Title The Difference in Survival of Dental Implants Placed via Guided Surgery is Not Statistically Significant Compared to Free-Handed Placement
Clinical Question In healthy patients having dental implants placed, is survival greater for guided placement at 1 year postsurgery, as compared to free-handed placement?
Clinical Bottom Line The survival of guided dental implants shows no definitive statistical significance at 1 year postsurgery as compared to free-handed implant placement.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24290308Voulgarakis/20141,267 partially or fully edentulous patients in 23 included studiesSystematic review of non-randomized trials
Key resultsThe systematic review did not generate desired statistical analysis of the data or definitively confirm whether fully guided or free-handed implant placement showed greater survival at one year post treatment due to the heterogeneity of factors and variables in each of the 23 studies. The included studies reported high survival rates for implant placement using flapless techniques overall. There was no significant variation in the survival rates according to the type of 3D navigation.
25237668Pozzi/201451 partially or fully edentulous patients requiring at least 2 implants to be restored with a single prosthesisRandomized Controlled Trial
Key resultsThe patients with 3D computer-planned and guided implant placement showed no statistically significant difference in implant survival versus patients with free-hand implant placement. Only one implant failed, which was part of the conventional free-hand implant placement group (P = 1.0). Patients were observed up to 1 year after implant placement.
Evidence Search (implants[All Fields] AND free-hand[All Fields]) AND guided[All Fields]
Comments on
The Evidence
Validity: The first article is a systematic review, but all of the included studies were either prospective or retrospective studies with the exception of one randomized control trial. There were a total of 1,267 patients in the 23 included studies. The second article is a randomized control trial. 51 patients were randomized into the two implant placement options and were followed up 1 year posttreatment. Perspective: Although the first article is a systematic review, it reviewed mostly prospective and retrospective studies, and the studies were hard to compare to one another in order to generate definitive results. Like the second randomized control trial, additional studies should evaluate the two methods of implant placement and their survival in a single study. By reproducing the randomized control trial, more data could be generated for a meta-analysis, which would provide a more definitive answer to whether or not there is a significant difference in the survival of dental implants placed guided compared to free-handed.
Applicability Partially and fully edentulous patients may have guided or free-handed implant placement performed. The randomized control trial patients required at least two implants that were to be restored with a single prosthesis. These patients had a minimum of 7 mm of bone height and 4 mm of bone width. Ultimately, the final decision in implant placement technique should be decided by the patient, their restorative dentist, and the practitioner placing the implant. However, compared to free-handed implant placement, guided placement is more expensive and requires more effort and time for software use.
Specialty (General Dentistry) (Oral Surgery) (Periodontics)
Keywords dental implants, guided surgery, free-hand placement
ID# 2831
Date of submission 03/27/2015
E-mail Lynott@livemail.uthscsa.edu
Author Monica Lynott
Co-author(s) e-mail
Faculty mentor E. Matthew Lamb, DDS
Faculty mentor e-mail LambEM@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available