Guided vs freehand dental implant surgery: what’s the difference?
In guided implant surgery, the implant’s position is planned on a computer from a 3D CBCT scan, and a 3D-printed surgical guide that sits over your teeth controls the angle and depth of every drill. In freehand surgery, the dentist works from the same scan but places the implant by hand. At Toothi London in Edgware we offer both, using Osstem OneGuide surgical guides for guided cases, and choose between them for each patient. Whichever is right for you, digital planning and the guide are included in the £1,995 single implant price.
Written and reviewed by Dr Ali El-Kabengi (GDC 270807), principal dentist at Toothi London, 1 Handel Parade, Edgware HA8 6LD, who has a special interest in implant dentistry. Updated 4 October 2026.
How guided implant surgery works
- A 3D scan of your jaw. A CBCT scan shows the height, width and density of the bone, and exactly where the nerve in the lower jaw and the sinus in the upper jaw sit. It is taken at a referral imaging centre and paid to them directly.
- A digital record of your teeth and gums. This shows the surface the guide will sit on and the space the new crown has to fill.
- Virtual planning. The two are merged and the implant is positioned on screen: its depth, its angle, and its distance from the nerve, the sinus and the neighbouring roots, with the final crown in mind. For guided cases this is done with our implant laboratory and checked by your dentist before the guide is made.
- The surgical guide. The lab 3D-prints a guide with a metal sleeve set at the planned position and angle.
- Placement. On the day, the guide is clipped over your teeth and every drill passes through the sleeve, so the implant goes in where it was planned. We check the guide sits perfectly still before we start; if it doesn’t, we don’t operate through it.
How freehand implant surgery works
Freehand doesn’t mean unplanned. The same CBCT scan is studied and measured before surgery, and the implant size and position are decided in advance. During the procedure the dentist views the bone directly, follows the planned position using measurements and the neighbouring teeth as reference points, and can adapt to what the bone shows. Freehand placement is long established and is how most implants have historically been placed.
Guided vs freehand at a glance
| Guided | Freehand | |
|---|---|---|
| Planning | Planned on computer from your CBCT scan; guide made by a lab | Planned from your CBCT scan measurements |
| Accuracy against the plan | Studies generally report smaller deviations from the planned position, especially in angle | Depends more on the dentist’s hand and visual judgement |
| Opening the gum | Sometimes possible through a small circular opening without lifting the gum (flapless) | Usually a small flap of gum is lifted to see the bone |
| Adjusting during surgery | Limited: the guide fixes the position | Position can be adapted to what the bone shows |
| Mouth opening needed | More, because the guide and drills stack up; can be tight at the back | Less |
| Before surgery | Time for the lab to plan and make the guide | No guide to wait for |
| Cost at Toothi | Included in £1,995 | Included in £1,995 |
When we choose guided surgery
- The implant will sit close to the nerve in the lower jaw or the sinus in the upper jaw.
- The bone is narrow and there is little room either side of the implant.
- It is a front tooth, where the angle of the implant decides how natural the crown looks.
- Two or more implants need to line up to carry a bridge.
- The bone allows flapless placement and you would like the least invasive approach.
When freehand can be the better choice
- The bone is wide and the reference points are clear, so a guide would add lab time without adding safety.
- A bone graft or sinus lift is being done at the same time, and the dentist needs to see and work on the bone directly.
- Mouth opening is limited, which can leave too little room at the back of the mouth for a guide and the drills.
Your dentist will tell you which approach is planned for you, and why, once your CBCT scan is back. Either way, your price doesn’t change.
Is guided surgery the same as keyhole implant surgery?
Not quite. Keyhole, or flapless, surgery means placing the implant through a small circular opening in the gum instead of lifting a flap. A guide makes flapless placement more practical because the dentist doesn’t need to see the bone to keep the drill on course, but not every guided case is flapless. If bone needs grafting, the gum has to be opened.
What it costs at Toothi
| New implant consultation — includes a written plan | Free |
| CBCT 3D scan — at a referral imaging centre, paid to them directly | Not included |
| Single tooth implant including crown — Osstem implant · abutment · porcelain crown · all reviews · digital planning and surgical guide when your case is guided | £1,995 |
| Second implant placed at the same visit | £1,795 |
| Implant bridge — 2 implants replacing 3 teeth, including the bridge | £4,495 |
| Bone graft — minor / socket preservation, if needed | from £395 |
| Sinus lift — internal, if needed | £595 |
Every figure is on our fees page. See also the dental implant procedure, step by step, how long implant treatment takes and what placement really feels like.
Common questions
Is guided implant surgery more accurate than freehand?
Studies comparing the two generally find that guided placement lands closer to the planned position, particularly in the angle of the implant. That accuracy still depends on a precise scan, a well-made guide and a guide that sits firmly in the mouth, which is why we check the fit before we start.
Does guided implant surgery cost more at Toothi?
No. When your case is guided, the digital planning and the surgical guide are included in the £1,995 single implant price. The CBCT scan is paid separately to the imaging centre, for guided and freehand cases alike.
Does guided implant surgery hurt less?
Both are done under local anaesthetic, so placement itself shouldn’t hurt. Where a guide allows flapless placement, there are often fewer stitches and less swelling afterwards, but that depends on your bone rather than the guide alone.
Can every implant be placed with a guide?
Most can, but not all. A guide needs firm teeth to sit on and enough mouth opening for the drills, and some cases are better done with a direct view of the bone, such as when a graft is placed at the same time.
Which implant system does Toothi use?
Osstem TSIII implants, with Osstem OneGuide surgical guides for guided cases.
Book a free implant consultation (a £50 deposit online, refunded when you attend or give 24 hours’ notice) · WhatsApp us · 020 3148 2444
0% finance is available over up to 10 months on treatment over £250. Cherry Dental Ltd trading as Toothi is a credit broker, not a lender, authorised and regulated by the Financial Conduct Authority (FRN 957242). Credit is provided by Tabeo, subject to status. All fees are confirmed in a written treatment plan before any treatment begins.
