Fully Guided Versus Half-Guided and Freehand Implant Placement: Systematic Review and Meta-analysis

Purpose: To compare the accuracy of different modalities of implant placement—static fully guided, static half-guided, and freehand surgery—through meta-analysis.
Materials and Methods: A thorough electronic and manual systematic search was conducted to identify applicable randomized clinical trials (RCTs) for evaluating the implant positioning accuracy between different static implant navigation surgeries. The coronal and apical horizontal deviation, vertical deviation, apical angle, and chair time were estimated as the weighted mean differences and standard deviation with confidence intervals. A P value of .05 was set for statistical significance.
Results: Based on the 10 RCTs that met the inclusion criteria for the quantitative analyses, results from the meta-analyses demonstrated the following: (1) a coronal deviation significant difference favoring the fully guided approach compared with the half-guided (weighted mean difference of –0.51 mm) and freehand approaches (weighted mean difference of –1.18 mm); (2) a significant weighted mean difference between the fully guided and half-guided approaches in relation to the apical deviation (weighted mean difference of –0.75 mm); (3) the vertical comparison did not yield significant weighted mean differences between the fully guided and half-guided techniques (–0.23 mm) and lacked statistically significant difference between the fully guided and freehand techniques (weighted mean difference of –0.17 mm); (4) the apical angle deviation demonstrated a significant weighted mean difference in favor of the fully guided approach compared with the half-guided group (weighted mean difference of –3.63 degrees); and (5) the comparison of chair time between the investigated groups did not exhibit a significant difference in any of the techniques.
Conclusion: Static fully guided implant navigation surgery has the highest accuracy for transmitting the presurgical positioning planning to the patient, followed by static half-guided surgery, while the freehand implant placement provides the least accuracy.