J Prosthet Dent. 2025 Nov 7:S0022-3913(25)00851-0. doi: 10.1016/j.prosdent.2025.10.039. Online ahead of print.
ABSTRACT
STATEMENT OF PROBLEM: The accuracy of dental implant placement influences prosthetic outcomes, biological complications, and long-term success. While guided surgery aims to improve precision, its advantages over conventional freehand techniques regarding survival, marginal bone stability, and complications remain unclear.
PURPOSE: The purpose of this umbrella review was to synthesize evidence from systematic reviews comparing clinical outcomes of guided versus freehand dental implant placement, focusing on accuracy, marginal bone loss, survival, and complications.
MATERIAL AND METHODS: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and PROSPERO registration, the PubMed, Scopus, Embase, Google scholar, and Cochrane Library databases were searched for studies published between January 2000 and July 2025. Eligible studies were systematic reviews and meta-analyses comparing guided (static or dynamic) and freehand implant placement. Methodological quality was assessed using a measurement tool to assess systematic reviews 2 (AMSTAR-2). Extracted data included implant placement accuracy, marginal bone loss, survival, and complications. Effect sizes and statistical outcomes were extracted directly from the included meta-analyses, and results were synthesized descriptively without conducting a new meta-analysis.
RESULTS: Thirteen systematic reviews were included. Guided and computer-assisted placement showed better accuracy than freehand methods (Standardized mean difference [SMD] for coronal deviation -0.97; 95% Confidence Interval [CI] -2.27 to -0.32; P<.01). Marginal bone loss and implant survival were comparable across techniques (Risk ratio [RR]1.02; 95% CI 0.98-1.06; P=.28), both remaining high. Complication rates were low, with guided techniques potentially reducing iatrogenic risk (RR 0.88; 95% CI 0.74-1.04; P=.11).
CONCLUSIONS: Guided implant surgery was found to improve placement accuracy and may reduce surgical risk in complex treatments. Freehand placement remained reliable with comparable long-term outcomes when performed by experienced clinicians. Selection should consider treatment complexity, clinician expertise, and available resources.
PMID:41206337 | DOI:10.1016/j.prosdent.2025.10.039
