Accuracy of guided implant placement using surgical guides with or without metal sleeves: systematic review and meta-analysis

purpose: To evaluate the accuracy of guided implant placement using surgical guides with or without metallic sleeves through a systematic review and meta-analysis. Materials and methods: A comprehensive search was conducted on PubMed, Scopus and Web of Science up to 2025, identifying in vivo and in vitro studies comparing static surgical guides with and without metallic sleeves. Studies reporting angular, horizontal or vertical deviations between planned and actual implant positions were included. Data were extracted and analysed using standardised mean differences, with heterogeneity assessed via the I2 index and Cochran Q test. Results: Four studies met the inclusion criteria: three in vitro and one in vivo randomised clinical trial, totalling 90 implants. Meta-analysis showed no statistically significant differences between sleeveless and sleeved guides in terms of angular deviation (standardised mean difference 0.18; 95% confidence interval −0.24 to 0.59; P = 0.402) or horizontal deviation (standardised mean difference −0.23; 95% confidence interval −0.70 to 0.24; P = 0.340). All studies demonstrated low heterogeneity (I2 = 0%). Conclusions: Clinical evidence comparing sleeveless and sleeved surgical guides remains very limited. Current data, mainly derived from in vitro studies and one small randomised clinical trial, suggest that both guide types may offer comparable accuracy; however, these findings should be interpreted with caution, and further high-quality clinical studies are required to validate these preliminary results and establish their applicability in different clinical scenarios.