Abstract
AIM: This systematic review and network meta-analysis aimed to answer the PICO question: In patients undergoing immediate implant placement (IIP) [P], does Computer-Assisted Implant Surgery (CAIS) [I] lead to higher accuracy [O] compared to free-hand (FH) [C] implant placement? METHODS: A systematic search of MEDLINE, Scopus, and Cochrane databases was conducted for randomized clinical trials (RCTs) published between January 2014 and September 2024, comparing accuracy of CAIS and FH for IIP. Two reviewers screened the studies and extracted data for a network meta-analysis. RESULTS: Of 2064 records screened, 7 RCTs (338 implants and 291 patients) met the inclusion criteria. These RCTs evaluated FH and dynamic, full static, and partial static CAIS for single or partial implant placement. No RCTs analyzing robotic-assisted implant surgery (RAIS) were found. In 71.4% of the studies, IIP was performed in the anterior maxilla using a flapless approach. Accuracy was assessed by angular, cervical, and apical deviations between planned and real implant positions. All CAIS methods demonstrated significantly higher accuracy than FH (p < 0.05), but no significant differences were observed between CAIS approaches. CONCLUSIONS: CAIS significantly improves IIP accuracy, enhancing 3D implant positioning and prosthetic outcomes. All CAIS techniques revealed comparable accuracy, allowing clinicians to select the most suitable approach for each patient. TRIAL REGISTRATION: PROSPERO identification number: CRD42024554241.