Abstract: Objective To compare the accuracy of pilot-drill guided and fully-guided immediate implant surgery in partially edentulous patients. Methods Forty-five partial edentulous patients (56 implants) in our hospital between January 2017 and June 2018 were randomly allocated to pilot-drill guided (PG) group (28 implants) and fully-guided (FG) group (28 implants) according to random number table. Cone beam CT (CBCT) was performed before the operation to collect data for three-dimensional reconstruction of teeth and jaw, simulation of implant 3D image design and producing guiding templates. PG and FG were performed in the two groups respectively. After implant insertion, CBCT was performed again for three-dimensional reconstruction. The deviations of positions and angulations of the implants were determined and calculated. The safety and stability (ISQ) of the implant were investigated at 4 w and 24 w after the operation. Results All 56 implants were successfully implanted under the guidance of template. AGD, AD, CGD, CLD, CVD, ALD and AVD in FG group were all lower than those in the PG group (all P<0.01). There was no significant difference in the safety and ISQ value between the two groups at 4 and 24 weeks after the operation (all P>0.05). Conclusions Digital template can provide a good technical support for immediate implant surgery. A higher degree of accuracy can be achieved by fully-guided surgery in immediate implant surgery of partially edentulous patients. PG and FG surgery demonstrate a similar safety and stability.