Title Dental Implant Guided Surgery is More Accurate Than Freehand Surgery
Clinical Question Is dental implant guided surgery more accurate in implant placement than freehand surgery?
Clinical Bottom Line Dental implant guided surgery is more accurate than freehand surgery. This is supported by comparative laboratory studies and randomized clinical trials that show that implant guided surgery is statistically significantly superior to freehand surgery in regard to placement accuracy.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24460748Vercruyssen/201459 patientsRandomized Clinical Trial
Key results59 patients requiring four to six implants were randomly assigned to two groups: surgical guided implant placement and freehand placement. CT was used pre- and post-operatively for accuracy comparisons. A significantly lower mean deviation was observed for the guided implant placement at the apex, the entry point and angular deviation.
24721507Noharet/20146 human cadaversLaboratory study
Key results39 implants were placed in six human cadavers by the same surgeon with 6 years of experience. 20 were placed freehand, and 19 placed with surgical guides. Using CT scans, accuracy was determined as the difference in planned implant placement and post-operative placement. Using the Kolmogorov-Smirnov bootstrap statistical test, Noharet found that guided surgery had significantly better accuracy at the platform (P=0.002), at the apex (P=0.001), and for the implant angle (P<0.001).
19463664Park/2009 45 implants placed in manikinsLaboratory study
Key resultsUsing a bone substitute block placed in a manikin typodont, Park placed 45 implants using a surgical guide and placed 45 implants freehand. The accuracy of the two groups was measured by a coordinate measuring machine and were compared with a two-way ANOVA. The guide-placed samples had a significantly smaller angular discrepancy (P<0.001) and significantly smaller measured distances from the reference points at both implant level (P<0.001) and abutment level (P<0.001).
Evidence Search ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields] OR ("dental"[All Fields] AND "implant"[All Fields]) OR "dental implant"[All Fields]) AND placement[All Fields] AND freehand[All Fields] AND accuracy[All Fields] ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields]) AND guided[All Fields] AND accuracy[All Fields]
Comments on
The Evidence
The evidence presented in these articles unanimously support the claim that accuracy of dental implant guided surgery is significantly superior to that of implants placed without guides. When comparing the accuracy of surgically guided to freehand implant placement the greatest variable that cannot be accounted for is the skill of the operator. While this variable was accounted for in Noharet’s study, it might be a source bias if an exceptional or an inexperienced operator was used. These studies are based on accuracy of implant placement methods, which does not necessarily translate to the success or failure of implants.
Applicability Technology will continue to improve, allowing for greater research and treatment options. When a procedure is to be performed on a human subject, the provider will determine which procedure is best to use based on their experience and the results found in the literature. In the case that the provider is concerned about accuracy, research has shown that surgical guided implant placement is statistically superior to other methods.
Specialty (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Dental implant accuracy, guided implant placement, implant surgery, implant surg, all on four,
ID# 2947
Date of submission 10/20/2015
E-mail syamken@livemail.uthscsa.edu
Author Michael Syamken, DDS
Co-author(s) e-mail
Faculty mentor Jeffrey Paz, DDS
Faculty mentor e-mail paz@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