/p\u003e \u003cp\u003e(2019) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA Randomized Controlled Clinical Trial Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 4: Accuracy of Implant Placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe International Journal of Periodontics \u0026amp; Restorative Dentistry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSwitzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWith flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eWith flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAngular deviation: T1 4.23\u0026deg;, T2 3.13% vs. control 7.36%; less deviation in shoulder and apex with guidance. Angular deviation: T1 4.23\u0026deg;, T2 3.13% vs. control 7.36%; less deviation in shoulder and apex with guidance.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eGuided surgery (CAIPP) demonstrated greater precision at the apex and in angulation compared to the conventional technique, although no significant differences were observed at the coronal level. Tooth-supported guides offered the highest levels of accuracy.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmitkarn\u003c/p\u003e \u003cp\u003e(2019) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe accuracy of single-tooth implants placed using fully digital-guided surgery and freehand implant surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal of Clinical Periodontology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThailand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAngular 2.8\u0026deg; vs 7.0\u0026deg;; apical 1.2 vs 2.2 mm; hombro 0.9 vs 1.3 mm; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eStatic guided surgery (CAIS) was more accurate than free placement in a single space: lower angular, coronal (3D), and apical deviations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS\u0026oslash;ndergaard (2021) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFully versus conventionally guided implant placement by dental students: A randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Oral Implants Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDenmark\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSignificant differences in apical and angular deviation in favor of FG; no differences in other areas.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eThere is no significant difference in 5 of 7 deviation parameters between fully guided and conventional surgery. Fully guided surgery showed less angular and apical deviation in the buccolingual direction. mesiodistal (sagittal).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVarga\u003c/p\u003e \u003cp\u003e(2020) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuidance means accuracy: A randomized clinical trial on freehand versus guided dental implantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Oral Implants Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHungary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGradual improvement in accuracy with a higher degree of guidance; all guided protocols superior to FH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eThe greatest improvement is observed in angular deviation, with fully guided surgery being the most accurate. The authors suggest that guided surgery should be considered the gold standard when precision in implant positioning is required.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVercruyssen (2014) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplant- and patient-centred outcomes of guided surgery, a 1-year follow-up: An RCT comparing guided surgery with conventional implant placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal of Clinical Periodontology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBelgium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMucosa-supported flapless and bone-supported with flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMBL 0.04 mm (guiada) vs 0.01 mm (control) al a\u0026ntilde;o; sin diferencias cl\u0026iacute;nicas relevantes; QoL mejor\u0026oacute; en ambos.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo differences were observed between guided and conventional surgery in terms of marginal bone loss, clinical parameters, or quality of life; all groups showed an improvement in their OHIP score. Guided surgery is presented as a valid and predictable alternative, with clinical and radiological results.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYotpibulwong (2023) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccuracy of implant placement with a combined use of static and dynamic computer-assisted implant surgery in single tooth space: A randomized controlled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Oral Implants Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThailand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic+dynamic combination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3D deviation platform/apical/angle: SD\u0026thinsp;\u0026lt;\u0026thinsp;S\u0026thinsp;\u0026asymp;\u0026thinsp;D\u0026thinsp;\u0026lt;\u0026thinsp;FH (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eThe static+dynamic (SD) combination produced the highest accuracy in platform, apex, and angle, superior to static (S) and dynamic (D) guidance separately and to free surgery (FH).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYounes\u003c/p\u003e \u003cp\u003e(2019) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA randomized controlled study on the accuracy of free-handed, pilot-drill guided and fully-guided implant surgery in partially edentulous patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal of Clinical Periodontology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBelgium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWithout flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAGD: FG 0.97 mm\u0026thinsp;\u0026lt;\u0026thinsp;PG 1.43 mm\u0026thinsp;\u0026lt;\u0026thinsp;FH 2.11 mm; more cemented in FH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eFully guided surgery was the most accurate (AGD\u0026thinsp;\u0026asymp;\u0026thinsp;1 mm; maximum\u0026thinsp;\u0026asymp;\u0026thinsp;2 mm), followed by pilot-drill (PG), and the least accurate was freehand (FH) (AGD\u0026thinsp;\u0026asymp;\u0026thinsp;2.1 mm; maximum\u0026thinsp;\u0026asymp;\u0026thinsp;4.8 mm). Several metrics (AD, CGD, ALD) confirmed the same order.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYounes F\u003c/p\u003e \u003cp\u003e(2018) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA randomized controlled trial on the efficiency of free-handed, pilot‐drill guided and fully‐guided implant surgery in partially edentulous patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Oral Implants Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBelgium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized clinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatic guide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWithout flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFull-thickness flap\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eFG more effective (AGD 0.97 mm) and more efficient (ICER \u0026euro;4.12/ % reduction in AGD).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eFully guided surgery is the most efficient approach in terms of precision and cost-effectiveness, although it involves a higher absolute cost compared to pilot-drill and free-hand techniques.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYounis\u003c/p\u003e \u003cp\u003e(2024) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccuracy of dynamic navigation compared to static surgical guides and the freehand approach in implant placement: a prospective clinical study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHead \u0026amp; Face Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProspective clinical study with random assignment to three groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eStatic (sCAIS) and Dynamic (dCAIS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eDynamic: with flap (soft-tissue reflection); Static: N/R on flap/flapless\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eBasic characteristics of the included studies\u003c/h2\u003e \u003cp\u003eThis rapid systematic review included 13 clinical studies published between 2014 and 2024 that compared the three-dimensional accuracy of guided surgery with that of traditional surgery in single implants in partially edentulous adult patients (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Only 12 studies were used for the meta-analysis. One study was excluded because it investigated patients' perceptions of guided and unguided surgery and did not provide numerical data for quantitative analysis (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Most of the articles were randomized clinical trials (5.8\u0026ndash;18), with parallel or split-mouth designs, and only one was a prospective non-randomized study (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The participating population consisted of 711 adult patients. In one study, they had total edentulism (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and in the remaining studies, they had partial edentulism (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), without active periodontal disease, and underwent single-implant restorations in posterior or aesthetic areas.\u003c/p\u003e \u003cp\u003eA total of 912 implants were placed, of which 659 were guided surgery, and 253 were 186 freehand conventional surgery. The patient\u0026rsquo;s age ranged from 18 to 65 years, and in 8 articles, women predominated (\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The type of guided surgery was static in 9 studies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), a combination of static and dynamic guided surgery was used in two studies (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and in 1 study, a non-restrictive, position-only guide was used (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The surgical approach in guided surgery was a full-thickness flap in nine studies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Flapless surgery was performed in three studies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and in one study, the mucosa-supported flapless technique and bone-supported flap technique were used (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the non-guided surgery group, most studies reported the use of full-thickness flaps (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The implant system brands were Astra Tech Implant System in four studies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e); Strauman in three studies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e); Neodent in one article (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Anyridge, MegaGen Implant in another study (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e); and MultiNeO, Alpha Bio in another (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe following software was used for implant planning: coDiagnostiX (5.8); Dental slice (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e); Simplant (12,14.15,17,18); SMART Guide (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e); R2 Gate CAD software (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A tooth-supported guide was used in 12 studies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and a mucosa-supported and bone-supported guide in one study (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The guides were manufactured using 3D printing in most studies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) The guide material was acrylic resin in three studies (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), model resin (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), light-curing resin (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and postoperative cone beam computed tomography (CBCT) in most studies (5,7,8,10\u0026ndash;13,15,116).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRisk of bias assessment\u003c/h2\u003e \u003cp\u003eIn the risk of bias assessment (Appendix 1), most of the included studies were of adequate methodological quality.\u003c/p\u003e \u003cp\u003eIn general, the domains of random sequence generation, allocation concealment, blinding, handling of incomplete data, and selective reporting of results were rated as low risk. Only one study, Huang et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), showed a high risk in random sequence generation. Several studies raised concerns (uncertain risk) in domains related to allocation concealment and blinding of participants or evaluators, likely due to limitations inherent to the clinical design and type of surgical intervention. Overall, the assessment suggests that most studies have a low overall risk of bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData synthesis\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eCoronal deviation of the implant in guided and non-guided surgery\u003c/h2\u003e \u003cp\u003eA random-effects meta-analysis was performed to assess coronal deviation in both study groups, as the \u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e statistic indicate high heterogeneity among the studies analyzed (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;87%). (This is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe statistical measure used the difference in means, with a 95% confidence interval. The overall mean difference was (\u0026ndash;0.35 mm; IC 95%: \u0026minus;\u0026thinsp;0,55, \u0026minus;\u0026thinsp;0,16), with a p-value of 0,0005 and a negative effect direction, indicating that with guided surgery, the mean coronal deviation was significantly lower than with non-guided surgery.\u003c/p\u003e \u003cp\u003eOverall, this analysis indicates that guided surgery reduces coronal deviation by approximately 0.35 mm on average compared to non-guided surgery, demonstrating its superiority surgery. The Z statistic\u0026thinsp;=\u0026thinsp;3.49 indicates that these differences are not due to chance (p\u0026thinsp;\u0026lt;\u0026thinsp;0,001).\u003c/p\u003e \u003cp\u003eThree studies (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), carried the most weight in this meta-analysis, reporting significantly lower coronal deviations in the guided surgery groups (differences between \u0026minus;\u0026thinsp;0,33 and \u0026minus;\u0026thinsp;0,59 mm). Other studies show effects close to zero, with minimal differences (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and one study reported a difference\u0026thinsp;\u0026minus;\u0026thinsp;1,40 mm (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eApical deviation of the implant in guided and non-guided surgery\u003c/h2\u003e \u003cp\u003eFollowing a similar procedure, a meta-analysis was performed to compare the apical deviation of implants with guided and non-guided surgery. The random effects model shows that the overall mean difference was \u0026minus;\u0026thinsp;0.78 mm (95% CI: -1.06 to 0.51), with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001, and the effect was negative. The model shows high heterogeneity (1'= 94%). The Z statistic\u0026thinsp;=\u0026thinsp;5.52, indicating that these differences are not due to chance (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eBased on this, the meta-analysis indicates that guided surgery achieves a significant 1 reduction in implant apical deviation of 0.78 mm compared to non-guided surgery. Three articles reported a reduction in implant apical deviation with guided surgery\u0026thinsp;\u0026gt;\u0026thinsp;1 mm (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), suggesting that digital guidance provides a significant improvement in reducing implant apical deviation. (See Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAngular deviation of the implant in guided and non-guided surgery\u003c/h2\u003e \u003cp\u003eTo compare the results in terms of angular deviation, another meta-analysis was conducted using the same statistical method as the previous analyses. As in these, heterogeneity was high (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;97%).\u003c/p\u003e \u003cp\u003eThe overall mean difference in angular deviation between the two methods (guided and non-guided surgery) was \u0026minus;\u0026thinsp;3.0\u0026deg; (95% CI: -4.36\u0026ndash;1.65), with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001. This means that guided surgery achieves a significant reduction of up to 3\u0026deg; in angular deviation compared to non-guided surgery. The Z statistic\u0026thinsp;=\u0026thinsp;4.33 indicates that these differences are not due to chance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe greatest effects in this analysis were observed in the studies by Younes et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) (-4.69\u0026deg;) and Vercruyssen et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) (-6.10\u0026deg;), showing an advantage in guided surgery. (See Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePublication bias and funnel plots\u003c/h2\u003e \u003cp\u003eThe funnel plot for coronal deviation (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) shows a reasonably symmetrical distribution of studies around the vertical line of mean effect, with a predominance of points at the top of the funnel, indicating high precision and low variance. One isolated study is in the lower left quadrant, representing a possible extreme effect associated with a smaller sample size, but without affecting the overall symmetry.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e This pattern is consistent with the results of the meta-analysis, which showed a mean difference of -0.35 mm (95% CI -0.55 to -0.16: p\u0026thinsp;=\u0026thinsp;0.0005) in favor of guided surgery with moderate heterogeneity (I'= 87%). No clear evidence of asymmetry or selective accumulation of positive studies was observed, so it is considered that there is no relevant publication bias for this outcome.\u003c/p\u003e \u003cp\u003eThe funnel plot for apical deviation (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) has a balanced conical shape a centralized distribution, suggesting the absence of systematic publication bias. The studies accumulation of positive studies was observed, so it is considered that there is no relevant publication bias for this outcome. Likewise, Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows a balanced, conical shape and a centralized distribution, suggesting the absence of systematic publication bias. The studies are mainly clustered around the overall effect line, with a leftward dispersion attributable to differences in sample size and methodological heterogeneity.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe corresponding meta-analysis in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed a mean difference of -0.78 mm (95% CI: -1.06 to -0.51; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that guided surgery significantly reduces apical deviation compared to the non-guided technique.\u003c/p\u003e \u003cp\u003eAlthough high heterogeneity was detected (1\u0026thinsp;=\u0026thinsp;94%), the graph does not show a systematic trend suggesting selective publication of studies with favorable results. Therefore, it can be inferred that there is no apparent influence of publication bias.\u003c/p\u003e \u003cp\u003eIn the case of angular deviation (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e), the funnel plot shows a slightly asymmetrical distribution, with a concentration of studies toward the left side of the central axis (effects more favorable to guided surgery and greater dispersion of small studies. This pattern could reflect both clinical and methodological heterogeneity across studies and the presence of small-study effects, without necessarily implying publication bias. The meta-analysis in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e showed an overall mean difference of -3.00\u0026deg; (95% CI: -4.36 to -1.65, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in favor of guided surgery, with very high heterogeneity (I\u0026deg;=97%). Given the limited number of studies and the variability in angular measurement methods, the funnel plot should be interpreted with caution.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eGuided surgery in any of its modalities (static, dynamic, or mixed) is superior to non-guided surgery in terms of results, in three-dimensional precision of the position of single dental implants in partially edentulous adults. The meta-analysis showed a statistically significant decrease in the average coronal, apical, and angular deviation of single implants in patients undergoing guided surgery compared to non-guided surgery. This is clinically relevant because it translates into optimized implant axis and depth, reduces anatomical damage, and greater prosthetic congruence.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputer-aided design\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDICOM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDigital imaging and communication in medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStereolithography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCone beam computed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eP.A.C.Q., and C.E.M., conceptualization; C.E.M., methodology; J.M.P.V., and M.R.M.P., management software; P.A.C.Q., and C.E.M., formal Analysis; P.A.C.Q., and C.E.M., writing original draft, writing review and editing, J.M.P.V., and M.R.M.P., supervision.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e \u003cp\u003eStaff of Universidad UTE.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eData used in this study are publicly available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlexandre Oliveira N, Matos Garrido N, Espa\u0026ntilde;a L\u0026oacute;pez A, Jim\u0026eacute;nez Guerra A, Ortiz Garc\u0026iacute;a I, Velasco Ortega E et al. 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Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/40756940/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/40756940/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Computer-Assisted Surgery, Dental Implantation, Oral surgery, Partially Edentulous, Rapid Systematic Review, Ecuador","lastPublishedDoi":"10.21203/rs.3.rs-9245128/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9245128/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo synthesize the evidence on the use of guided surgery for the placement of single implants compared to non-guided surgery, evaluating the accuracy of the 3D position of the implant, implant location and the effect of guide fabrication.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA rapid systematic review was conducted. Publications were taken from Medline/PubMed, LILACS, Cochrane Library and Epistemonikos. A qualitative synthesis of the included articles was performed, and for the main outcomes (coronal, apical, and angular deviation) a meta-analysis of random effects was developed for the differences in means (DM), with a con 95% confidence interval, using RevMan5.0.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 1114 articles were identified, and 13 were included. The meta-analysis indicated a statistically significant reduction in the coronal, apical and angular deviations, favoring guided surgery. Coronal deviation: DM = -0,35 mm (IC 95%: -0,55 a -0,16; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,0005). Apical deviation: DM = -0,78 mm (IC 95%: -1,06 a -0,51; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0,00001). Angular deviation: DM = -3,0\u0026ordm; (IC 95%: -4,36\u0026ordm; a -1,65\u0026ordm;; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0,0001). The analysis showed high heterogeneity (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e \u0026gt;80%), although the results were consistent and statistically significant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eGuided surgery in any modalities (static, dynamic, or mixed) is superior to non-guided surgery in terms of results and three-dimensional precision of the position of single dental implants, in adults with edentulism.\u003c/p\u003e","manuscriptTitle":"Accuracy of guided vs non-guided surgery in three-dimensional positioning of single implants: a rapid systematic review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 09:39:04","doi":"10.21203/rs.3.rs-9245128/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2df57a03-2e2c-4307-bbfe-a4e8bdab3a05","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T10:26:43+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 09:39:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9245128","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9245128","identity":"rs-9245128","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}