Guided vs. Non-Guided Implant Surgery: A CBCT In Vitro Comparison

Objectives The aim of the study is to compare the accuracy of dental implant placement using guided surgery versus freehand (non-guided) techniques in a laboratory (in vitro) setting. Methods Twelve upper jaw models simulating edentulous maxillae were used and divided into two groups. In Group A, implants were placed using 3D-printed surgical guides based on CBCT planning. Group B received implants placed freehand, using only clinical judgment. The same implant system and drilling steps were followed for both groups. After placement, CBCT scans were taken to measure angular deviation, and five clinicians visually assessed how closely the implants matched the planned positions. Results Implants placed with guided surgery showed higher accuracy, with a mean angular deviation of -0.41°, compared to -4.83° in the freehand group. The guided group also had less variation. Visual evaluations by five clinicians showed stronger agreement for the guided group (κ = 0.943) than for the freehand group (κ = 0.868). Conclusions Guided implant surgery proved more accurate and consistent than the freehand method, making it especially useful in complex or sensitive cases. While freehand placement may work in simpler situations, it carries more risk of error. These results support using guided techniques as a standard approach in implant practice.