Background: Achieving an accurate three dimensional, prosthetically driven position of the implant is one of the most important goals for the future successful result. The contemporary protocol requires combination and merging the DICOM data from the CBCT cone beam scan, with the physical STL scan of the patient. But in some cases the accuracy of the alignment could be disturbed by the presence of scatter caused by preexisting metal alloy restorations or metallic brackets. Aim/Hypothesis: The purpose of the article is to present a clinical approach that could serve as a solution and to compare the accuracy of two different clinical approaches for merging images, guide indexing and clinical protocols cases with plenty of scatter. Materials and Methods: For the purpose of the study 27 cases with partial dental loss and preexisting PBM restorations were submitted to CBCT cone beam scan, for the purpose of implant placement with no additional radiographic appliances. Silicon impressions were taken and a study models were cast from plaster. A digitally planned radiographic stent was printed 3 D printed. A second CBCT was made for the same patient with the stents inserted. Two different settings were used for each patient on the platform of Implant studio 3Shape, to fabricate two separate guides. The first was a combination between the first “no stent” CBCT DICOM and the STL from the model, using the option for dental indexation of the STL. And the second was between the second CBCT DICOM “with the stent” and the STL, but using the setting for edentulous guide fabrication. The assessment was made on the base of the discrepancies that were obtained by using the automatic merge option, with no manual manipulation of the models. Results: Showed significant discrepancies between the two approaches. Better accuracy was registered on the “edentulous” approach on the cases with partial edentulation. Conclusions and Clinical Implications: A better clinical benefit can be derived using guided implant placement in cases with partial edentulation and presence of disturbing scatter, by choosing the edentulous approach instead of dental indexed approach. This method could be a powerful tool for resolving cases with present local artefacts, or scatter. Keywords: DICOM, STL, radiographic stent, guided surgery