Accuracy of digital surgical guides for dental implant placement: A systematic review, meta-analysis and region-specific analysis of the anterior maxilla.

PURPOSE: This systematic review and meta-analysis evaluated the accuracy of dental implant placement using digital surgical guides in the anterior maxilla. The anterior maxilla was assessed as a region-specific subgroup due to its unique anatomical constraints, high aesthetic demands and increased sensitivity to positional deviations compared to other arch regions. MATERIALS AND METHODS: A comprehensive literature search was conducted across the PubMed, Google Scholar, and EBSCOhost databases. The search followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and included studies reporting the accuracy of digital surgical guides used for implant placement in the anterior maxilla. Six studies met the inclusion criteria for qualitative synthesis, of which five were eligible for quantitative meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute checklists tool for clinical studies and the Quality Assessment Tool for In Vitro Studies for in vitro designs. Meta-analysis was performed using a random-effects model and certainty of evidence was further evaluated using the Grading of Recommendations Assessment, Development and Evaluation analysis. RESULTS: All included studies reported deviation metrics between the virtually planned and postoperative implant positions. The pooled meta-analysis demonstrated mean apical deviation of 0.89 mm (P 0.00001), depth deviation of 0.43 mm (P 0.00001) and angular deviation of 2.47° (P 0.00001). Substantial heterogeneity (I2 > 90%) was observed among the included studies; therefore, a random-effects model was used. According to the the Grading of Recommendations Assessment, Development and Evaluation assessment, the certainty of evidence was moderate for apical deviation but low for depth and angular deviation. CONCLUSION: Digital surgical guides demonstrated implant placement deviations within commonly reported clinical thresholds in the anterior maxilla, suggesting acceptable accuracy in appropriately selected clinical scenarios. However, due to substantial heterogeneity among studies and low-to-moderate certainty of evidence, these findings should be interpreted with caution. CONFLICT-OF-INTEREST STATEMENT: The authors declare that there are no conflicts of interest relating to this study.