Static computer-aided, partially guided, and free-handed implant placement: A systematic review and meta-analysis of randomized controlled trials

Objective: To analyze the outcomes of static computer-aided implant placement (sCAIP) compared to partially guided (PGIP) and free-handed (FHIP) implant placement. Material and Methods: This study was registered in PROSPERO (CRD42019131397). A comprehensive literature search was performed by two independent examiners. Only randomized controlled trials (RCTs) were selected. Treatment modalities included sCAIP, PGIP, and FHIP. Data pertaining to the outcomes of interest were extracted. Random-effects meta-analyses were feasible for a subset of outcomes. Results: From an initial list of 2,870 records, fourteen articles for a total of ten RCTs were selected. Data from 7 of these studies allowed for the conduction of three meta-analyses comparing accuracy of implant placement across modalities. Survival rate up to 12 months post-loading was high (>98%) and comparable between treatments (low-quality evidence). No tangible differences in terms of patient perception of intra- or postoperative discomfort were observed (low-quality evidence). Quantitative analyses revealed significantly lower angular (MD = 4.41°, 95% CI 3.99–4.83, p <.00001), coronal (MD = 0.65 mm, 95% CI 0.50–0.79, p <.00001), and apical (MD = 1.13 mm, 95% CI 0.92–1.34, p <.00001) deviation values for sCAIP as compared to FHIP (8 studies, 383 patients, 878 implants, high-quality evidence). A similar discrepancy, in favor of sCAIP, was observed for angular deviation only as compared to PGIP (MD = 2.11°, 95% CI 1.06–3.16, p <.00001). Conclusions: sCAIP is associated with superior accuracy compared to PGIP and FHIP.