Implant positioning errors in freehand and computer-aided placement methods: a single-blind clinical comparative study

Int J Oral Maxillofac Implants. 2013 Jan-Feb;28(1):190-204. doi: 10.11607/jomi.2691.


Purpose: Simultaneous insertion of multiple implants may exhibit suboptimal positions, especially in edentulous jaws considered for a fixed restoration. The aim of this study was to compare the incidence of and confounding factors in implant positioning errors related to the use of freehand and computer-aided treatment methods.

Materials and methods: A total of 353 implants were placed in 54 patients with at least one edentulous jaw using freehand and computer-aided methods involving 16 mucosa- and 12 bone-supported single- and multiple-type stereolithographic surgical guides. At the stage of prosthesis delivery, a blinded examiner evaluated seven positioning error criteria. Results were analyzed by chi-square test and logistic regression.

Results: Interproximal emergence (OR = 2.82, P < .0001), insufficient interimplant distance (OR = 1.42, P < .0001), and improper parallelism (OR = 1.24, P = .001) errors were significantly higher in implants placed by the freehand method. The highest probability of positioning error (88%) was associated with the use of the freehand method, whereas the lowest (6%) was associated with single-type, mucosa-supported guides with other significant confounding factors.

Conclusion: Utilizing computer-aided methods may alleviate the occurrence of implant positioning errors that are frequently associated with the freehand method. The use of software planning with enhanced viewing capabilities and single-type, mucosa-supported stereolithographic surgical guides in suitable patients minimizes errors.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chi-Square Distribution
  • Computer-Aided Design
  • Confounding Factors, Epidemiologic
  • Dental Implantation, Endosseous / instrumentation
  • Dental Implantation, Endosseous / methods*
  • Dental Implantation, Endosseous / statistics & numerical data
  • Dental Implants
  • Dental Impression Technique
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods
  • Jaw, Edentulous / rehabilitation*
  • Male
  • Medical Errors / prevention & control
  • Medical Errors / statistics & numerical data*
  • Middle Aged
  • Single-Blind Method
  • Software
  • Surgery, Computer-Assisted / methods*


  • Dental Implants