Accuracy in dental implant placement: A systematic review and meta-analysis comparing computer-assisted (static, dynamic, robotics) and noncomputer-assisted (freehand, conventional guide) approaches

Statement of problem: Computer-assisted implant placement has been reported to provide better accuracy, particularly in complex situations, while noncomputer-assisted approaches remain effective for more straightforward procedures. However, comprehensive evidence comparing these approaches across various clinical scenarios is limited. Evaluating factors such as cost-effectiveness, edentulous span, and clinician expertise is essential for optimizing treatment planning. Purpose: The purpose of this systematic review and meta-analysis was to compare the accuracy of dental implant placement between computer-assisted and noncomputer-assisted workflows. Material and methods: A systematic search of the PubMed, Embase, and Scopus databases (up to August 2024) was conducted using keywords related to surgery, computer-assisted techniques, and dental implants. The primary outcomes were angular, 3-dimensional (3D)-coronal, and 3D-apical deviations. Studies were selected based on predefined inclusion and exclusion criteria, and quantitative meta-analysis was performed. Results: Forty-five studies met the inclusion criteria. In clinical studies, meta-analysis showed a mean difference (MD) of 0.65 mm (95% CI: 0.56 to 0.74; P<.001) for global coronal deviation, 1.10 mm (95% CI: 0.95 to 1.20; P<.001) for global apical deviation, and 3.87 degree (95% CI: 3.31 to 4.44; P<.001) for angular deviation, favoring the computer-assisted implant workflow, based on 22 studies. In in vitro studies, the MD was 0.45 (95% CI: 0.36 to 0.54; P<.001) for global coronal deviation, 0.63 mm (95% CI: 0.50 to 0.76; P<.001) for global apical deviation, and 3.60 degree (95% CI: 2.66 to 4.54; P<.001) for angular deviation, favoring the computer-assisted implant workflow, with data from 23 studies. Among the navigation systems, robotic-assisted implant surgery (r-CAIS) achieved the highest clinical accuracy across all metrics compared with noncomputer-assisted techniques. Conclusions: Overall, computer-assisted implant workflows significantly improved the accuracy of implant placement, with r-CAIS demonstrating the highest accuracy in clinical scenarios. However, factors such as cost-effectiveness, edentulous span, and clinician expertise must be considered, as conventional methods remain suitable alternatives in certain straightforward situations. These findings highlight the importance of tailored treatment planning to optimize the outcomes of implant-supported prostheses.