Accuracy of Metallic-Sleeved Versus Sleeve-Free Surgical Guides in Static Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis
4 affiliations
- 1Oral Surgery Unit, Department of Dentistry, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain
- 2Doctoral School, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
- 3Department of Orthodontics, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain
- 4Department of Restorative Dentistry and Endodontics, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain
Abstract
Background/Objectives: Metallic sleeves are widely used in static computer-assisted implant surgery (sCAIS), whereas sleeve-free guides may simplify the workflow. This systematic review and meta-analysis compared metallic-sleeved and sleeve-free guides for angular, coronal/platform, and apical deviation. Methods: The protocol was registered in the Open Science Framework and the review followed PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library/CENTRAL, and Google Scholar were searched; reports published in any language were eligible for assessment. Methodological quality and risk of bias were assessed using QUIN for in vitro studies and RoB 2 for the randomized trial. Random-effects meta-analyses were complemented by sensitivity and leave-one-out analyses. Results: Eleven studies were included (10 in vitro and one randomized controlled trial). Nine studies contributed to quantitative synthesis overall. Sleeve-free guides showed lower angular deviation (MD = −0.61°; 95% CI: −1.12 to −0.10; p = 0.019) and apical deviation (MD = −0.27 mm; 95% CI: −0.50 to −0.05; p = 0.017), while no statistically significant difference was detected for coronal/platform deviation (MD = −0.03 mm; 95% CI: −0.16 to 0.11; p = 0.689). Heterogeneity was substantial to high, and the 95% prediction intervals for angular and apical deviation crossed zero, reflecting variability across the evaluated guided systems. Sensitivity and leave-one-out analyses supported the overall direction of the findings. Conclusions: Sleeve-free guides showed modest average advantages in angular and apical deviation, while no statistically significant difference was detected for coronal/platform deviation. Performance depended on guide design, manufacturing accuracy, support, site morphology, and surgical protocol. The SLEEVE Rule was proposed as a structured framework to improve standardisation and comparability in future research. Further well-designed clinical studies are required to determine the clinical relevance of these technical differences.
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BibTeX
@article{muwaquet2026accuracy,
title = {{Accuracy of Metallic-Sleeved Versus Sleeve-Free Surgical Guides in Static Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis}},
author = {Kais Hijazi Muwaquet and Maria Dolores Gómez-Adrián and Julián Espinosa-Giménez and Jose Juan Enciso-Ripoll and Francisco Javier Villanueva-Arregui and Tawfiq Hijazi Alsadi and Susana Muwaquet Rodriguez and Javier Barberá-Millán},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207935},
url = {https://www.mdpi.com/2077-0383/15/20/7935},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Accuracy of Metallic-Sleeved Versus Sleeve-Free Surgical Guides in Static Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis
AU - Kais Hijazi Muwaquet
AU - Maria Dolores Gómez-Adrián
AU - Julián Espinosa-Giménez
AU - Jose Juan Enciso-Ripoll
AU - Francisco Javier Villanueva-Arregui
AU - Tawfiq Hijazi Alsadi
AU - Susana Muwaquet Rodriguez
AU - Javier Barberá-Millán
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207935
UR - https://www.mdpi.com/2077-0383/15/20/7935
AB - Background/Objectives: Metallic sleeves are widely used in static computer-assisted implant surgery (sCAIS), whereas sleeve-free guides may simplify the workflow. This systematic review and meta-analysis compared metallic-sleeved and sleeve-free guides for angular, coronal/platform, and apical deviation. Methods: The protocol was registered in the Open Science Framework and the review followed PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library/CENTRAL, and Google Scholar were searched; reports published in any language were eligible for assessment. Methodological quality and risk of bias were assessed using QUIN for in vitro studies and RoB 2 for the randomized trial. Random-effects meta-analyses were complemented by sensitivity and leave-one-out analyses. Results: Eleven studies were included (10 in vitro and one randomized controlled trial). Nine studies contributed to quantitative synthesis overall. Sleeve-free guides showed lower angular deviation (MD = −0.61°; 95% CI: −1.12 to −0.10; p = 0.019) and apical deviation (MD = −0.27 mm; 95% CI: −0.50 to −0.05; p = 0.017), while no statistically significant difference was detected for coronal/platform deviation (MD = −0.03 mm; 95% CI: −0.16 to 0.11; p = 0.689). Heterogeneity was substantial to high, and the 95% prediction intervals for angular and apical deviation crossed zero, reflecting variability across the evaluated guided systems. Sensitivity and leave-one-out analyses supported the overall direction of the findings. Conclusions: Sleeve-free guides showed modest average advantages in angular and apical deviation, while no statistically significant difference was detected for coronal/platform deviation. Performance depended on guide design, manufacturing accuracy, support, site morphology, and surgical protocol. The SLEEVE Rule was proposed as a structured framework to improve standardisation and comparability in future research. Further well-designed clinical studies are required to determine the clinical relevance of these technical differences.
SN - 2077-0383
ER -