The aim of this systematic review and meta-analysis was to determine the accuracy of different methods of measuring horizontal condylar guidance (HCG) angle in comparison with extraoral Gothic arch tracing for completely edentulous patients. This was a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers searched the EBSCOhost, Cochrane Library, and PubMed/MEDLINE databases and the Google Scholar search engine for in vivo studies, randomized controlled trials, cross-sectional studies, and quasi-experimental studies published from January 2005 to December 2022 on various other methods of determining HCG angle in completely edentulous patients compared with extraoral Gothic arch tracing method. Meta-analysis was conducted from the reported quantitative data. A total of 513 articles were obtained from different electronic databases, of which 22 studies were included for qualitative synthesis and 20 studies were included for meta-analysis. For the right side, a statistically significant difference was observed for panoramic radiograph (P < 0.05, pooled mean difference = 5.08 [2.17, 7]) and cephalogram (P < 0.05, pooled mean difference = 10.65 [8.81, 12.49]), whereas no statistically significant difference was observed for cone-beam computed tomography (CBCT) (P = 0.41, pooled mean difference = 4.39 [-6.10, 14.87]) and protrusive interocclusal wax record (P = 0.92, pooled mean difference = -0.45 [-9.62, 8.72]) as compared with extraoral Gothic arch tracing method. For the left side, a statistically significant difference was observed for panoramic radiograph (P < 0.05, pooled mean difference = 5.07 [1.95, 8.18]) and cephalogram (P < 0.05, pooled mean difference = 10.24 [8.65, 11.83]), whereas no statistically significant difference was observed for CBCT (P = 0.31, pooled mean difference = 4.05 [-3.74, 11.84]) and protrusive interocclusal wax record (P = 0.72, pooled mean difference = -1.21 [-7.86, 5.43]) as compared with extraoral Gothic arch tracing method. The cephalogram and panoramic radiograph obtained higher HCG angles in completely edentulous patients than extraoral Gothic arch tracing.