Accuracy of Freehand, Static, and Dynamic Computer-Assisted Implant Placement: A Systematic Review and Meta-Analysis

Although static navigation (sCAIS) has been shown to be a well-established technique in clinical practice, innovative methods such as dynamic navigation (dCAIS) are currently on the rise. The objective of this systematic review is to compare the accuracy of freehand (FH), sCAIS, and dCAIS.

Following PRISMA guidelines, a systematic review and meta-analysis with electronic and manual searches for comparative studies on transfer accuracy (TA) of freehand dental implant placement versus sCAIS versus dCAIS in pre-clinical and clinical studies was conducted. The main outcome was TA between planned and placed implant positions, measured via axial, global coronal, and global apical deviations reported as mean values with standard deviation.

A total of 37 of 4511 screened articles were included, reporting data on 3104 implants across 606 models and 801 patients. Clinical studies revealed no statistically significant differences in TA between dCAIS and sCAIS. The pooled mean deviations were as follows: axial deviation -0.09° [95% CI: -0.66 to 0.48; PI: -2.11; 1.93], global coronal deviation -0.03 mm [95% CI: -0.16 to 0.11; PI: -0.47; 0.42], and global apical deviation -0.24 mm [95% CI: -0.48 to 0.00; PI: -1.12; 0.64]. However, subgroup analysis including RCTs only demonstrated that both sCAIS and dCAIS achieved statistically significantly higher accuracy in all investigated deviation parameters compared to the freehand protocol.

Both static and dynamic computer-assisted implant placement techniques are considered reliable methods for enhancing accurate implant positioning, offering significantly greater accuracy compared to the conventional freehand approach. The presence of bias risks and notable heterogeneity in the included investigations warrants careful consideration of the results.