Guided vs. conventional surgery for anterior maxillary implants: does experience still matter? – An in vitro study

Objective: To evaluate the accuracy of immediate implant placement in the anterior maxilla, comparing guided and conventional surgical methods according to operator expertise. Material and Methods: Twenty operators participated: ten used guided techniques and ten used conventional approaches, all in the region of teeth 12 and 22. Cases were randomly assigned to four groups: experienced–guided (EG), experienced–conventional (EC), inexperienced–guided (IG), and inexperienced–conventional (IC), with ten implants in each group (40 implants total). Standardized training models were scanned with cone beam computed tomography (CBCT) for virtual planning and surgical guide fabrication using coDiagnostiX® software. After implant placement, new CBCT scans were obtained. Virtual planning and postoperative scans were superimposed to assess accuracy, measuring global (3D), angular, and linear deviations in mesiodistal (MD), buccolingual (BL), and apicocoronal (AC) dimensions. Results: Among experienced operators, guided surgery showed significantly lower angular and linear deviations at the platform and apex in 3D, MD, and BL measurements. In inexperienced operators, similar advantages were observed for guided surgery in BL and in 3D and MD deviations at the apex. Overall, guided surgery consistently achieved greater accuracy, regardless of operator experience. Conclusion: Guided surgery demonstrated greater accuracy than conventional surgery for immediate implant placement in the anterior maxilla, regardless of operator experience, highlighting its potential to enhance surgical precision and clinical outcomes.