Comparison Of the Accuracy of CAD CAM Milled And 3D Printed Surgical Guides in Implant Placement- A Systematic Review and Meta Analysis

Abstract

Aim: Evaluating accuracy of of CAD CAM milled and 3D printed surgical guides in implant placement

Methods: Review was adhered and preferred reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020 and registered in PROSPERO – CRD42023470684. Electronic databases were searched for studies evaluating accuracy of 3D printed surgical guides compared to CAD/CAM milled surgical guides in implant placement and reporting outcomes in terms of angular deviation, coronal deviation, apical deviation, depth deviation and deviation at apex. Screening and data extraction was done by two independent reviewers. Quality assessment of studies was evaluated through Cochrane risk of bias (ROB)-2 tool. The standardized mean difference (SMD) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant through Review manager (RevMan) version 5.3.

Results: Seven studies were included in qualitative synthesis and five studies for meta -analysis with data evaluated from 357 implants placed. Included studies showed moderate to low ROB. Effectiveness between both implant placement techniques were evaluated for angular deviation, coronal deviation, apical deviation, depth deviation and deviation at apex. Meta-analysis revealed that 3D printing surgical guide had shown reduced angular deviation (SMD = -0.52 (-0.83 – 0.20), coronal deviation (0.29 (-0.13 – 0.72), apical deviation (-0.74 (-1.05 – 0.42), depth deviation (-0.53 (-0.84 – 0.22) and deviation at neck (SMD = -0.80 (-1.13 – 0.46) indicating that 3D printing guides implant placement technique being more efficient than CAD/CAM milled surgical guide (p<0.05). Funnel plot did not show presence of publication bias in meta-analysis.

Conclusion: It was found that better results with overall accuracy and safety margin was seen with 3D printed surgical guides, with fabrication ease, less time wastage and reduction of laboratory time with an increased cost-effectiveness.