title: Accuracy comparison of guided surgery for dental implants according to the tissue of support: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically assess the current dental literature comparing the accuracy of computer-aided implant surgery when using different supporting tissues (tooth, mucosa, or bone).
  
  
  METHODS
  Two reviewers searched PubMed (1972 to January 2015) and the Cochrane Central Register of Controlled Trials (Central) (2002 to January 2015). For the assessment of accuracy, studies were included with the following outcome measures: (i) angle deviation, (ii) deviation at the entry point, and (iii) deviation at the apex.
  
  
  RESULTS
  Eight clinical studies from the 1602 articles initially identified met the inclusion criteria for the qualitative analysis. Four studies (n = 599 implants) were evaluated using meta-analysis. The bone-supported guides showed a statistically significant greater deviation in angle (P < 0.001), entry point (P = 0.01), and the apex (P = 0.001) when compared to the tooth-supported guides. Conversely, when only retrospective studies were analyzed, not significant differences are revealed in the deviation of the entry point and apex. The mucosa-supported guides indicated a statistically significant greater reduction in angle deviation (P = 0.02), deviation at the entry point (P = 0.002), and deviation at the apex (P = 0.04) when compared to the bone-supported guides. Between the mucosa- and tooth-supported guides, there were no statistically significant differences for any of the outcome measures.
  
  
  CONCLUSIONS
  It can be concluded that the tissue of the guide support influences the accuracy of computer-aided implant surgery.
authors.affiliation: School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Yolanda Natali
authors.initials: YN
authors.lastname: Raico Gallardo
authors.affiliation: School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Isabela Rodrigues Teixeira
authors.initials: IRT
authors.lastname: da Silva-Olivio
authors.affiliation: APCD, São Paulo, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mukai
authors.affiliation: School of Dentistry, Ibirapuera University, São Paulo, Brazil.
authors.forename: Susana
authors.initials: S
authors.lastname: Morimoto
authors.affiliation: School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Newton
authors.initials: N
authors.lastname: Sesma
authors.affiliation: Eastman Dental Hospital, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cordaro
mesh_terms: D003757:Dental Implantation; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D006801:Humans; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants
keywords: computer-aided design; computer-aided manufacturing; computer-aided surgery; dental implants; systematic review