Search Results (7,629)

Background: Total hip arthroplasty (THA) for the late sequelae of childhood septic hip arthritis is technically demanding, and infection-related risk remains incompletely defined. This systematic review and meta-analysis address the research question: “In adults undergoing THA after childhood septic arthritis of the hip, what is the incidence of post-THA infection, revision, and mechanical/neurologic complications?” We systematically reviewed and meta-analyzed outcomes after THA in patients with septic hip arthritis diagnosed at ≤18 years. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to 31 December 2025 (PRISMA). Eligible studies reported THA outcomes after childhood septic arthritis and met a Methodological Index for Non-Randomized Studies (MINORS) threshold (≥9). A random-effects meta-analysis of events per hip was performed. Results: Nine studies were included; eight contributed to the quantitative synthesis (343 hips). The pooled incidence of any post-THA infection was 1.55% (95% CI 0.38–3.48; I² = 23.8%; 5/343); when microbiology was available, no relapse due to the index organism was reported and events were classified as new infections. The pooled incidence of revision for any cause was 4.99% (95% CI 2.27–8.70; I² = 43.4%; 15/334). Non-infectious complications were clinically relevant, including intraoperative fracture (6.95%) and nerve palsy (4.84%). Evidence was limited by retrospective designs and heterogeneous reporting. Conclusions: THA after childhood septic hip arthritis demonstrates a low risk of postoperative infection, with relapse of the original pathogen appearing rare in carefully selected quiescent cases, but a clinically meaningful burden of mechanical and neurologic complications. These findings underscore the importance of careful preoperative assessment, meticulous surgical technique, and highlight the limitations of the current evidence. The protocol was registered in PROSPERO (ID: CRD420261298181). No external funding was received. Full article

Background: Surgical palatal techniques are established alternatives to continuous positive airway pressure (CPAP) in selective patients with obstructive sleep apnea (OSA) with retropalatal airway collapse. Anterior palatoplasty (AP) stiffens and advances the soft palate, whereas radiofrequency-assisted uvulopalatoplasty (RF-UPP) uses thermal ablation to reduce palatal tissue. This study aimed to compare the 6-month efficacy and morbidity of AP vs. RF-UPP in treating mild-to-moderate OSA. Materials and Methods: We conducted a single-center retrospective cohort study (March 2023–March 2025) of 86 adults (mean age ~42 years; 69.8% male) with mild-moderate OSA (apnea–hypopnea index [AHI] 5–30) due to palatal obstruction; 43 patients underwent AP and 43 patients underwent RF-UPP. Polysomnographic AHI, Epworth sleepiness scale (ESS), snoring severity (0–10 visual analog scale, VAS) and sleep-related quality of life (functional outcomes of sleep questionnaire, FOSQ) were analyzed at baseline and 6 months postoperatively. Postoperative pain (0–10 VAS), recovery time, and bleeding events were also assessed. Results: Baseline characteristics were similar between groups (AHI ~22 vs. 21 events/h; ESS ~11 vs. 10; snoring VAS ~8.4 vs. 8.2 in AP vs. RF-UPP, all p > 0.1). At 6 months, the AP group achieved a greater mean AHI reduction than the RF-UPP group (−13.5 ± 7.5 vs. −8.0 ± 7.2, p < 0.001), with post-treatment AHI averaging 8.5 ± 6.0 vs. 13.2 ± 6.5 events/h (AP vs. RF-UPP). AP yielded a higher surgical success rate (34/43 (79.1%) vs. 23/43 (53.5%), p = 0.012), meeting the criteria of ≥50% AHI reduction to <15; p = 0.01. Subjective outcomes improved in both groups, but AP showed greater mean reductions in ESS (−5.5 vs. −3.1 points, p = 0.001) and snoring VAS (−5.7 vs. −3.1, p = 0.002). The improvements in ESS, snoring VAS, and FOSQ scores were observed in both groups, with significantly greater gains after AP. Postoperative pain and time to resumption of normal diet were higher in the AP group. No major complications occurred in either group. Conclusions: Anterior palatoplasty demonstrated superior efficacy to RF-UPP in mild-moderate OSA at the expense of increased postoperative pain and a longer recovery period. AP may offer a greater therapeutic benefit in appropriately selected patients with palatal obstruction. Full article

Background/Objectives: Pericardial effusion (PEf) is a frequent finding after cardiac surgery. Progression to cardiac tamponade (CT) is a rare but life-threatening complication. Current evidence remains limited due to insufficient data on prevalence, progression predictors and management strategies. Methods: We retrospectively analyzed anamnestic, clinical, laboratory, echocardiographic and therapeutic data from 2662 patients (74 ± 11 years) admitted to the Cardiac Rehabilitation ward between 2022 and 2024. Results: Among 2152 (81%) cardiac surgery patients, 382 (18%) developed PEf: 58% mild, 38% moderate, and 4% severe. Patients developing PEf tended to be younger and more frequently male. In addition, PEf development was seen more commonly after aortic and combined surgeries. All patients with severe PEf or CT had undergone surgery via sternotomy, whereas minithoracotomy was inversely associated with PEf severity. Postoperative complications occurred in 92% of PEf patients, mainly due to arrhythmia, hemodynamic deterioration, or heart failure. Overall outcome was favourable in 98% of patients. CT occurred in eight patients (2%). Anticoagulation therapy was more frequent among patients who developed PEf or CT. Preventive colchicine was prescribed in only 16% of cases. No PEf-specific therapy was administered in 56% of PEf patients, while corticosteroids and nonsteroidal anti-inflammatory drugs were used in 28% and 8% of cases, respectively, without surgical wound complications. No PEf recurrences were observed during follow up (517 ± 424 days). Conclusions: PEf is a common complication after cardiac surgery, more frequently in young males, usually of mild or moderate severity. The majority of these cases resolve using either a conservative or pharmacological approach, predominantly via corticosteroids. Patients undergoing aortic surgery, experiencing postoperative complications (especially arrhythmias), and receiving anticoagulation therapy were associated with severe PEf or CT. Despite guideline recommendations, colchicine remains markedly underutilized. Full article

Background/Objectives: For men with bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) requiring surgical intervention, UroLift has been shown to be an effective and durable, minimally invasive method. Methods: A retrospective review was conducted for 72 patients who underwent UroLift at a single hospital in Australia between 2018 and 2025. Data regarding baseline demographics, the pre- and post-operative International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), the post-void residual (PVR), and complications were collected prospectively. Inclusion criteria for patients selected for UroLift were males over 50 years with a prostate volume between 20 and 70 mL, pre-operative PVR of <350 mL and Qmax and IPSSs of <15 mL/s and >12 respectively. The purpose of this study is to assess the clinical outcomes of patients treated with UroLift at our institution and compare these findings to the existing literature. Results: Complete data was available for 34 patients. Our cohort had a median age of 63.0 years (interquartile range [IQR] 58.0–69.0) and UroLift was performed using a median number of 4.05 implants per patient. Median prostate volume (mL) was 43.0 (IQR 38.0–59.0). Post-operatively, the median percentage changes in the IPSS, Qmax (mL/s) and PVR (mL) were −30.9% (IQR 5.8–−71.1, p = 0.0048), 40.1% (IQR −6.6–165.1, p = 0.0159) and −36.4% (IQR −84.6–29.8, p = 0.0232), respectively. Most patients (n = 24, 73.5%) were discharged on the same day of the UroLift procedure with the remainder (n = 9, 26.5%) being discharged on day 1 post-operatively. The median time (months) for post-operative review was 2 (IQR 0.9–3.3). Conclusions: UroLift is safe, effective, and a minimally invasive treatment option in suitable patients with bothersome LUTS requiring surgical intervention. Full article

Background/Objectives: The subciliary approach offers excellent exposure for orbital and zygomaticomaxillary complex fracture repair but is associated with a relatively high risk of postoperative lower eyelid ectropion. This study evaluated the preventive efficacy of an acellular dermal matrix (ADM; WITHderm^®) spacer graft placed during subciliary incision repair. Methods: This prospective observational cohort study included 20 patients who underwent open reduction and internal fixation for orbital wall or zygomaticomaxillary complex fractures using a subciliary approach between June and December 2024. A human-derived ADM (WITHderm^®) spacer graft was interposed between the orbital septum and the orbicularis oculi muscle during incision closure. Postoperative outcomes were assessed at three time points: ectropion grading at 1 month and scar outcomes at 3 and 6 months using the Patient and Observer Scar Assessment Scale (POSAS). Results: No patients developed postoperative lower eyelid ectropion at 1-month follow-up (0% incidence). Both patient-reported and observer-reported scar outcomes improved significantly over time. The mean total PSAS score decreased from 21.0 ± 2.85 at 3 months to 11.3 ± 2.13 at 6 months (p < 0.001), while the mean total OSAS score decreased from 21.35 ± 2.25 to 11.4 ± 1.67 (p < 0.001). Overall patient satisfaction and objective scar ratings also showed significant improvement. Conclusions: ADM (WITHderm^®) spacer grafting during subciliary incision repair appears to be a safe and effective strategy for preventing early postoperative lower eyelid ectropion and achieving favorable scar outcomes. Further studies are warranted to confirm these findings. Full article

Objective: This study investigates the prognostic value and clinical utility of the neutrophil percentage-to-albumin ratio (NPAR) in patients with resected non-small-cell lung cancer (NSCLC). Methods: We retrospectively included 335 patients with NSCLC who underwent lung resection at our institution between January 2017 and October 2018. Optimal cutoffs for preoperative and postoperative day 1 (D1) NPAR were determined using X-tile (version 3.6.1; Yale University, New Haven, CT, USA) to define high and low groups. Overall survival (OS) was evaluated using Kaplan–Meier analysis and Cox proportional hazards models. A perioperative NPAR trajectory (low–low, low–high, high–low, high–high) was constructed to characterize dynamic risk patterns. To mitigate potential bias associated with postoperative measurements, a D1 landmark analysis was performed. A nomogram was developed based on the multivariable model and assessed by calibration at 1, 3, and 5 years. Incremental clinical value beyond TNM stage and surgical approach was evaluated using decision curve analysis (DCA), as well as by 5-year continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: The optimal cutoffs for preoperative and postoperative D1 NPAR were 14.5 and 23.1, respectively. In univariate analyses, sex, smoking history, preoperative NPAR, postoperative D1 NPAR, pathologic type, TNM stage, surgical approach, and adjuvant therapy were associated with OS (all p < 0.01). In multivariable Cox regression, high preoperative NPAR (HR 1.896, 95% CI 1.135–3.168; p = 0.014) and high postoperative D1 NPAR (HR 1.905, 95% CI 1.097–3.305; p = 0.014) were independent risk factors, along with TNM stage (Stage II: HR 2.824, 95% CI 1.209–6.595; p = 0.016; Stage III: HR 9.470, 95% CI 4.935–18.171; p < 0.001) and open surgery (HR 2.350, 95% CI 1.341–4.117; p = 0.003). Trajectory analysis further stratified risk, with the high–high group showing the poorest survival (adjusted HR 3.48, 95% CI 1.43–8.47; p = 0.006). The association of postoperative NPAR persisted in the D1 landmark analysis (HR 1.836, 95% CI 1.071–3.148; p = 0.027). Adding NPAR to TNM stage and surgical approach improved 5-year risk reclassification (continuous NRI 0.377, 95% CI 0.094–0.659; IDI 0.028, 95% CI −0.002–0.054) and increased net benefit on DCA. The nomogram demonstrated acceptable calibration at 1, 3, and 5 years. Conclusions: This study demonstrates that NPAR serves as an independent prognostic marker for long-term outcomes in patients with NSCLC. The use of NPAR offers clinicians a comprehensive and precise tool for assessing patient prognosis. Full article

Background/Objectives: Obesity has been associated with the development and severity of benign prostatic hyperplasia (BPH), yet its influence on outcomes following definitive surgical management, like holmium laser enucleation of the prostate (HoLEP), remains unclear. Furthermore, gradation of body mass index (BMI) severity has yet to discern personalized outcome stratification. We evaluated BMI’s influence on perioperative, immediate, short-term follow-up, and patient-reported outcomes for HoLEP patients. Methods: We performed a retrospective review of a prospectively maintained database of patients undergoing HoLEP for BPH at a single institution between January 2021 and August 2025. Outcomes included operative characteristics, post-operative complications, and validated symptom score changes. Analyses treated BMI as both a continuous and categorical variable. Multivariable linear and logistic regression models adjusted for common colinear confounders. Results: Among 1445 patients, BMI was not associated with most immediate, three-month, or patient-reported outcomes. Surgical complications were low across all BMI categories, and post-operative reported outcomes indicating high success rate for HoLEP. Higher BMI correlated with a modest increase in enucleation time (β = 0.197; p = 0.0132), increased odds of dysuria (OR = 1.084; p < 0.001), and change in American Urological Association Symptom Score (β = 0.211; p = 0.0334). All other operative metrics, complication rates, continence outcomes, and symptom scores (17 other total) were independent of BMI. Conclusions: After adjustment for relevant confounders, BMI does not meaningfully predict surgical safety, functional recovery, or patient-reported benefit following HoLEP. BMI alone should not influence candidacy or risk stratification for HoLEP in patients with BPH, instead favoring personalized, risk-stratified approaches. Full article

Background/Objectives: Nipple-sparing mastectomy with immediate reconstruction is a preferred option for selected patients undergoing prophylactic or therapeutic mastectomy. Optimizing postoperative wound care is essential to support healing, preserve the nipple–areola complex, and prevent delays in oncologic treatments. This retrospective observational study aimed to evaluate the clinical outcomes associated with the use of the NovoX^® Cup medical device in post-NSM surgical wound management, assessing clinical–surgical outcomes and quality of life (QoL). Methods: We conducted a retrospective observational study on 54 patients who underwent NSM with immediate reconstruction at AOUI Verona between January 2025 and January 2026; Novox^® Cup was applied intraoperatively and changed every 48 h according to protocol. Surgeon-reported outcomes were assessed by the skin flap viability scale and the complications by Clavien–Dindo classification. Patient-reported outcomes were assessed via the Wound-QoL17 questionnaire at 7, 30, and 90 days. Clinical outcomes were supported by photographic documentation. Results: Mean age was 51.5 years; BMI averaged 23.9 kg/m². Local complications occurred in 30.4% of cases (infections 12%, dehiscence 10%, seromas 4%). Mean healing time was 15 days, with 87.4% of patients having drains removed by day 14. One patient required surgical revision, and one (1.8%) experienced delayed adjuvant therapy. Wound-QoL17 responses showed minimal discomfort and high satisfaction. Clinical evaluation revealed favorable wound appearance and preserved NAC perfusion within 48 h. Conclusions: Novox^® Cup appears effective in supporting wound healing and NAC preservation after NSM, with high patient satisfaction and minimal treatment delays. Its integration into postoperative care may enhance outcomes and maintain oncologic timelines. Full article

Background: Active middle ear implants (AMEIs) provide an alternative auditory rehabilitation strategy for patients who cannot tolerate conventional hearing aids. However, clinical data regarding the outcomes of Vibrant Soundbridge (VSB) implantation using the incus short process (SP) coupler in older adults remain limited. Objective: This study aimed to evaluate the audiological outcomes, patient-reported hearing benefits, tinnitus improvement, and surgical safety of VSB implantation using the SP coupler in older adults with bilateral sloping sensorineural hearing loss. Methods: This retrospective study included 45 older male veterans (mean age 76.1 ± 5.3 years) with bilateral sloping sensorineural hearing loss who underwent unilateral VSB implantation with the SP coupler between 2019 and 2023. Functional hearing gain was assessed using preoperative and postoperative sound-field pure-tone thresholds. Patient-reported outcomes were evaluated using the Speech, Spatial and Qualities of Hearing Scale (SSQ) and the Tinnitus Handicap Inventory (THI). Operative characteristics and postoperative complications were also analyzed. Results: Mean operative time was 40.2 ± 8.7 min. Functional hearing gain increased progressively across speech-critical frequencies, reaching +20 dB at 2 kHz and +30 dB at 4 kHz. The mean four-frequency pure tone average improved from 57.4 ± 8.3 dB HL preoperatively to 35.6 ± 6.9 dB HL postoperatively (p < 0.001). All SSQ subdomains showed significant improvement (p < 0.001). THI scores decreased significantly from 43.2 ± 8.4 to 17.1 ± 6.2 (p < 0.0001), with clinically meaningful tinnitus improvement observed in 75.6% of patients. No major surgical complications occurred. Conclusions: Vibrant Soundbridge implantation using the incus short process coupler provides effective auditory rehabilitation for older adults with sloping sensorineural hearing loss. The procedure yields meaningful high-frequency hearing gain, improved hearing-related quality of life, and significant tinnitus reduction while maintaining a favorable surgical safety profile. Restoration of auditory input through active middle ear implantation may also contribute to improved central auditory processing in older adults. Full article

Background: Idiopathic epiretinal membranes (iERMs) are treated with pars plana vitrectomy and epiretinal membrane peeling. Simultaneous internal limiting membrane (ILM) peeling could reduce the recurrent rate. We aimed to explore the anatomical and functional factors influencing recovery outcomes in patients with iERM after surgical intervention. Methods: We enrolled 85 eyes of 85 participants with iERM who underwent pars plana vitrectomy with ERM and ILM peeling from January to December 2020 in Kaohsiung Veterans Hospital. We analyzed ERM staging, preoperative and postoperative vision and findings of retinal microstructures, and thickness changes determined using optic coherence tomography (OCT), as well as pre- and postoperative inner and outer retinal layer thickness changes. Results: The mean age was 65.64 ± 6.19 years, and no ERM recurrence was observed within one year. Males comprised 44.71% of participants (38/85). The mean preoperative vision score was 0.47 [Snellen equivalent (SE), 68/200] ± 0.29 logMAR, and the mean final vision score was 0.32 (SE, 96/200) ± 0.30 logMAR. Visual improvements were significant (p < 0.001, paired t-test). Preoperative vision (β = 0.327, p = 0.010) and final lens status (β = 0.400, p = 0.002) were significantly correlated with final vision (R² = 0.309). Central foveal thickness and inner and outer retinal layer thickness decreased continuously until 12 months postoperatively in the pseudophakia group, whereas for those in the phakia group, the outer retinal layer thickness only decreased in the first 6 months. Conclusions: Poor initial vision and final phakia significantly worsened final visual outcomes. Postoperative vision, central foveal thickness, and thickness of the inner and outer retinal layers showed the continuous statistical improvement in pseudophakic eyes over 6 months. Full article

Background: Intravascular lithotripsy (IVL) has emerged as a novel vessel preparation device for patients with peripheral artery disease undergoing angioplasty. The IVL catheter includes an integrated balloon, which emits high pressure and transient sonic waves. The release of shockwaves results in cracking of intimal and medial calcium within the vessel wall improving lumen patency. Objectives: The aim of this prospective observational cohort study is to evaluate the morphological and imaging changes in atherosclerotic plaque in patients with PAD undergoing IVL as a vessel preparation technique, followed by angioplasty with drug-coated balloon (DCB) or stent placement if required. Secondary endpoint is to evaluate the efficacy of IVL in the perfusion of the lower extremities, by calculating the ankle–brachial index (ABI) and toe–brachial index (TBI) post-angioplasty, as well as adverse events within 30 days. Methods: Consecutive adult (≥18 years of age) patients with symptomatic femoropopliteal artery disease selected to undergo IVL will be included in the study. Computed tomography angiography (CTA) of the lower limbs will be performed pre- and postoperatively. Intraoperatively, an intravascular ultrasound (IVUS) will be used before and immediately post-angioplasty, for real-time evaluation of the morphological and quantitative changes in the atherosclerotic plaque. All participants will be clinically re-evaluated in 30 days postoperatively and a color Duplex ultrasound of the lower extremity arteries will be performed. The perfusion of the peripheral arteries will be assessed using ABI and TBI post-procedurally. Outcomes: The primary outcome is the quantitative assessment of changes in plaque morphology and volume within the index target lesion, based on pre- and post-procedural computed tomography angiography using TeraRecon™ (Durham, NC, USA) plaque analysis module, reflecting plaque modification and redistribution, in the context of IVL-based vessel preparation. Secondary outcomes include improvement of peripheral arterial perfusion and freedom from clinically driven target lesion revascularization (CD-TLR) and major adverse events. Full article

Background: Craniopharyngiomas are histologically benign but clinically aggressive epithelial tumors that pose significant surgical challenges due to their proximity to the hypothalamic–pituitary axis. While traditional transcranial approaches are well-established, the endoscopic endonasal transplanum–transtuberculum approach (EETTA) has emerged as a specialized corridor offering direct midline access. This systematic review evaluates the surgical efficacy, functional outcomes, and complication profiles of the EETTA over two decades of clinical evolution. Methods: Following PRISMA guidelines, a systematic search was conducted across five databases. Eligible studies included patients of all ages undergoing EETTA for craniopharyngioma. Data on the extent of resection (EOR), visual and endocrine outcomes, and CSF leak rates were extracted. Quality was assessed using NIH/JBI tools, and evidence was graded via AANS/CNS criteria. Results: Fifty-one studies (677 patients) were included. The cohort had a mean age of 43.4 years and predominantly suprasellar tumors (mean diameter 2.9–4.0 cm). Gross total resection (GTR) was achieved in 66.4% of cases (364/548). Postoperative visual improvement was reported in 79.8% of patients, while 7.1% experienced deterioration. Endocrine morbidity remained significant, with 120 patients developing new-onset diabetes insipidus and 105 developing new anterior pituitary deficits. The pooled CSF leak rate was 9.2%, with contemporary series frequently reporting 0% due to advanced multilayer reconstruction with nasoseptal flaps. The pooled recurrence rate was 7.8% over a mean follow-up of 37.4 months. Conclusions: The EETTA is a safe and effective primary strategy for suprasellar and retrochiasmatic craniopharyngiomas, offering more favorable visual outcomes and resection rates in this specific cohort. While endocrine dysfunction remains a pervasive challenge inherent to the tumor’s location, technical refinements in skull base reconstruction have successfully addressed historical concerns regarding CSF leaks. These findings support the use of the EETTA at high-volume centers with multidisciplinary expertise. Full article

Background: Lumboperitoneal (LP) shunt surgery is an established treatment for idiopathic normal pressure hydrocephalus (iNPH). In Japan, patients undergoing LP shunt surgery are often hospitalized for several days to more than one week after surgery, even in uncomplicated cases, reflecting concerns regarding early complications, cerebrospinal fluid overdrainage, and discharge readiness in older adults. This study evaluated the feasibility and short-term safety of a perioperative optimization pathway for planned short-stay hospitalization after LP shunt surgery. Methods: This single-center retrospective before-and-after cohort study included 15 consecutive patients who underwent elective LP shunt surgery. Six patients were managed using a conventional hospitalization pathway, whereas nine patients were treated under a short-stay pathway targeting discharge after one postoperative night. Key perioperative modifications included a uniform higher initial programmable valve pressure (level 7), structured discharge education, scheduled postoperative analgesia, waterproof wound sealing permitting early showering, and early outpatient follow-up with head computed tomography for staged valve pressure adjustment. The primary outcome was 30-day safety, defined as readmission, reoperation, or major postoperative complications. Results: Baseline characteristics were generally comparable between groups, although the short-stay group was slightly older and had more frequent antithrombotic therapy. Mean hospital length of stay was shorter in the short-stay group than in the conventional group (3.7 ± 2.0 vs. 9.7 ± 0.8 days; median, 3 vs. 9.5 days). Orthostatic headache requiring valve adjustment occurred in three conventional cases but in none of the short-stay patients. No patients in the short-stay group required readmission or reoperation within 30 days. Conclusions: In this pilot before-and-after study, a short-stay LP shunt pathway incorporating perioperative optimization and individualized discharge decision-making was feasible and was not associated with an apparent increase in early adverse events. These findings should be interpreted as exploratory and may support further evaluation of short-stay management strategies for selected patients undergoing LP shunt surgery in Japan. Full article

The accuracy of static computer-aided implant surgery (s-CAIS) is fundamental for predictable clinical outcomes. The objective of this study was to evaluate the influence of different guide-support modalities on the linear and angular accuracy of implant placement. In this retrospective clinical investigation conducted at a single specialty hospital, a total of 180 implants were analyzed, divided into three equal groups (n = 60) based on the guide support type: tooth-supported, bone-supported, and mucosa-supported. Accuracy was assessed by superimposing preoperative virtual plans with postoperative cone-beam computed tomography (CBCT) scans, measuring linear deviations at the neck and apex of the implant, as well as angular discrepancies. The type of guide support was found to be a significant factor associated with surgical accuracy (p < 0.001). Tooth-supported guides demonstrated the highest level of accuracy, with a mean angular deviation of 1.81° ± 0.45° and linear deviations at the neck and apex of 0.59 ± 0.18 mm and 0.73 ± 0.19 mm, respectively. These were followed by bone-supported guides (2.14° ± 0.48°; 1.04 ± 0.26 mm; 1.61 ± 0.31 mm), while mucosa-supported guides exhibited the greatest deviations (2.95° ± 0.60°; 1.47 ± 0.29 mm; 1.87 ± 0.37 mm). Significant intergroup differences and large effect sizes were observed, particularly regarding angular and horizontal discrepancies. These findings demonstrate a distinct gradient of accuracy based on guide support, establishing tooth-supported guides as the most accurate, followed by bone-supported and, lastly, mucosa-supported guides. While all modalities are clinically applicable, the use of mucosa-supported guides necessitates increased safety margins to account for the increased risk of linear and angular discrepancies inherent to mucosal tissue displacement. Full article