Background: The accuracy of prosthetically driven implant placement relies heavily on the technique used for surgical guide fabrication. However, a significant challenge arises in accurately transferring the planned implant position to the surgical site. Aim of the study: the aim of this in vitro study is to compare between the accuracy of additive (3D printing) and subtractive methods (CAD/CAM Milling) in surgical guides fabrication. Materials and methods: cone beam computed tomography (CBCT) obtained from dental implant software library of demo case with missing mandibular first molar was used. The mandible was 3D printed to obtain the master cast. Prosthetically driven implant planning was done and fabrication of surgical guides using additive (3D Printing) and subtractive (CAD/CAM Milling) methods. Twenty-four duplicates of master cast were obtained by epoxy resin models. Models were divided into two equal groups according to the fabrication method. Implants were placed following guided surgery protocol using tooth supported surgical guides, followed by digitally scanning using scanning bodies connected to the implants. Supper imposition of planned and placed implants was performed using Geomagic software, and degree of deviation was calculated at point of entry, apical point, and angular deviation. The Mann-Whitney U test was used for comparison (P ≤0.05). Results: Statistically significant difference between SLA and milled groups was found for angular deviation (P