Guided surgery with tooth-supported templates for single missing teeth: A critical review

aim: to systematically scrutinise the scientific literature to evaluate the accuracy of computer-guided implant placement for single missing teeth, as well as to analyse the eventual clinical advantages and treatment outcomes. material and methods: the electronic and manual literature search of clinical studies published from january 2002 up to november 2015 was carried out using specified indexing terms. outcomes were accuracy; implant and prosthetic failures; biological and mechanical complications; marginal bone loss (MBL); sulcus bleeding index (SBI); plaque score (PS); pink esthetic score [PES]; aesthetic and clinical outcomes. results: the search yielded 1027 relevant titles and abstracts, found during the electronic (n = 1020) and manual (n = 7) searches. after data extraction, and screening of titles, abstracts, and full-texts, 32 studies fulfilled inclusion criteria and were included in the critical review: two randomised controlled clinical trials, six prospective observational single cohort studies, one retrospective observational study, three in vitro comparative studies, 10 case reports and 10 systematic reviews. a total of 209 patients (18 to 67 years old) were treated with 342 implants using computer-guided implant surgery. the follow-up ranged from 12 to 52 months. the cumulative survival rate ranged from 96.5% to 100%. eleven implant planning softwares and guided surgery systems were used and evaluated. conclusions: computer-guided surgery for single missing teeth provides comprehensive treatment planning, reliable implant positioning, favourable clinical outcomes and aesthetics. a tooth-supported template for the treatment of single missing teeth results in greater accuracy of implant positioning than with mucosa-supported or bone-supported templates. the limited scientific evidence available suggests that guided surgery leads to implant survival rates as good as conventional freehand protocols. computer-guided surgery implies additional costs, that should be analysed in terms of cost-effectiveness, considering the reduction of surgery time, postoperative pain and swelling, as well as, the potential increased accuracy. long-term randomised clinical trials are eagerly needed to investigate the clinical performance of guided surgery in partially edentate patients.