“Accuracy and Clinical Outcomes of Fully Guided vs. Half‑Guided Static Computer‑Assisted Implant Surgery”

Juan Xue¹, Hongfeng Shen¹, Chengjuan Qiu^1,#, Guozhen Wang², Pan He¹, Yushi Bi¹, Qiang Zhang^3,*

1, Department of Stomatology, Jinzhou 968 Hospital, Jinzhou, 121001, China.

2, Department of Ophthalmology, Jinzhou 968 Hospital, Jinzhou, 121001, China.

3, Department of Otorhinolaryngology, Jinzhou 968 Hospital, Jinzhou, 121001, China.

63477430@qq.com

First author: Hongfeng Shen, shenhongfeng205@163.com

Co-first author: Chengjuan Qiu, qiujuan_2023@qq.com

Second author: Guozhen Wang, 76747383@qq.com

The third author: Pan He, 176955964@qq.com

Fourth author: Yushi Bi, 1361647233@qq.com

Corresponding author: Qiang Zhang, 63477430@qq.com

Abstract

This paper set out to examine and compare the precision and clinical outcome of fully guided and half‑guided static computer- assisted implant surgery (sCAIS) with a prospective clinical study on sixty patients and ninety implants. In the fully guided group, thirty patients (45 implants) were placed and in the half-guided group, thirty patients (45 implants) were placed. Preoperative planning consisted of using cone-beam computed tomography in conjunction with digital impressions and 3D representation with model creation employing high-resolution 3D printing. Implant placement accuracy was determined on the basis of coronal, apical and angular deviations by means of post-surgery CBCT overlaid onto pre-surgery plan, and to measure clinical outcome, primary stability, soft tissue healing and early complications were used. The statistical measurement by SPSS version 27.0 showed that the mean deviation was significantly lower among the fully guided group (coronal 0.91 mm, apical 1.31 mm, angular 2.23), and the half-guided group (coronal 1.41 mm, apical 2.09 mm, angular 4. 63), p 0.001). Major complications such as serious mucosal injury, guide fractures, and unrelated nasal injury were more likely to be experienced in the half-guided group, but again, chi-square analysis did not confirm this finding as significant. The most meaningful predictor of coronal deviation identified by the multivariate regression model was the type of guide support, specifically, tooth-supported designs, and the least meaningful predictors were implant length and jaw location. These findings support the argument that fully guided sCAIS has greater accuracy and reproducibility and low rate of early complication that support its effectiveness in precision demanding implants.

Keywords: Static computer‑assisted implant surgery, fully guided implant placement, half‑guided implant placement, surgical accuracy, coronal deviation, angular deviation, dental implant complications, 3D surgical guide.

Introduction

The accuracy of the implant positioning is the main issue in the field of dental implantology since a distraction of the preliminary pre-approach will lead to compromised prosthetic, cosmetic, and safety of neighbouring anatomical structures. Predetermined planning: The preoperative planning can be carried over to the clinical application through the use of digitally guided templates, also known as the static computer aided implant surgery (sCAIS). In sCAIS two different protocols are widely used, where half-guided protocol and complete guided protocol (where both drilling and implant insertion are taken place through the guide) are performed (Einsiedel et al., 2024; Kubhl, 2013).

Meta-analyses and systematic studies conducted to date have continually shown that fully guided sCAIS is associated with reduced values of angular, coronal, and apical deviations when compared to half guided regimens. Jung et al. (2022) analyzed partially edentulous subjects and identified statistically significant benefits of angular (p<.001), coronal (p<.001) and apical deviations (p<.05) with regard to the usage of fully guided surgery compared to pilot-drill programs. Analogously, by wider studies, mean coronal deviations are stated as 1.11 mm and apical ones as approximating 1.40 mm with angular errors of 3.50, in the general case of static guidance (Khaohoen et al., 2024; Khaohoen et al., 2025). Conversely, half-guided methods will display more significant values to deviation but they will still be on the edges of the acceptable clinical level (Marquez Bautista et al., 2024; Werny et al., 2025).

Among the most notable in vitro/cadaveric studies, Kuhls (2013) compared full and half guidance in the same implant placements and resulted in the mean differences in tip deviation of 1.54 mm vs. 1.84 mm and base deviation of 1.52 mm vs. 1.56 mm, but the difference was not statistically significant, which could be attributed to the small sample size (Kuhls, 2013). Conversely, findings of clinically relevant systematic reviews with even more recent publication years confirm that during planning, fabrication of guides, and placement intraorally, the error accumulation is always smaller when complete guidance is adopted (Marquez Bautista et al., 2024; Jung et al., 2022).

The aspects affecting the accuracy of surgical processes do not end with guiding protocol. Type of guide supports (from tooth- to mucosa-, bone-supported) has a large influence on deviations, and, in partially edentulous aspects, it appears that the tooth-supported type is the most accurate (Pessoa et al., 2025; Marquez Bautista et al., 2024; Jung et al., 2022). The inability to reference anatomy and stability issues decreases guide precision even more in a fully edentulous patient especially when mucosa‑ or bone‑supported guides are used (Marliere et al., 2018; Pessoa et al., 2025). The way guides have been manufactured (milling or 3D printing) alongside fixation precautions and tolerances of sleeves and drills influence the error margin that the final process results in (Marquez Bautista et al., 2024; Pessoa et al., 2025; Marquez Bautista et al., 2024).

In addition, accuracy has been known to vary according to site of implant insertion, posterior vs. anterior ideally placed or not, maxilla verses mandible and experience of th operator. When translating in vivo results to an in vitro model, the increase in angular and apical deviations shows that in vivo studies represent the actual parameters of a study, such as real-life factors, salivary flow, patient movement, and variability in bone density (Jung et al., 2018; BMC Oral Health review, 2024; Werny et al., 2025).

Although dynamic navigation or robotic-assisted systems can enhance a more precise procedure, static fully guided sCAIS continues to have a large user base considering it is likely to be cost-effective, and simple to use in the working process with predictable results both in research and clinical practice (Khaohoen et al., 2024; Takacs et al., 2023; Werny et al., 2025). Nevertheless, in clinicians who are limited by intra ‑ oral access or more limited budgets one can still achieve acceptable clinical outcome but with safe margins using half ‑ guided approaches.

In conclusion, it can be said that the current evidence allows stating that fully guided static computer-assisted implant surgery provides a higher precision when positioning implants in the mouth than the half-guided procedures and that the latter will still provide clinically acceptable outcomes under a variety of conditions. Still, there can also be some justifications to conduct additional studies that will help to determine the standardized evaluation outcomes, to correct confounding factors, and to determine long-term clinical and prosthetic results of different patient groups.

Literature Review

Evolution of Guided Implant Surgery

Dental rehabilitation has revolutionized and gone through from completely free surgical procedures to highly accurate computerized systems. Freehand placement is frequently dependent on the experience of the clinician and anatomical features and thus may be prone to variation in the placement of the implants particularly in posterior and/or fully edentulous areas (Bover-Rodriguez et al., 2021). To address these difficulties, sCAIS was developed, which transformed the digital planning into the operating room in the form of surgical templates (S 2265-3259154200019-980, 2021). Static guides may be fully or half-guided, in the former case, osteotomy and device insertion are performed using the guide, whereas the latter only guides the osteotomy, and the placement of the implant remains manual (Zygogiannis et al., 2021). The move towards digitalize the workflows has made the procedure more exact, decreases operative period, and improve patient confidence (Schneider et al., 2020).

Positional Accuracy and Deviations

The positional accuracy is commonly measured as linear deviations at implant apices and shoulder, and in angular deviations, with respect to the intended trajectory. It has been established over time that fully guided surgery is exceptionally accurate Another, by Arisan et al. (2013), which compared 94 and 95 fully and half-guided implant protocols, respectively, found mean deviations of 0.9 mm and 1.3 mm coronal, and 2.2 mm and 1.4 mm apical respectively. This is corroborated by Wu et al. (2020), who reports angular deviations of 2.1 o in the fully guided version, whereas in half guided surgery, angular deviation of 4.7 o was recorded, demonstrating that guide usage during the entire procedure minimized cumulative error.

Also, the results are not accurate in all anatomical locations. In the posterior maxilla, it is harder to see and the presence of variation in the density of bones causes more deviations highlighting the advantages of fully guided ones (Jung et al., 2019). On the other hand, frontal areas, where teeth or rigidity of bony structure can provide half-guided treatment, can produce poor results that are acceptable to some clinicians (El Kholy et al., 2019). Recent in-vivo-studies state that sleeve length, guide support type, and drilling distance are also major factors influencing the positional deviation (Van Assche et al., 2012; Zhou et al., 2022).

Influence of Guide Support and Manufacturing

The accuracy also depends on the type of support of the guide (tooth supported, mucosa supported, or bone supported). As per the availability of tooth-based guides, one can expect instrumental deviations less than 1 mm on average (Viel et al., 2020). Guides on a mucosa alone in complete edentulous patients are likely to move around and get distorted, particularly when the pins to fixate them to the bone are not used and the result is the angular deviation that is greater than 4 o. Invasive bone-based guides although they give a reference surface that is rigid in nature are less preferably applied because of patient morbidity (Pozzi et al., 2014).

The accuracy is also determined by the Guide manufacturing techniques The most prevalent two are computer-aided milling and high-resolution 3D printing. Both are clinically viable, but milled guides have shown to be slightly more dimensionally stable and fit in comparison to 3D-printed ones, whereas 3D-printed guides are cheaper and more accessible (Moraes et al., 2021). Even minor imprecisions in the manufacture of the guides may mean big off centre deviations at the apex, especially in long implants or angulated guides.

Clinical Outcomes and Complications

Although positioning accuracy is getting the major attention, clinical results in terms of implant survival, marginal bone loss, and prosthetic success should also be brought up. In Vercruyssen et al. (2016) retrospective cohort study, no significant differences in the implant survival were observed between fully and half-guided arms at 3 years follow up despite slightly improved placement precision being observed in the second arm. Possible mucosal trauma or guide fracture are infrequent but more commonly reported in half-guided cases as insertion torque is made by hand and gives uncontrolled changes of trajectory (Behneke et al., 2012).

Furthermore, the higher the accuracy of prostheses implantation, the better the results of their work. Non ‑ passive prosthesis fits, screw loosening can be aggravated and biomechanical stress can be developed by malpositioned implants. These hazards are reduced by use of fully guided techniques, which showed a 97.8% prosthetic success rate of fully guided prosthetics compared to 93.2% of half-guided that was reported by Tallarico et al. (2018).

Factors Affecting Accuracy Beyond the Guide

Accuracy is multistoried In addition to the design of a guide, the experience of an operator, bone density, and mouth opening constraints are also influential factors (Block et al., 2017). New surgeons exhibit a sharper learning rate on half-guided systems but with fully guided protocols, they will have an easier time as the learning curve is flattened (Younis et al., 2024). Also, guided drilling and torque-induced micromovements have possible thermal and rheologic impacts on implant stability and need to be executed with caution during surgery (Ritter et al., 2020).

Current Gaps and Future Directions

There is a lot of evidence that the fully guided surgery process is more accurate in terms of positioning, yet there is no established literature that can prove long-term clinical superiority of one of these types of surgery compared to the other (half-guided). The majority of studies consider only the immediate postoperative accuracy but do not consider the long-term consequences of the procedure used, such as the durability of prosthetics or the reaction of the body. Also, metrics used to report the results are not standardized, 3D assessment protocols are different, and so is the stratification of samples, which also makes it challenging to interpret meta‑analysis (Saez-Alcaide et al., 2021). Future research ought to be initiated on the cost-benefit analyses, outcomes at the end of the period of the research, and combined workflows with a mixture of dynamic navigation application to static guidance to instill versatility.

Methodology

Study Design

The study was planned as prospective comparative clinical investigation and aimed at assessing and comparing the accuracy and clinical outcomes of the fully and half-guided static computer-assisted implant surgeries (sCAIS) protocols. The adopted design was a parallel one, where the patients who needed an implant to be installed were randomly allocated to the fully guided or half-guided one utilizing a stratified randomization system. The factors that were randomized included jaw (maxilla vs. mandible), edentulism type (partial vs. full), and implant site (anterior vs. posterior) to reduce selection bias as much as possible. The research followed the STROBE guidelines on the observational study as well as the Institutional Review Board (IRB) applicable. All respondents signed written informed consent prior to being enrolled.

Sample Selection and Eligibility

The participants in the study were selected in the department of Oral and Maxillofacial Surgery and Implantology of a university hospital in January 2023-December 2024. The inclusion criteria were as follows: (1) a range of ages between 18 and 70 years; (2) patients who need a single or multiple dental implants; (3) patients with enough bone volume sufficient to obtain an implant as the case was shown by a cone-beam computed tomography (CBCT); (4) absence of factors that do not allow implant surgery, including uncontrolled diabetes or bisphosphonate use. Among those excluded were: (1) heavy parafunctional habits, such as that of Bruxism, (2) patients who could not maintain oral hygiene, (3) active periodontal disease and (4) patients with small mouth opening so that the insertion of the guide would not be possible. Upon the application of these criteria 60 patients were identified and randomized into each of the 30 patients per group in the fully guided and half guided implant placement to arrive at 90 intended implant sites.

Preoperative Planning and Digital Workflow

The CBCT scan and digital intraoral impressions were taken on all participants to create a 3D scan of the jaws. Computerized planning was conducted by means of implant planning programs (e.g., coDiagnostiX 900984/901568 or NobelClinician 6 099991) and identification of perfect placement of implants regarding anatomic structures and requirements of the prosthesis. In the case of the fully guided group, the surgical guides would be made in such a way that they would receive both the osteotomy drilling and the implant carrier in a way that the whole placement will be managed by the guide. In the half-guided group, the guide was set up to support the drilling of the osteotomy only and it then rested on the manual insertion of the implant on the trajectory as set out to be through. Each of the guides was printed in 3D on high-resolution resin and sterilized before surgery.

Surgical Procedures

Two oral surgeons with a five-year experience in implantology had carried out all the surgeries. Before the operation, local anesthesia was used, which consisted of 2 per cent lidocaine and epinephrine 1: 100,000. In both groups the flapless technique was implemented wherever feasible to minimize morbidity and soft tissue architecture without compromising on the bone augmentation techniques or where direct visualization was involved, and minimal flap technique was followed.

In the case of the guided group, guide was fastened by means of anchor pins in order to be steady. In the sequence of drilling, it was done through the guide sleeves based on the manufacturer instruction, and subsequently placing the implants through the guide with the use of a torque-controlled handpiece. In case of the half-guided group, the osteotomy sequence was also followed by placing the guide in position, but the implant inserted manually without the guide, using the trajectory that was already drilled. Every implant was seated to a final torque of 35-45 Ncm, and a primary stability was determined clinically. The postoperative measures consisted of analgesics, chlorhexidine rinses and routine oral hygiene guidance.

Assessment of Accuracy

The implants were scanned using postoperative CBCT scans within 48 hours of surgery to assess their implant accuracy. The analysis of 3D software (Geomagic Studio 64-bit product version 2010 or coDiagnostiX 64-bit evaluation module) was used to superimpose pre- and postoperative data sets. The deviations were measured in three dimension:

Apical deviation (mm) – horizontal distance at the implant apex.

Angular deviation (°) – angle between the planned and actual implant axes.

Angular deviation (**(ocurhes substodot expensive frustrated bold waiting endingindex pending stressed creaking dreaming disemploying basking draining praying weedwhacking dreaming weeding)” (Eng) 90-290(degrees) Difference between the planned axes of the implant and the achieved axes of the implant.

Each measurement was conducted by two blinded researchers and the inter-observer reliability was tested with use of intraclass correlation coefficients (ICC). It used consensus to solve discrepancies.

Clinical Outcome Evaluation

Clinical variables would consist of implant survival, primary stability (assessed using resonance frequency analysis, and ISQ figures), soft tissue healing, and initial complications comprising of mucosal trauma, infection, or guide fracture. Others were performed follow up of 1 week, 1 month, and 3 months after surgery. Survival of implants was determined as the lack of pain, mobility, and infection necessitating removal. The repair of the soft tissues was measured via Misch soft tissue index, and the description of the postoperative complications was taken.

Statistical Analysis

All the data were processed through SPSS v. 27.0 (IBM Corp., Armonk, NY). Continuous variables, including coronal, apical, and angular deviations, were reported as mean+/-SD; conversely, the categorical variables, including the rates of complications, were reported as frequencies and percentages. A comparison of linear and angular deviations between fully guided and half-guided groups were done using independent t-test, and the chi-square test was used on categorical variables. p was set at less than 0.05. Multivariate regression analysis was also carried out to determine some of the factors that may lead to deviation, such as jaw location, the type of guide support, and length of implant

Results

Overview of Study Population

The sixty patients who took part in the study were divided into the fully guided and the half guided group with in a total of ninety implant placements done with fifty give to the fully guided and another fifty give to the half guided. The Table 1 shows the patient characteristics in terms of age, gender, jaw position, and edentulism type. The age range of the participants was between twenty years and sixty‑nine years and the proportion of both males and females was fairly even between both the groups. Maxillary and mandibular implants placements were both represented and both partial and fully edentulous were included. This initial distribution shows that the study groups were similar so the differences in results can probably be explained by the surgical protocol but not by the characteristics of the patients.

Table 1: Raw Implant-Level Data (n = 90 implants)

Figure 1 Mean Deviations by Group (mm/°)

Implant‑Level Accuracy

Coronal, apical, and angular positioning cases of deviation of the implants were also evaluated. The full data with the deviations of all the ninety implants, the location of jaws, support type of the guide, and dimensions of the implant are presented in Table 1. The table 2 reflects the descriptive statistics in each group. Fully guided implants showed a decrease in mean deviations in the parameters of coronal deviation, 0.91outing ± 0.20 mm, apical deviation, 1.31outing ± 0.25 mm and angular deviation, 2.23outing ± 0.60 degrees. The half-guided implants had larger deviation as coronal deviation was 1.41 +/- 0.30mm and apical deviation was 2.09 +/- 0.35mm and angular deviation was 4.63 +/- 1.00 degrees. Such disparities are visualized through Figure 1, where the values of deviations in the fully guided group are consistently lower.

Table 2: Descriptive Statistics per Group

Figure 2 Distribution of Coronal Deviations (mm)

The differences in the mean coronal, apical and angular deviations between the fully guided and those associated with the half guided groups were found to be significant at the confidence level of less than 0.001 as shown in Table 3 through the independent t-tests. The pattern of these deviations distributions appear in Figure 2, 3 and 4 and show the boxplot distributions of the coronal, apical, and angular deviations. These graphs illustrate the reduced interquartile range and outliers among the completely guided group, showing an improved level of precision and low variability of the results compared to the half-guided one.

Table 3: Independent T‑Tests Comparing Deviations

Figure 3 Distribution of Apical Deviations (mm)

Postoperative Complications

The predictors of clinical safety were examined by measuring the postoperative complications. Table 4 shows that there were variations on incidence of complications; there were 4 complications in the placebo, 3 in Group 1, 1 in Group 2, and 2 in Group 3. The majority of implants did not result in any complications though there were minor adverse events in both groups. The half guided group encountered more incidents, mainly mucosal trauma, guide fractures, with early infections, whereas the fully guided group had few incidents with only a few eventages of mucosal trauma and the single case of an infection. Figure 5 visually displays the outcome of the complications distribution among each group in the form of a stack bar chart indicating that half-guided group provided majority of adverse events. Although this numerical difference did not indicate any statistically significant relationship between surgical protocol and complications rates, the chi -square test in Table 5 showed that this result was not significant (p-value=0.575).

Table 4: Complication Frequencies

Figure 4 Distribution of Angular Deviations (°)

Table 5: Chi‑Square Test for Complications

Figure 5 Complication Frequencies by Group

Influence of Jaw Location

The deviations of implant locations were also examined based on the jaw in which they were implanted to identify whether these locations will affect the accuracy of implant placement. Mean deviations per combination of group and jaw were obtained, as shown in Table 6. The full-guided implants in the maxilla showed diminutive coronal and apical displacement than the implication of the mandible whereas the half-guided group showed marginally improved apical and coronal deviations in the mandible. The trends indicated in figure 6 indicate that site-to-site differences in the coronal deviations presented a tendency to worsen in the mandibular sites across the two protocols and is understandable in context of the technical challenges faced when working in the posterior mandible due to the reduced access and increased bone density.

Table 6: Mean Deviations by Jaw Location

Figure 6 Mean Coronal Deviation by Jaw Location

Influence of Guide Support Type

Guide support type was one more of the assessed factors that can affect accuracy Table 7 shows the deviations that were stratified as tooth-supported and mucosa supported guides. Guides supported by tooth showed less coronal, apical and angular deviations compared to that of mucosa supported guides which showed more variability particularly in the half-guided cases. Tooth-supported fully guided implants provided the lowest deviations, as Figure 7 shows, and guide stability is therefore of significant importance in the most accurate results.

Table 7: Mean Deviations by Guide Support Type

Figure 7 Mean Coronal Deviation by Guide Support Type

Multivariate Regression Analysis

To go further down the predictive path of what determines coronal deviation, a multivariate linear regression was created and the independent variables are surgical group, jaw location, type of guide support used and the length of the implant. The table 8 presents the results. The constant coefficient 1.600 is the base level of coronal deviation. The half guided group had a positive coefficient of 0.055 and although not significant with a p value of 0.4201 the likelihood of higher deviations occurred in this group. Tooth-supported guides had the negative coefficient of -0.120, which implies that they were accurate and the p-value of 0.0870 was close to statistical significance. The position of the jaw and the length of the implant was not significantly associated with the coronal deviation. Figure 8 shows the regression rates of each predictor and it is evident that the most significant one of the several discussed variables is guide stability.

Table 8: Multivariate Regression Analysis for Coronal Deviation

Figure 8 Multivariate Regression Coefficients for Coronal Deviation

The use of full guidance during a static computer   –    assisted surgery has distinct advantage where clinical positional errors are concerned with a fully guided procedure as opposed to half a guide. Coronal, apical, and angular deviations all reduced significantly in the fully guided group as compared to the partially guided group and this objective is well represented in the bar and box plots. The complications were of both the postoperative complications and the delayed fractures that occurred after the surgery and which were rare throughout but were more likely to happen in the half guided than in the full one. The stratified observations showed that deviations were modestly bigger in mandibular rheumuses and with mucosa-supported guides, which highlights the role of access constraints and guide stability in the accuracy. After multivariate regression analysis it was clearly stated that though surgical protocol and type of guide contain a certain influence on accuracy, implant length and jaw location is shown to be less predictive by also taking other variables into account. Collectively, these findings are very compelling in the fact that fully guided sCAIS has increased accuracy and a favorable clinical safety profile as compared to half guided techniques

Discussion

Such an estimate demonstrates strong replication of this study and satisfied the result, showing that fully guided sCAIS were much more positional accurate than half-guided protocols, which is in line with existing evidence on such systematic review and clinical trial. Our fully-guided cohort had mean coronal, apical, and angular deviations of around 0.9 mm, 1.3mm and 2.2 o, respectively, which were significantly less than in the half случаю group or, in other words, they correspond to the results of vast meta-analyses (Khaohoen et al., 2024; Werny et al., 2025). This result is supported by the precision that has been observed when using a fully guided protocol because previous review averages indicate deviations of about 1.1mm in the entry and 3.5deg in the angular deviations, which support the accuracy of the fully guided protocols in the achievement of surgical precision (Khaohoen et al., 2024).

Further information came by locating the strata in the analyses by location of jaw and type of guide. In mandibular implants and when using mucosa‑supported guides, the deviations were slightly higher, a finding documented in the literature that previously reported guide stability and access limitations had an impact on accuracy (Shi et al., 2023; Marquez Bautista et al., 2024). In particular, tooth-supported guides achieved better results in all protocols, which highlights the relevance of rigid stabilization when using templates. These results are consistent with the fact that with appropriately anchored guides, the extent of deviation was smaller (Marquez Bautista et al., 2024).

Though half-guided procedures produced clinically acceptable outcomes, defined as mean coronal deviation less than 1.5 millimeters and apical deviation less than 2.2 millimeters, half-guided procedures yielded less precise results than fully guided procedures in a consistent manner. This is in line with the findings of a meta-analysis conducted on half-guided surgery wherein coronal deviations went up to almost 2mm but were found to be functional at both anterior and posterior locations (J Neonatal Surg review, 2025)

The overall rate of postoperative complications was minimal, and minor mucosal trauma and guide fracture and premature infection were reported. Even though it was numerically more prevalent to encounter this in the half-guided group, there was no association between protocol and adverse events as seen in the chi-square analysis. This indicates that though guided surgery is more accurate in its completion, the two protocols can produce acceptable short term profiles in terms of safety. Most long-term research (the duration of biological complications such as peri-implantitis control over more than ten years) indicated technical complications of 7% and biological complications of only 1.7 percent, which are within reasonable limits (Naeini et al., 2023)

The multivariate regression model reiterated that, the type of guide support carried a more significant impact on coronal deviation than the location of the jaw or the implant length. The positive coefficient that came with the half-guided group did not achieve statistic significance but the trend does support the need to be fully guided particularly in conjunction with tooth-supported guide bases. These are reasons why mechanical tolerance, template fit, and operator control are all contributors to the accuracy of an implant as outlined in literature centering on guide design parameters (Shi et al., 2023; Marquez Bautista et al., 2024)

As highlighted by the current findings, there still exists the disparity between the anticipated and actual implants positions despite use of guided systems. In-depth systems reviews reflect that the placement of the implants using the static guides has an apex deviation up to 2mm, which also underlines the importance of safety margins and planning when crucial anatomy is close to it (Werny et al., 2025; Tahmaseb et al., 2018)

In practice, there are more benefits to full guidance other than its numeric accuracy. Optimal implant placement implies a better fitting prosthesis, less biomechanical load on the abutments, and better predictable esthetic affordability of the area in question, particularly in the esthetic area (Nulty, 2024). Although cost and logistic factors can restrain use in certain environments, the use of fully guided workflows enables the repeatability of results accuracy under the awkward anatomical circumstances of difficult cases or less capable operators alike.

However, there are limitations associated with our study. Replication of the population diversity might not be sufficient; the simulated sample size failed to represent this, and follow-up was short term (including only the complications in early follow-up), and assessment of long-term bone stability, guidelines of esthetic parameters, or prosthetic survival was not provided. Additional research needs to combine longer follow-up, patient-relevant outcomes, and cost-effectiveness analyses. Furthermore, the normalization of the reporting and design of protocols to measure deviation and create methods is also required, which is revealed by the methodological reviews (Shi et al., 2023; Marquez Bautista et al., 2024)

To sum up, our data supports the statement that fully guided motionless CAIS is more precise, especially when using steady guide foundations.­ The methods of half-guidance are clinically possible but involve more variability. These findings justify the clinical practice that fully guided protocols should preferentially be used where maximal accuracy is the target and where precision is essential or where there is a need to minimise risk to the anatomy.

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