What is guided implant surgery?
In guided implant surgery, the implant position is planned on a computer before the operation. A surgical guide (or surgical template) made for you then carries the plan into your mouth: it sits in place during surgery and directs where, at what angle and how deep the implant site is prepared.
A 2008 consensus report of the International Team for Implantology (ITI) distinguishes two computer-assisted approaches:
- Static (guided) surgery: a template reproduces the planned implant position and, according to the report, does not allow it to be changed during the operation.
- Dynamic (navigated) surgery: a navigation system follows the plan and allows the position to be adjusted during the operation.
This guide is about the static approach, which is what most people mean by “guided implants”.
How is a surgical guide planned?
A systematic review prepared for the 2018 ITI consensus conference (Tahmaseb et al., 2018) describes the digital workflow as 3D imaging, a surface scan of the mouth and planning software. For you, it usually looks like this:
- Examination: the gap, gums and neighbouring teeth are checked and the options are discussed.
- CBCT scan: according to Manchester University NHS Foundation Trust, cone-beam CT is an X-ray examination that produces 3D images of the teeth and jaws and is especially useful for implant planning.
- Digital scan or model: your teeth and gums are recorded with an intraoral scanner, or a model made from an impression is scanned. The 2018 ITI recommendations advise aligning these surface scans with the CBCT data to improve accuracy.
- Virtual planning: the position, angle and depth of the implant are set on the computer. The 2013 ITI statements say this should always be prosthetically driven: the position of the future tooth comes first. Nerves, the sinus, implant size, any need for bone grafting and the planned crown, bridge or denture are all considered.
- Making the guide: the plan is turned into a guide made for you. The 2013 statements recommend guides that rest on the teeth, the gum or implants, which were more accurate than guides resting on bone.
If there is not enough bone, grafting may be needed. Our dental implants page explains how implant treatment is planned overall.
How accurate is a surgical guide?
A guide helps keep the implant close to the plan, but the result is not an exact copy of it. Based on 20 clinical studies, the 2018 ITI consensus statements give these mean deviations between planned and actual position:
| Measurement | Mean deviation |
|---|---|
| Entry point of the implant | 1.2 mm |
| Tip of the implant | 1.5 mm |
| Angle | 3.5 degrees |
The same statements report better accuracy when some teeth remain than in jaws with no teeth. The 2008 ITI report found the technology accurate enough to justify its use in selected situations, but noted that in some studies the largest deviation exceeded clinically acceptable limits. For this reason, the 2013 and 2018 recommendations advise keeping a safety margin of 2 mm from critical structures such as nerves.
A 2025 systematic review and meta-analysis found computer-assisted methods (static guides, dynamic navigation and robotics) more accurate overall than placement without computer assistance.
Does the guide replace the dentist’s judgement?
No. The 2013 ITI statements describe guided surgery as an adjunct to, not a replacement for, appropriate diagnosis and treatment planning. The 2018 recommendations add that experience and training are needed for a favourable outcome, and the 2008 report warned of a steep learning curve and of unrealistic expectations of the technology.
Judgement also matters during the operation:
- The 2013 statements recommend a small X-ray during surgery (a periapical radiograph) as a safety measure in borderline cases.
- In the review by Romandini et al., flapless guided placement had an intraoperative complication rate of 12%, and in 7% of cases the implant could not be placed with this protocol. Reported problems included guides that did not fit and perforation of the thin bone wall on the cheek side.
- A review for the ITI by Joda et al. found that fracture of the guide was rare but should be considered a major complication.
Who can it help, and when is it not needed?
The 2013 ITI statements list the indications for guided surgery as:
- helping with treatment planning
- complex anatomy
- minimally invasive surgery
- helping patients understand their treatment needs and options
According to the same statements, it can be used where some or all teeth are missing.
Not every implant needs a guide. The authors of the 2025 review say that cost-effectiveness, the length of the gap and the clinician’s experience should be considered, and that conventional methods remain suitable in certain straightforward situations. Mouth opening can also matter: in the Romandini review, some trials only included patients whose mouth opening allowed computer-aided placement.
Can the implant be placed without lifting the gum?
Usually the gum over the implant site is lifted as a flap so that the bone can be seen; in flapless surgery it is not. The 2013 ITI statements say guided surgery can be used either way, so a guide does not automatically mean flapless surgery.
Romandini et al. (2023) combined five randomised controlled trials (124 participants, 449 implants) comparing flapless guided placement with placement after lifting the gum. With the flapless guided approach:
- patients reported less pain after surgery and less discomfort during it, although the certainty of the evidence on pain was low
- no clear difference in swelling was shown (very low certainty)
- implants were placed more accurately, but deviations from the plan still occurred
The authors suggest limiting flapless placement to cases with enough firm (keratinised) gum and no need for bone grafting; the trials only included implants placed in fully healed sites. The Joda review adds that the improved comfort seems to be linked more to the flapless approach than to the guide itself. Flapless placement is therefore an option in some cases, not a standard.
What will you experience?
Before surgery you will have a CBCT scan and a digital scan. According to the Manchester leaflet, you need to stay completely still during the CBCT scan, so a headband and chin rest are used, and you may be asked to remove earrings or facial jewellery. The radiation dose is higher than a traditional dental X-ray but far lower than a medical CT scan.
On the day, the guide is placed in your mouth and the implant site is prepared through it. For better accuracy, the 2013 ITI statements recommend inserting the implant itself through the guide too where possible (fully guided placement).
Does guided surgery mean teeth on the same day?
Not necessarily; these are separate decisions. The 2013 ITI statements say guided surgery can be used with different loading protocols, and the 2008 report mentions immediate loading with restorations prepared in advance as one use. A guide alone does not mean a tooth will be fitted on the day. When that is possible is explained in our guide to same-day dental implants; full-jaw treatment is covered on our full-arch implants page.
What should you ask if you are travelling for treatment?
- Is a surgical guide planned for my case, and why or why not?
- Can a CBCT scan taken at home be used, or will a new one be taken at the clinic?
- How much time is needed between the scans and the operation to plan and make the guide?
- Will the gum be lifted, or is flapless placement suitable for me?
- What happens if the plan cannot be followed on the day?
How do we decide on a surgical guide at Rönesans?
Our clinic has a cone-beam CT (CBCT) scanner and an intraoral digital scanner. We do not use a surgical guide for every patient: whether a guide is used depends on your situation and is decided by the dentist after the examination and the CBCT scan. When a guide is used, it is made for you individually.
We communicate with patients in English, German and Turkish. You can reach us on WhatsApp at +90 532 363 49 54 or through our contact page; you can also call our landline on +90 264 606 09 43.