in vitro comparison of surgical guide technologies on osteotomy precision in anterior maxillary implant sites

Accurate implant osteotomy positioning in the anterior maxilla remains a clinical challenge because the precision of different surgical guide fabrication methods has not been fully established. Therefore, it is of interest to compare the accuracy of osteotomy preparation using conventional vacuum-formed, desktop 3D-printed and industrially milled surgical guides in standardized anterior maxillary resin models. Thirty identical maxillary resin models with simulated central incisor edentulous sites were allocated into three groups (n=10 each) and osteotomy deviations from a single virtual implant plan were assessed using post-operative CBCT superimposition software for coronal, apical, angular and depth discrepancies. Industrially milled guides showed the lowest mean deviation at both the coronal (0.38 ± 0.14 mm) and apical (0.52 ± 0.18 mm) levels, followed by 3D-printed guides (0.54 ± 0.19 mm and 0.78 ± 0.22 mm), whereas conventional guides showed the greatest deviation. Digitally fabricated guides, particularly industrially milled guides, provided significantly greater osteotomy accuracy than conventional vacuum-formed guides in anterior maxillary implant placement.