Advancing accuracy in guided implant placement: A comprehensive meta-analysis

This meta-analysis aimed to determine the accuracy of currently available computer-assisted implant surgery (CAIS) modalities under in vitro conditions and investigate whether these novel techniques can achieve clinically acceptable accuracy. In vitro studies comparing the postoperative implant position with the preoperative plan were included. Risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool) and a sensitivity analysis was conducted using funnel plots. A systematic search was performed on April 18, 2023, using the following three databases: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials. No filters or restrictions were applied during the search. A total of 5,894 studies were included following study selection. Robotic- and static CAIS (sCAIS) had the most accurate and clinically acceptable outcomes. sCAIS was further divided according to the guidance level. Among the sCAIS groups, fully guided implant placement had the greatest accuracy. Augmented reality-based CAIS (AR-based CAIS) had clinically acceptable results for all the outcomes except for apical global deviation. Dynamic CAIS (dCAIS) demonstrated clinically safe results, except for horizontal apical deviation. Freehand implant placement was associated with the greatest number of errors. Fully guided sCAIS demonstrated the most predictable outcomes, whereas freehand sCAIS demonstrated the lowest accuracy. AR-based and robotic CAIS may be promising alternatives. To our knowledge, this is the first meta-analysis to evaluate the accuracy of robotic CAIS and investigate the accuracy of various CAIS modalities.