Comparison of the accuracy/precision among guided (static), manual, and dynamic navigation in dental implant surgery: a systematic review and meta-analysis.

OBJECTIVE: To assess whether dynamic navigation (dCAIS) has greater accuracy/precision and less discrepancy in parallelism compared to guided (static, sCAIS) and free-hand (FH) surgery in Implantology. MATERIALS AND METHODS: A search was conducted across six databases using specific key terms. Randomized controlled trials (RCTs), retrospective or prospective clinical studies published within the last 10 years (2014-2024) were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. A meta-analysis using a random-effects model was employed. The heterogeneity analysis was conducted using Cochran's Q-test and Higgins' I2 statistic. RESULTS: Thirteen articles were included. A total of 554 patients and 687 implants were enrolled, with 215 using the FH system, 195 using sCAIS, and 277 using dCAIS. The meta-analysis compared the following: (1) dCAIS vs. sCAIS; (2) dCAIS vs. FH; (3) sCAIS vs. FH. The first group had a mean difference of -0.08 mm, with a substantial heterogeneity (I² = 52%) and no statistically significant difference (p = 0.08); the second presented a mean difference of -0.48 mm, high heterogeneity (I²=89%), and a statistically significant better accuracy for dCAIS than FH (p < 0.01); the last comparison found a mean difference of -0.62 mm, with a considerable heterogeneity (I²=84%), and sCAIS showing statistically significantly better accuracy than the FH approach (p < 0.01). CONCLUSIONS: Using CAIS (dCAIS or sCAIS) substantially improved accuracy compared to the FH approach, with no statistically significant difference between dCAIS and sCAIS. CLINICAL RELEVANCE: The findings support the use of CAIS for improved implant accuracy and precision compared to FH techniques.