## 4 Discussions
Having a shallower implant position affects the zenith and gingival margin of the final restoration, resulting in a shorter clinical crown appearance when compared with a natural adjacent tooth. For a screw-retained implant, the placement of an implant too coronally may lead to a ridge-lap prosthetic design. This could be corrected by planning a deeper implant position or a deep implant bed preparation. After implant placements, clinicians should also verify that the depth of the implant was at the expecting level. An error in the vertical direction is to be expected (a too superficial implant position). This may be due to the presence of debris in the implant cavity and/or a blockage of the implant holders in the sleeves of the guide during surgery [18; 19]. When analyzing the buccolingual and meso-distal deviation directions of the implant position for all three groups, we observed that most deviations were in buccal and mesial directions. Buccolingual deviations were more numerous than meso-distal deviations when using the three different implant planning software programs. This was due to surgical guide deformations or bending during the implant bed preparation and the insertion process. Previous studies showed similar results to this study, with the buccolingual direction having a more prominent deviation as it did not have as rigid a structure (e.g., teeth) as the meso-distal direction [20; 21; 22]. The accuracy of the implant positioning is important, especially in cases where the implants are placed by computer-guided flapless implant surgery and computer-guided immediate implant placements. Other studies have shown that placing implants too bucally could result in a buccal mucosa recession due to buccal bone resorption. This means that the harmonious gingival course would be significantly disturbed, causing severe esthetic complications. These complications have been frequently observed in immediate implant placement cases [23; 24; 25]. [PERSON] et al. demonstrated that the presence of a fully intact facial bone wall with a thickness \(>1\) mm and a thick gingival biotype were the most vital features required for an immediate implant placement [26]. Both of these requirements were taken into consideration for the present study. The present case showed that digital planning software was more advantageous in planning an accurate immediate implant placement in the esthetic zone [27]. Therefore, in cases where static computer-assisted implant placements are used, one must take into account the distance caused by the deviation of the static computer-assisted implant placement, no matter which program is used. Moreover, for immediate implant placement cases where immediate loading is needed, deviations from the implant position may also cause temporary prostheses (prepared beforehand) to not fit properly and to need another clinical adjustment. In a worst case scenario, they may not fit at all and a new impression of the position of the implant fixture would be required to fabricate a new temporary prosthesis. Many former educational studies often assessed the accuracy of computer-assisted implant surgery by comparing the planned implant position with the actual implant position. Such a comparison technique made by using these methods still results in errors from those digital workflow processes. Many factors have been reported to influence the deviation of implant positions achieved from static computer-assisted implantation systems.