Articles - Forum Implantologicum

Article

Feature Article

Sep 09, 2026 // 15 min read

Static Computer-assisted Implant Surgery (sCAIS) in Partial Edentulism: Tooth-supported Guides

Florian Marxer

Nadja Naenni

Riccardo D. Kraus

DOI: 10.63580/ITI.FI.45788

dental implant implant surgery surgical guide

Abstract

Static computer-assisted implant surgery (sCAIS) has gained widespread adoption in implant dentistry, supported by advances in CBCT imaging, intraoral scanning and digital planning software. Despite growing clinical use, a critical and structured overview of its indications, workflows, and limitations remains relevant for everyday practice.

This article provides a comprehensive overview of sCAIS, with particular emphasis on fully guided, tooth-supported approaches in partially edentulous patients. Clinical workflows, accuracy, key determinants of treatment success, indications and limitations are discussed and illustrated by selected clinical cases.

A narrative review of the current literature was performed, supplemented by three representative clinical author cases demonstrating the application of sCAIS in anatomically and prosthetically demanding scenarios, including posterior maxillary rehabilitation with short implants, multi-implant placement in a complex partially edentulous maxilla, and implants in the esthetic zone.

Static computer-assisted implant surgery consistently demonstrates superior placement accuracy compared with freehand techniques, with mean deviations of 1-1.5 mm and 3-4° of angulation. However, improved accuracy does not translate into measurable differences in implant survival, osseointegration, or patient-reported outcomes. Primary stability is primarily determined by bone quality and implant design rather than guide use. Tooth-supported guides offer the highest positional stability. Cumulative errors throughout the digital workflow and anatomical constraints – such as restricted mouth opening – remain relevant limitations.

The use of sCAIS should be based on a clear clinical indication and evaluated on a case-by-case basis. While it facilitates prosthetically driven implant positioning and minimally invasive approaches, it requires clinical expertise, careful workflow execution, and appropriate patient selection to achieve predictable outcomes.

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Introduction

Modern dental implantology has become increasingly complex, requiring not only careful evaluation of biological and clinical parameters but also a strong emphasis on patient-centered outcomes. Clinicians are expected to provide time- and cost-efficient treatments while ensuring safe, minimally painful procedures that align with patient expectations. At the same time, daily practice is marked by growing challenges, including an aging patient population, comorbidities, polypharmacy, and the need to manage intricate re-dentistry cases.

Despite these demands, the fundamental objective of implant placement remains unchanged: to achieve long-term success through precise positioning and high primary stability, while minimizing invasiveness, surgical stress, and patient morbidity. When crucial factors such as prosthetically driven implant position, distances to adjacent structures and a properly designed restoration are considered, clinicians can deliver predictable, high quality outcomes that ultimately enhance patient satisfaction.

Within this evolving landscape, computer-assisted implant surgery (CAIS) has emerged as a valuable part of implant treatment. Its growing adoption is closely linked to continuous improvements in CBCT imaging, intraoral scanning, and digital planning software. CAIS can be performed using static or dynamic systems with varying degrees of guidance. This article focuses on static CAIS (sCAIS), which includes pilot drill and partially guided protocols as well as fully guided workflows in which every surgical step – including implant insertion – is executed through the guide. Fully guided approaches offer the most accurate transfer of the virtual plan to the clinical setting (Werny et al. 2025; Putra et al. 2021).

CAIS has been shown to enhance implant placement accuracy, facilitate minimally invasive techniques such as flapless surgery – often improving patient comfort (Laleman et al. 2016; Pimkhaokham et al. 2022) – and achieve high short-to-medium term implant survival rates of up to 97% (Aghaloo et al. 2023). Moreover, outcomes appear less dependent on the surgeon's level of experience (Li et al. 2023; Lops et al. 2024), thus coming along with several potential benefits. However, limitations remain, including potential deviations from the planned position, higher costs, and reliance on precise digital workflows.

Against this background, the aim of the present article is to provide a comprehensive and critical overview of static computer-assisted implant surgery, with particular emphasis on fully guided approaches. The discussion addresses clinical workflows, accuracy, key determinants of treatment success, and the indications and limitations of sCAIS in everyday practice.

Fig. 1: Baseline intraoral occlusal view of the surgical site

Fig. 2: Baseline panoramic radiograph prior to implant placement

Fig. 3: Prosthetically driven virtual implant planning with Straumann coDiagnostiX software, based on superimposition of the CBCT dataset with STL files of the intraoral scan and the digital diagnostic wax-up

Fig. 4: Prosthetically driven virtual implant planning with Straumann coDiagnostiX software, based on superimposition of the CBCT dataset with STL files of the intraoral scan and the digital diagnostic wax-up

Fig. 5: Prosthetically driven virtual implant planning with Straumann coDiagnostiX software, based on superimposition of the CBCT dataset with STL files of the intraoral scan and the digital diagnostic wax-up

Fig. 6: Intraoral view of the transmucosal punch preparation at the planned implant site

Fig. 7: Close-up view of the transmucosal tissue punch

Fig. 10: Status following initial osteotomy drilling with the surgical guide

Fig. 11: Guided sequential osteotomy preparation with the surgical guide manually stabilized, demonstrating the system-specific sleeve indicator for drill depth control

Fig. 12: Osteotome technique for internal sinus lift (Summers technique)

Fig. 13: Application of Bio-Oss granules (Geistlich) for sinus augmentation

Fig. 14: 6 mm implant prior to implant insertion through the static surgical guide

Fig. 15: Partial implant insertion in region 26 through the static surgical guide; full seating depth will be achieved in the subsequent step using the hand ratchet

Fig. 16: Final implant seating to full depth using the hand ratchet in region 26

Fig. 17: Occlusal view of the healing abutment in situ in region 26 immediately following implant placement

Fig. 18: Occlusal view of the healing abutment in situ in region 16 immediately following implant placement

Fig. 19: Panoramic radiograph taken immediately after implant insertion in regions 16 and 26

Fig. 22: Final panoramic radiograph after insertion of the implant-supported crowns in regions 16 and 26

Fig. 23: The baseline models and the diagnostic wax-up were digitized

Fig. 24: Following superimposition of the CBCT dataset and STL files, implant positions were planned according to the local anatomy and the prosthetic information derived from the diagnostic wax-up

Fig. 25: Three-dimensional design of the tooth-supported surgical guide

Fig. 26: Clinical situation after fully guided implant placement in the first quadrant

Fig. 27: Clinical situation after fully guided implant placement in the second quadrant

Fig. 28: Guided bone regeneration in the first quadrant with DBBM, a collagen membrane, and polylactide pins

Fig. 29: Wound closure by primary intention

Fig. 30: Clinical situation after abutment connection and soft tissue conditioning using fixed provisional restorations

Fig. 31a: Final metal-ceramic implant-supported restorations

Fig. 31b: Final metal-ceramic implant-supported restorations

Fig. 31c: Final metal-ceramic implant-supported restorations

Fig. 33: Implant position was planned based on local anatomy and prosthetic requirements derived from the diagnostic wax-up, following digital superimposition of the CBCT dataset and STL files

Fig. 34: Implant position was planned based on local anatomy and prosthetic requirements derived from the diagnostic wax-up, following digital superimposition of the CBCT dataset and STL files

Fig. 35: Implant position was planned based on local anatomy and prosthetic requirements derived from the diagnostic wax-up, following digital superimposition of the CBCT dataset and STL files

Fig. 36: Preoperative clinical situation of the surgical site

Fig. 37: Intraoral view of the tooth-supported surgical guide in situ

Fig. 38: Accurate seating of the tooth-supported surgical guide in situ

Fig. 39: Occlusal view through the sleeve of the surgical guide at the planned implant site

Fig. 40: Positioning pin inserted through the guide sleeve, confirming accurate implant axis transfer

Fig. 41: Wound closure following implant placement

Fig. 45: Anterior view of the definitive implant-supported crowns in situ

Fig. 46: Occlusal view of the definitive implant-supported crowns in situ

Fig. 47: Intraoral frontal view of the definitive implant-supported crowns in situ