Comparison Between Computer-Assisted and Free-Hand Dental Implant Placement: A Systematic Review and Meta-analysis.

Purpose: This systematic review and meta-analysis aimed to compare computer-assisted implant surgery (CAIS) and free-hand implant placement (FHIP) in terms of clinical and radiographic outcomes.

Methods: A comprehensive search of five databases, hand-searching, and cross-referencing identified randomized controlled trials (RCTs) comparing CAIS and FHIP published up to November 2024. Outcomes included marginal bone loss (MBL), implant survival rate, patient satisfaction, pink esthetic scores, probing depth, and complications. The Cochrane risk-of-bias tool and GRADE approach were used to assess study quality and evidence certainty. Meta-analysis and sensitivity/subgroup analyses were conducted.

Results: Twelve publications from 9 RCTs (395 participants, 1,242 implants) were included. Although overall differences in MBL and implant survival were not statistically significant, subgroup analyses revealed several significant findings. CAIS demonstrated significantly reduced MBL in fresh socket placements (P=0.04), higher patient satisfaction (P=0.03), and improved pink esthetic scores (P=0.009). FHIP was associated with fewer biological complications (P=0.04) and lower MBL when compared to tissue-supported CAIS (P=0.03). Sensitivity analyses confirmed robustness for most outcomes, though evidence quality ranged from very low to moderate, and six studies showed high risk of bias.

Conclusion: Considering the limitations related to the quality of the included studies, both CAIS and FHIP achieved high survival rates (>98%). CAIS showed advantages in fresh socket cases and esthetic/patient-reported outcomes, while FHIP had fewer biological complications and better outcomes when using an open flap approach.