Accuracy of Static, Dynamic, and Robotic Guided Surgery in Immediate Implant Placement: A Systematic Review and Network Meta-Analysis.

To evaluate the accuracy of static, dynamic, and robotic computer-assisted protocols in immediate implant placement (IIP), compared to freehand (FH) techniques. A systematic search was conducted for studies published through March 2025. Clinical studies on Computer-Aided Implant Surgery (CAIS), reporting angular and/or linear deviations between the planned and actual implant position after IIP were included. Eligible designs comprised randomized controlled trials (RCTs), non-randomized controlled trials (nRCTs), prospective/retrospective cohort studies (Retro), and prospective/retrospective case series (PCS/RCS). A network meta-analysis was performed to assess deviations in implant angulation, platform, and apex positions among FH, half-guided static (HG-sCAIS), fully-guided static (FG-sCAIS), dynamic (dCAIS), and robotic (rCAIS) protocols. Covariates such as jaw, site position, study design, and risk of bias were included. Two post hoc sensitivity analyses were also conducted. Eighteen studies encompassing 780 immediately placed implants were analyzed (6 RCTs; 2 PCS; 7 RCS; 3 Retro). Compared with FH, every guided protocol significantly enhanced accuracy. Mean angular deviation decreased by 3.36° with rCAIS, 2.66° with dCAIS, 1.73° with HG-sCAIS, and 1.85° with FG-sCAIS (p < 0.05). Corresponding reductions in platform deviation were 0.68, 0.71, 0.27, and 0.54 mm, while apex deviation decreased by 1.43, 1.32, 1.23, and 0.81 mm, respectively (p < 0.05). rCAIS and dCAIS ranked highest across all metrics. Within the limitations of this study, guided surgery significantly improves the accuracy of immediate implant placement. rCAIS and dCAIS demonstrated the most favorable accuracy profiles, although sensitivity analyses restricted to higher-quality evidence suggest that differences among guided protocols may be less pronounced.