As is widely known, in dental implant surgery, accurate three-dimensional positioning is essential to obtaining optimal results for a proper prosthetic rehabilitation . In recent years, the combination of cone beam computed tomography (CBCT) and computer-aided design/computer-aided manufacturing (CAD/CAM) technology began to play an important role in the field of oral implantology . This technology allows the production of Dent. J. 2023, 11, 123. https://doi.org/10.3390/dj11050123 https://www.mdpi.com/journal/dentistry Dent. J. 2023, 11, 123 2 of 12 different types of static surgical guides, using 3D printing technology [3,4]. As reported in a recent review, the accuracy of implant placement with computer-guided surgery has been reported in many studies (47) of traditional implantology . Deviations between the virtually planned and the placed implants might represent an aggregate of errors, from imaging through data processing to guiding the placement during surgery [6,7]. However, different authors reported that digital surgical guides can improve the accuracy of implant placement [5–9]. Zygomatic implant rehabilitation is an alternative treatment for patients with severe maxillary atrophy to avoid bone-lifting or grafting procedures . These long implants are inserted in a region with limited space and visibility. The implant’s apex must lie completely in the zygomatic bone both to respect many anatomical limitations and to achieve the maximum bone-implant contact . Hung et al. identified the posterior superior region and the central region of the zygomatic bone as suitable areas for implant tip placement . In this technique, a proper position is crucial to place the ZI without functional and aesthetic complications . The accuracy of the diagnostic and planning phases and the skill and experience of the operators are key factors in this surgery [14–16]. To date, guided surgery for the conventional implant is widely accepted as highprecision surgery [17–19]. For the same reason, guided surgery for the ZI based on bonesupported drill templates appears to be useful for increasing safety and accuracy . Obtaining the correct implant angulation is so crucial, especially for the multiple and contemporary ZI placements to achieve a complete restoration of the upper atrophic maxilla . Discrepancies between the planned and the real implant position have become a critical point in this advanced implant surgery. Consequently, an assessment of clinical accuracy is required to determine whether guided surgery errors are clinically acceptable [21,22]. The aim of this study was to perform a three-dimensional (3D) analysis to investigate the accuracy of a novel statical surgical guide applied to zygomatic implant placement using a reliable transfer guide from a planned cooperating theatre. The primary outcome was to compare the planned and the post-operative implant positions, evaluating angular discrepancies and linear deviations in all three spatial axes. No discrepancy between the planned and placed ZIs was considered as the null hypothesis.