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Methodology for evaluating implant placement accuracy in computer-assisted implant surgery: Results from a systematic
Purpose:
To evaluate and compare the accuracy of implant placement measured by using CBCT or intraoral scanning in computer-assisted implant surgery in terms of angular, coronal, apical and depth deviations between planned and actual implant position.
Methods:
A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews database (CRD420250648755). The population, intervention, comparison, outcomes and study design and study type question addressed the accuracy of implant placement surface scanning versus CBCT in in vitro and in vivo studies on computer-assisted implant surgery. The literature was searched using the PubMed, Scopus and Web of Science databases up to 2025. Studies reporting quantitative data on angular, coronal, apical and signed depth deviations were included. Risk of bias was assessed using the Quality Assessment Tool for In Vitro Studies, Risk of Bias In Non-randomised Studies of Interventions tool and Cochrane Risk of Bias Tool. Meta-analyses were conducted using standardised mean differences, heterogeneity was assessed with I2 and forest plots were generated.
Results:
Eight studies were included. The meta-analysis showed no statistically significant differences in angular deviation (standardised mean difference 0.76 degrees, P = 0.2315) or apical deviation (standardised mean difference 0 mm, P = 0.9820) between CBCT and intraoral scanning. Intraoral scanning demonstrated lower coronal deviation (standardised mean difference -0.21 mm, P = 0.0435) and a trend towards reduced depth deviation (standardised mean difference -0.40 mm, P = 0.0620). Intraoral scanning also exhibited lower variability across studies. Risk of bias was low in in vitro studies and moderate to high in most in vivo studies.
Conclusion:
Most existing studies rely on pre- and postoperative CBCT imaging, whereas intraoral scanning-based methods remain underexplored. Preliminary evidence suggests that intraoral scanning-based analyses may offer higher accuracy than CBCT, although the differences are not statistically significant. When deciding between intraoral scanning and CBCT, clinicians should consider clinical practicality, including equipment availability and radiation exposure.
