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Treatment Algorithm · Module

Choosing your guidance: freehand, static, or dynamic

Matching the level of surgical guidance to case complexity, esthetic and anatomic risk, and flapless intent. Grounded in ITI consensus and accuracy meta-analyses of computer-aided implant surgery.

Use: Workflow selection reference Driver: Risk & accuracy need Framework: ITI · CAIS meta-analyses
01 — Modalities
Three levels of surgical guidance

Modalities differ in how the planned position is transferred to surgery. Higher guidance generally improves accuracy but adds cost, planning time, and access constraints.

Modality
Freehand
  • No physical guide; planning from imaging/clinical judgment
  • Lowest cost, fastest, flexible intra-op
  • Largest deviation from plan
  • Best for simple, low-risk, single sites with ample bone
Modality
Static guide
  • CAD/CAM surgical guide with drill sleeves
  • Tooth-, mucosa-, or bone-supported
  • Enables predictable flapless placement
  • Fixed plan; limited intra-op adjustment
Modality
Dynamic navigation
  • Real-time tracking of handpiece vs plan on screen
  • No physical guide; intra-op flexibility
  • Marginally best angular control
  • Learning curve, hardware cost, line-of-sight needs
02 — Decision Pathway
Interactive guidance selector

Select the dominant case characteristic. The recommendation reflects the typical evidence-based choice; clinician experience and equipment availability also weigh in.

Tap the factor that most defines this case.

Step 1 — What dominates the case?

LOW COMPLEXITY
Simple single site, ample bone
Low esthetic/anatomic risk, flap acceptable.
HIGH RISK
Esthetic or near vital structures
Anterior maxilla, tight margins to canal/sinus.
FLAPLESS / FULL-ARCH
Flapless intent or multiple/full-arch
Prosthetically driven, minimally invasive.
COMPLEX / EVOLVING
Complex anatomy, intra-op flexibility needed
Limited mouth opening or plan may change.
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03 — Quick Reference
Accuracy, indications & limitations

Pooled accuracy figures from CAIS meta-analyses (global coronal / apical / angular deviation). Values are approximate means with wide reported ranges and moderate-to-high study heterogeneity.

ModalityTypical deviationBest indicationLimitation
FreehandLargest (no fixed pooled mean; greater than CAIS)Simple single site, ample bone, low riskLeast predictable transfer of plan
Static guide~0.8 mm coronal · ~1.1 mm apex · ~2° angleFlapless, esthetic zone, multiple/full-archFixed plan; needs access/mouth opening for guide + sleeves
Dynamic navigation~0.7 mm coronal · ~0.8 mm apex · ~2° angleComplex anatomy, limited opening, evolving plansHardware cost, learning curve, line-of-sight tracking
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published consensus and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. Reported accuracy figures carry wide ranges and study heterogeneity; guided surgery does not eliminate the need for sound surgical fundamentals.
  1. Tahmaseb A, Wu V, Wismeijer D, Coucke W, Evans C. The accuracy of static computer-aided implant surgery: a systematic review and meta-analysis. Clin Oral Implants Res. 2018;29(Suppl 16):416–435.
  2. Wismeijer D, Joda T, Flügge T, et al. Group 5 ITI Consensus Report: digital technologies. Clin Oral Implants Res. 2018;29(Suppl 16):436–442.
  3. Jorba-García A, González-Barnadas A, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Accuracy of dynamic computer-assisted implant surgery: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(5):2479–2494.

Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0