Guided versus freehand single implant placement: A 3-year parallel randomized clinical trial

Area of Science:

• Dental Implantology
• Oral Surgery
• Biomaterials Science

Background:

• Peri-implant marginal bone loss is a key factor in long-term dental implant success.
• Surgical technique and operator experience may influence peri-implant bone stability.
• Sub-crestal implant placement requires precise control to maintain bone levels.

Purpose of the Study:

• To compare marginal bone level stability around sub-crestally placed implants using guided surgery (GS) versus freehand (FH) techniques.
• To evaluate the impact of operator experience (non-expert vs. skilled) on peri-implant bone stability.
• To assess the influence of soft tissue height on marginal bone levels.

Main Methods:

• A parallel randomized clinical trial involving 60 platform-switched implants in 18 patients.
• Implants were placed using either digitally static guided surgery (GS) by a non-expert or freehand (FH) by a skilled operator.
• Marginal bone level (MBL) was measured radiographically at prosthesis installation and at 1, 2, and 3 years post-surgery.

Main Results:

• No statistically significant difference in MBL change was observed between the GS and FH groups (0.11 ± 0.22 mm, p = 0.61).
• Implants with less than 3 mm of supra-crestal soft tissue height showed a trend towards higher MBL at prosthetic loading, but this was not statistically significant (P = 0.065).
• The study demonstrated comparable marginal bone remodeling between the two surgical approaches over a 3-year follow-up.

Conclusions:

• Digitally static guided implant placement by a non-expert operator yields comparable marginal bone stability to freehand placement by an experienced operator.
• Digital planning and guided surgery can empower less experienced clinicians to achieve successful dental implant outcomes.
• Sub-crestal implant placement with careful planning may lead to stable peri-implant bone levels over time.