Accuracy of freehand versus guided immediate implant placement: A randomized controlled trial

Purpose: This randomized controlled trial (RCT) aimed to compare the accuracy of immediate implant placement with freehand and static guided surgery. Methods: An RCT was conducted on 61 subjects who received a total of 80 dental implants. The enrolled patients were randomly allocated to two groups: freehand surgery (control group, n = 40 implants) and static guided surgery with R2Gate (R) (Megagen, Gyeongbuk, South Korea, test group, n = 40 implants). Crestal and apical deviations in both mesiodistal and buccolingual dimensions, as well as depth and angular deviations, were calculated by comparing the three-dimensional (3D) position of the implant in the planning software with the final implant position, revealed by an intraoral scan of the fixture after placement. The Mann-Whitney test was used for comparative assessment. Results: In the freehand group (control), crestal deviations of 1.13 +/- 0.89 mm and 1.00 +/- 0.76 mm were found in the mesiodistal and buccolingual directions, respectively, versus 0.34 +/- 0.26 mm (p<0.001) and 0.37 +/- 0.24 mm (p = 0.03) in the static guided surgery group (test). Apical deviation was also higher in the freehand group (control) than in the static guided surgery group (test) in the mesiodistal (4.04 +/- 1.90 mm vs. 0.97 +/- 0.55 mm, p = 0.04) and buccolingual directions (3.46 +/- 1.82 mm vs. 0.94 +/- 0.67 mm, p = 0.02). Freehand surgery had greater angular deviation (6.09. +/- 3.23) compared to guided surgery (0.83. +/- 0.53, p = 0.02). However, depth deviation was similar in the freehand surgery group (2.24 +/- 1.58 mm) and static guided surgery group (0.66 +/- 0.43, p = 0.09). Conclusions: Immediate implant placement with static guided surgery demonstrated better accuracy than free-hand surgery. Statement of clinical relevance: Guided implant surgery showed fewer deviations compared to freehand surgery in fresh extraction sockets; therefore, the use of static guides should be given preference over the freehand modality.