## 1 Introduction  
Immediate implant placement has been shown by multiple authors to be a predictable treatment option for single tooth replacement [1; 2; 3]. Major benefits of this treatment option are shorter treatment times and fewer surgical interventions, making it highly desirable from a patient perspective [4]. However, immediate implant placement is far more challenging from a surgical point of view, compared to placing implants in a healed ridge. Unlike in healed ridge cases, immediate implants must be placed in the frequently limited bone located on the apical and palatal aspect of the extraction socket. Immediately placed implants in this position have an increased risk of the implant's shoulder unintentionally shifting towards the buccal bone plate during site preparation [5; 6]. Consequently, implants with a bucally positioned shoulder have a considerably higher chance of mucosal recession, compared to implants with a palatally positioned shoulder [7]. Furthermore, a recent systematic review has shown that immediate implants should be placed without raising a flap [8]. However, a flapless surgical approach impairs visual control of the site preparation and implant placement process. Guided, or computer-aided, implant surgery is a popular approach to assist oral surgeons in managing these requirements for difficult procedures. With the assistance of cone beam computed tomography (CBCT) and digital intra-oral scans, an optimal three-dimensional (3D) implant position can be virtually planned within a surgical planning software package [9]. Once planned, the virtual implant position can be transferred to the mouth of the patient using guided surgery, which can be either dynamic or static. During dynamic guided surgery, the operator receives real-time feedback on the drill position and angulation during osteotomy preparation and implant placement. Static guided surgery, on the other hand, involves the use of surgical templates during osteotomy preparation and implant placement. While dynamic guided surgery has been found to be more accurate than freehand implant placement [10], static guided surgery is more practical [11] and provides similar accuracy to dynamic guided surgery [12; 13; 14; 15]. Static guided surgery templates can be supported on bone, mucosal, or tooth levels, with surgical guides supported on the tooth level having been found to be significantly more accurate than guides supported on bone or mucosal levels [16]. The level of guidance provided by static surgical templates can be further characterized as fully guided, partially guided, or pilot-guided. Fully guided surgical guides assist during every step in the process, from initiating and preparing the osteotomy to placement of the implant using guiding sleeves placed in the guide. Partially guided surgical guides are designed to assist for the preparation of the osteotomy, after which the guide is removed, and the implant is placed freehand to retain tactile feedback of implant stability during placement [17; 18]. Pilot guides only provide guidance for initiating the osteotomy using the very first (pilot) drill through an integrated metal sleeve in the guide [19]. The remainder of the osteotomy preparation and implant placement is then performed freehand using mental navigation. To the best of our knowledge, no studies evaluating the accuracy of fully guided, pilot-guided, and freehand surgical approaches for immediately placed implants have been published. A clinical study comparing the accuracy of fully guided versus pilot-guided surgical approaches for immediately placed implants was published by [PERSON] et al. [20], while another clinical study by [PERSON] et al. compared the accuracy of immediate implants placed fully guided versus freehand [21]. The aim of this in vitro study was to investigate the influence of the guidance level (fully guided, pilot-guided, or freehand) on the accuracy of implants placed in simulated post-extraction sockets.