To assess and quantify survival rates and marginal bone levels (MBLs) of implants placed using guided surgery with a flapless approach vs traditional flap elevation. An electronic literature search was conducted in PubMed and the Cochrane Library and refereed by two independent reviewers. Data were synthesized for MBL and survival rates for "flapless" vs traditional "flap" implant placement approach groups. Meta-analyses and nonparametric tests for differences between groups were performed. Rates and types of complications were compiled. The study was conducted under PRISMA 2020 guidelines. A total of 868 records were screened. Full-text review of 109 articles resulted in a total of 57 included studies (50 included for quantitative synthesis and analysis). The survival rate was 97.4% (95% CI: 96.7%, 98.1%) for the flapless approach vs 95.8% (95% CI: 93.3%, 98.2%) for the flap approach; weighted Wilcoxon rank sum test for significance was = .2339. MBL for the flapless approach was 0.96 mm (95% CI: 0.754, 1.16) vs 0.49 mm (95% CI: 0.30, 0.68) for the flap approach; weighted Wilcoxon rank sum test for significance was = .0495. The outcomes of this review have suggested that surgical guided implant placement can be used as a reliable method regardless of approach. Additionally, flap and flapless approaches provided similar implant survival rates, but the flap technique provided a slightly better MBL than the flapless approach.
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