###### Abstract  
The aim of this systematic review was to assess the scientific literature on the accuracy of guided implant surgery and the methods used for its quantification. Two reviewers searched PubMed and the Cochrane Library to identify relevant articles published before 2023. Two methodological quality-assessment tools were used to assess the quality of the studies included. Inter-investigator reliability was verified using kappa statistics. Twenty-three clinical studies out of the 3299 articles initially identified met the inclusion criteria. The \"radiographic matching method\" and \"digital registration method\" were used to assess accuracy in guided surgery. The mean angular, coronal, and apical deviations of mucosa-supported guides ranged from 2.7\({}^{\circ}\) to 5.14\({}^{\circ}\), 0.87 mm to 2.05 mm, and 1.08 mm to 2.28 mm, respectively. With bone-supported guides, these ranged from 2.49\({}^{\circ}\) to 5.08\({}^{\circ}\), 0.71 mm to 1.60, and 0.77 mm to 1.65 mm, respectively. In tooth-supported guides, deviations were from 2.5\({}^{\circ}\) to 5.62\({}^{\circ}\), 0.39 mm to 1.63 mm and 0.28 mm, and 1.84 mm, respectively. Regardless of the evaluation method, all systems exhibit some error. The minimum and maximum deviation ranges found between the planned and placed implants show that, although deviations occur, guided surgery is not far from accurate. accuralcy; guided surgery; computer-aided planning; computer-assisted; dental implants; systematic review 2024 14 11479 10.3390/APPl  
[PERSON], [PERSON]; M.; C.; C.  
navigation system that allows real-time surgical visualization, as well as intraoperative modification of the implant position. In contrast, the term \"computer-guided (static) surgery\" refers to the use of a static surgical template that reproduces the virtually planned implant position but does not allow for intraoperative modification. Static-guided surgery has allowed the development of less invasive surgical techniques such as the \"flapless surgical technique\", which, together with guided implant placement, improves the patient's postoperative comfort and allows adequate implant placement, along with the fabrication of prosthetic structures in advance of surgical procedures [3]. Although the advantages of this technique are evident, the literature also reports that flapless implant surgery is a blind surgical technique. On the one hand, it can cause thermal damage due to limited external irrigation during surgical drilling, and on the other, it makes it impossible to manipulate soft tissue during surgery [7]. Nevertheless, copious literature supports the reliability and safety of flapless implant surgery, providing patient selection criteria are applied correctly. The most critical step in achieving the preoperatively planned outcome is the transfer of the virtually planned implant position from the software to the patient's mouth. However, the transference of virtual planning to the operative field without any deviation remains an unrealistic goal [8]. Accuracy in implant placement with static-guided surgery depends on multiple factors, contributing to a successive accumulation of errors from planning to surgery. A clinical trial by [PERSON] et al. [9] classifies these errors into three groups: errors during image acquisition (the manufacture of the surgical guide, the acquisition of CBCT images, CBCT surface registrations, and dental registrations), errors related to the type of support provided by the surgical guide (bone, mucosa, tooth-support), and errors during the surgical procedure (fully or partially guided surgery and the surgeon's skill). Moreover, other authors [10] add that errors may also result from the physical properties of the material, as well as from the technologies used for manufacturing surgical guides. They also affirm that the incorporation of metal sleeves and fixation screws in mucosa-supported surgical guides is an important factor in reducing deviations during drilling and implant placement [10; 11].