## 4 Discussion  
Achieving the correct implant position was identified by [PERSON] and colleagues as an important factor for achieving an optimal aesthetic outcome [5]. An incorrectly positioned implant has been reported to not only increase the risk of buccal dehiscence [25], but also the risk of peri-implantitis [26]. Static surgical guides are a means to ensure that implants can be accurately placed according to a pre-surgically planned position, thereby reducing the risk of long-term complications. The aim of the present study was to evaluate the influence of the static surgical guidance level (fully guided, pilot-guided, or freehand) on the accuracy of implant placement in post-extraction sockets. The results presented above show that the guidance level affects the accuracy of implants placed in post-extraction sockets; therefore, the null hypothesis was rejected. The results from this study confirm that a fully guided approach provides significantly less global deviation for immediately placed implants (and is therefore more accurate), compared to pilot-guided and freehand approaches. This result contrasts with [PERSON] et al., who reported no significant difference in accuracy between the fully guided and pilot-guided groups [20]. In terms of global platform deviation, [PERSON] et al. reported greater mean deviations in the FG and PG groups (1.26 \(\pm\) 0.57 and 1.34 \(\pm\) 0.99, respectively), compared to the FG and PG groups in the present study (0.81 \(\pm\) 0.21 mm and 1.21 \(\pm\) 0.41 mm, respectively; see Table S1). Similarly, greater global apical deviation was reported by [PERSON] et al. in the FG and PG groups (2.50 \(\pm\) 1.67 mm and 1.97 \(\pm\) 1.04 mm), compared to the corresponding groups in the present study (1.47 \(\pm\) 0.31 mm and 1.85 \(\pm\) 0.33 mm; see Table S1). Possible reasons for smaller global deviations being found in the present study compared to the randomized controlled trial (RCT) of [PERSON] et al. include patient-related factors such as varying quality or quantity of available bone, as well as a lack of support for the implant on the facial aspect of the socket during placement. A common consequence of this lack of support is that the implant tends to drift facially during placement, especially when placed in a socket with softer bone. The greater global apical deviation in the FG group compared to the PG group reported by [PERSON] et al. [20] suggests that this may have been the case, since 16 mm long implants were used and implant placement through a fully guided surgery impairs visual control. On the other hand, the significant difference in accuracy between the fully guided and freehand groups from the present study agrees with the results from the RCT by [PERSON] et al. [21]. While global platform and apical deviation results were not reported by [PERSON] et al., the mesial-distal deviation results at platform and apex levels for the FG group (0.40 \(\pm\) 0.28 mm and 0.95 \(\pm\) 0.52 mm, respectively) were in roughly the same range as the corresponding secondary outcomes from the FG group in the present study (0.52 \(\pm\) 0.16 mm and 1.08 \(\pm\) 0.35 mm, respectively; see Table S1). Similarly, the buccal-palatal deviation results at the platform and apex level for the FG group reported by [PERSON] et al. (0.42 \(\pm\) 0.24 mm and 0.90 \(\pm\) 0.65 mm, respectively) were roughly in the same range as the corresponding secondary outcomes in the FG group in the present study (0.32 \(\pm\) 0.23 mm and 0.74 \(\pm\) 0.41 mm, respectively; see Table S1). However, the angular deviation results in the FG group from [PERSON] et al. (0.94 \(\pm\) 0.59\({}^{\circ}\)) were considerably smaller than the angular deviation results in the FG group in the present study (3.05 \(\pm\) 0.97\({}^{\circ}\); see Table S1). This discrepancy is perplexing as the angular deviation results from the FG and PG groups in the present study (3.05 \(\pm\) 0.97\({}^{\circ}\) and 3.62 \(\pm\) 1.01\({}^{\circ}\), respectively; see Table S1) are in the same range as those reported by [PERSON] et al.