Accuracy of dental implant surgery with robotic position feedback and registration algorithm: An in-vitro study

Accuracy of robotic computer-assisted implant surgery in clinical studies: a systematic review and meta-analysis

OBJECTIVES

To analyze the accuracy of the robotic system in clinical studies and assess potential factors that might affect the accuracy of robotic implant placement.

MATERIALS AND METHODS

PubMed, Embase, and Cochrane Central Register of Controlled Trials were used to search for studies published from August 2014 till October 2024. Studies on robotic computer-assisted implant surgery (R-CAIS) were identified. Furthermore, manual searches were performed for selected journals. Only clinical studies were included. Subgroup analysis was performed based on robot autonomy, different dentitions, and the working principle of the camera.

RESULTS

Sixteen studies met the inclusion criteria, evaluating 908 implants. The meta-analysis of accuracy showed that the average global platform deviation, global apex deviation, and angular deviation were 0.69 mm (95% CI: 0.61‒0.77, I2 = 94%), 0.72 mm (95% CI: 0.64‒0.79, I2 = 93%), and 1.62° (95% CI: 1.34°‒1.89°, I2 = 96%), respectively. In subgroup analysis, Meta-generic inverse variance analysis observed statistically significant differences in global platform deviation and apex deviation between robots using infrared and mechanical tracking (p < 0.01), as well as between those using visible light and mechanical tracking (p < 0.01). No significant differences were observed between autonomous and semi-active systems and different dentitions.

CONCLUSION

The R-CAIS technology demonstrated a high level of accuracy. However, further large-scale, multi-center, randomized, controlled clinical trials are necessary to compare robotic implant placement with other techniques, and the additional factors influencing robotic implant placement must be explored.

Accuracy of robot and template systems in implant cases: A retrospective non-randomized controlled study

OBJECTIVES

This clinical study aimed to compare the accuracy of implant placement obtained using a robotic system and a full-guide template in patients with dentition defects.

MATERIALS AND METHODS

A total of 188 implants were placed in 130 patients with dentition defects. Among them, 94 implants were placed in 56 patients using the robotic system, and 94 implants were placed in 74 patients using the full-guide template. Deviations between ideal and actual implants were calculated postoperatively. The Mann-Whitney U test was used to compare the accuracy between the two groups.

RESULTS

Evaluation of the 94 implants in the r-CAIS group demonstrated an average 3D platform deviation of 0.52(0.27) mm (95 % confidence interval [CI]. 0.49-0.60), 3D apex deviation of 0.57(0.36) mm (95 % CI 0.58-0.69), and 3D angle deviation of 1.47(1.16) ° (95 % CI 1.40-1.76). Evaluation of 94 implants in the s-CAIS group exhibited an average 3D platform deviation of 0.90(0.73) mm (95 % CI 0.91-1.16), 3D apex deviation of 1.33(0.85) mm (95 % CI 1.24-1.53), and 3D angle deviation of 3.41(3.54) ° (95 % CI 3.22-4.07). Significant differences in accuracy were noted between the two groups (p < 0.05).

CONCLUSIONS

The implant accuracy of the robotic system was significantly higher than that of the full-guide template in patients with dentition defects.

CLINICAL SIGNIFICANCE

Implant robotic systems have undergone further functional upgrades based on template and dynamic navigation systems. Research indicates that in routine simple implant cases, the robotic system demonstrates stable and reliable implant placement accuracy. When clinical conditions permit, the robotic system can be preferred over the template system.

Accuracy of an autonomous dental implant robotic system versus static guide-assisted implant surgery: A retrospective clinical study

STATEMENT OF PROBLEM

The accuracy of implant placement is a prerequisite for prosthetically driven implant surgery and is necessary to ensure the long-term stability of dental implants. Imprecise implant position may bring difficulties for restoration, damage anatomic structures, affect peri-implant tissues, and lead to ultimate implant failure.

PURPOSE

The purpose of this retrospective clinical study was to compare the accuracy of implants placed with an autonomous dental implant robotic (ADIR) system with those placed with static computer assisted implant surgery (sCAIS).

MATERIAL AND METHODS

Thirty-nine participants were enrolled in this retrospective study: 20 participants had received implant surgery with the ADIR system and 19 participants had implants placed with sCAIS. The preoperative plans and postoperative cone beam computed tomography (CBCT) scans after implant placement were matched during the study. The coronal, apical, and angular deviations were measured and analyzed. A linear regression model was established to analyze the source of deviation. MANOVA was used to compare differences in the major outcome variables (α=.05).

RESULTS

A total of 60 implants were placed in 39 participants (30 in each of the 2 groups). The mean ±standard deviation coronal, apical, and angular deviation of the ADIR system group and sCAIS group were 0.43 ±0.18 mm versus 1.31 ±0.62 mm (P<.001), 0.56 ±0.18 mm versus 1.47 ±0.65 mm (P<.001), and 1.48 ±0.59 degrees versus 2.42 ±1.55 degrees (P=.003), respectively. In addition, there was no significant difference in accuracy in the different implant regions (anterior, premolar, molar, maxilla, mandible) (P>.05). No complications were observed.

CONCLUSIONS

The accuracy of the implant position using the ADIR system was significantly higher than with sCAIS, suggesting that the ADIR system can achieve minimally invasive and excellent accuracy. In addition, implant regions had no significant influence on the accuracy of implant placement. (Keywords: Robotic system, Implant surgery, Static guide, Autonomous, Accuracy).

Accuracy of robot-assisted implant surgery versus freehand placement: a retrospective clinical study

PURPOSE

This study evaluated the accuracy of implant placement using a robotic system (Remebot) compared to freehand surgery and explored factors influencing accuracy.

METHODS

This retrospective study included 95 implants placed in 65 patients, divided into robot-assisted (50 implants) and freehand (45 implants) groups. Platform, apical, and angular deviations were measured by superimposing preoperative plans and the postoperative CBCT images. Mean deviations between groups were compared, and regression analysis assessed the impact of implant dimensions and positioning on accuracy.

RESULTS

The robot-assisted group exhibited significantly lower mean deviations in platform (0.44 ± 0.17 mm), apical (0.46 ± 0.17 mm), and angular deviations (0.85 ± 0.47°) compared to the freehand group (1.38 ± 0.77 mm, 1.77 ± 0.82 mm, and 6.63 ± 3.90°, respectively; p < 0.001). Regression analysis indicated no significant impact of implant location, jaw type, or implant dimensions on the robotic system's accuracy, unlike the freehand placement where these factors influenced deviations.

CONCLUSIONS

Robot-assisted implant surgery significantly enhances accuracy and clinical safety compared to freehand techniques. Despite limitations, robotic surgery presents a promising advancement in implant dentistry by reducing human error.

Accuracy and operation procedure of robotic computer-aided implant surgery

This study assessed the accuracy of robotic computer-aided implant surgery (rCAIS) in partially edentulous patients using a standard operation procedure. Patients who underwent implant placement surgeries using the robotic system under a standard operation procedure were recruited. Deviations of dental implants were calculated after superimposition of the preoperative and postoperative cone-beam computed tomography (CBCT) images. The possible effects of the implant regions on these deviations were investigated. A total of 30 participants were enrolled in the study and 44 implants were inserted. The median (25th-75th percentile) global coronal deviation, global apical deviation, and angular deviation were 0.62 mm (0.46-1.00), 0.62 mm (0.49-1.01) and 1.16 (0.69-1.69) °, respectively. The jaw was a factor in the lateral coronal, vertical coronal, and vertical apical deviations (P < 0.05). Both the lateral coronal and apical deviations were greater for immediate implant placements than for delayed implant placements (P < 0.05). The implant dimensions significantly affected the apical deviation (P < 0.05). These results indicate that rCAIS based on a standard operation procedure is safe and accurate in partially edentulous patients. However, there remains a need to optimize robotic systems to simplify the workflow and improve their ability to recognize and respond to complex bone structures. Further clinical studies should also focus on comparing the long-term implant success rate and related complications of rCAIS with traditional approaches.

Clinical and in vitro application of robotic computer-assisted implant surgery: a scoping review

In recent years, the emergence and application of robotic computer-assisted implant surgery (r-CAIS) has resulted in a revolutionary shift in conventional implant diagnosis and treatment. This scoping review was performed to verify the null hypothesis that r-CAIS has a relatively high accuracy of within 1 mm, with relatively few complications and a short operative time. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). From the 3355 publications identified in the PubMed, Scopus, Web of Science, and Google Scholar databases, 28 were finally included after a comprehensive review and analysis. The null hypothesis is partly accepted, as r-CAIS has a relatively high accuracy (coronal and apical deviation within 1 mm), and no significant adverse events or complications have been reported to date, although additional confirmatory studies are needed. However, there is insufficient evidence for a shorter surgical time, and further clinical research on this topic is required.

Dental implant placement accuracy with robotic surgery compared to free-hand, static and dynamic computer assisted techniques: Systematic review and meta-analysis

Background

This systematic review and meta-analysis compared the accuracy of robotic-assisted dental implant placement (r-CAIS) with conventional freehand, static computer-assisted (s-CAIS), and dynamic computer-assisted (d-CAIS) techniques.

Methods

A comprehensive search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library from January 2000 to January 2024. Studies meeting PICOST criteria, including clinical and in vitro studies, were included. Data on coronal, apical, and angular deviations were extracted for meta-analysis. The risk of bias (RoB) was assessed using the QUIN RoB and JBI RoB tools.

Results

A total of 134 models and 100 patients with edentulous and partially edentulous arches were included. Eight studies (four in vitro, four in vivo) were reviewed, demonstrating that r-CAIS offers superior accuracy compared to freehand, s-CAIS, and d-CAIS techniques. Among the studies, two in vitro and two in vivo studies had a low RoB, while others had a high RoB. The meta-analysis of five studies showed significant improvements in coronal, apical, and angular deviations with robotic systems.

Conclusion

Robotic-assisted systems showed greater accuracy than traditional non-robotic systems. However, this finding should be interpreted with caution due to the limited number of clinical studies and potential funding biases. Moreover, the high cost of robotic systems presents challenges for routine clinical implementation. Future research should focus on cost-effectiveness and seek broader clinical validation.

Accuracy of robotic computer-assisted implant surgery for immediate implant placement: A retrospective case series study

OBJECTIVES

This study investigated the accuracy of robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement.

METHODS

Twenty cases with 20 implant sites were selected based on predefined inclusion criteria. The preparation of the implant bed and implant placement followed the standardized dental implant robotic surgery protocol. Postoperative cone-beam computed tomography scans were conducted to assess possible discrepancies between actual and planned implant positions.

RESULTS

The r-CAIS technology for immediate implant placement exhibited a mean global coronal deviation of 0.71 ± 0.27 mm (95% CI: 0.58-0.83 mm), a mean global apical deviation of 0.69 ± 0.26 mm (95% CI: 0.56-0.81 mm), and an angular deviation of 1.27 ± 0.47° (95% CI: 1.05-1.49°). A substantial number of deviations were observed buccally at both coronal (90%) and apical (95%) levels, with a consistent tendency for buccal deviation.

CONCLUSIONS

The r-CAIS technology proved a promising approach for immediate implantation in the anterior region, with satisfactory clinical outcomes. However, an optimized surgical protocol for r-CAIS technology is required for particular implant sites like extraction sockets or bone defects.

Prediction of primary stability via the force feedback of an autonomous dental implant robot

STATEMENT OF PROBLEM

While the high osteotomy and implant placement accuracy via robotic implant surgery has been verified, whether the force feedback in the osteotomy process can be used to determine appropriate primary implant stability remains unknown.

PURPOSE

The purpose of this in vitro study was to explore the relationship between the force feedback and the primary stability of implants placed by using an autonomous dental implant robot.

MATERIAL AND METHODS

Five groups (n=7) of wooden and polyurethane foam blocks were used to execute an implant surgery by using an autonomous implant robot. Tapered bone-level titanium dental implant replicas were placed in the blocks. The Young modulus, the maximal vertical and lateral drilling resistances, the position accuracy, and the insertion torque of implants were recorded. Simple linear regression, principal component analysis, and multiple linear regression were used. The osteotomy strategy for the implant site was adjusted according to the maximal vertical resistance of the pilot drill to achieve appropriate insertion torque. The correlation, Gompertz growth curve fitting of the insertion torque, and Young modulus were determined. The effect of the drilling resistances on the insertion torque was analyzed using 2-way ANOVA, simple linear regression, and the principal component analysis.

RESULTS

The vertical resistance of the Ø2.2-mm pilot drill, the Ø3.5-mm twist drill, and the Ø4.1-mm profile drill had a strong simple linear correlation with the insertion torque of the implants, and the lateral resistance had a moderate linear correlation with the insertion torque. The contributions of these 6 variables to the implant torque, among which the vertical resistance of the twist drill and the pilot drill ranked first and second, were comparable. Adjustments to the strategy of site preparation according to the vertical resistance of the pilot drill achieved appropriate insertion torque (P<.001).

CONCLUSIONS

The force feedback of the autonomous dental implant robot was significantly correlated with the insertion torque of implants, which may fit an interpretable mathematical model, allowing dental implants to be placed with predictable primary stability.

Accuracy and safety of implant placement with a novel semi-autonomous robotic-assisted surgical system: A translational research study

STATEMENT OF PROBLEM

Translational studies evaluating the feasibility, accuracy, and safety of semi-autonomous implant robots, from model test to animal experiment and clinical trial, are currently lacking.

PURPOSE

The purpose of this study was to evaluate the accuracy and safety of a novel semi-autonomous robotic-assisted surgical system (sa-RASS) in implant placement.

MATERIAL AND METHODS

A translational study was conducted to assess the application of the sa-RASS in a model test, an animal experiment, and a clinical controlled trial. The study included 45 resin models in the model test, 7 male beagle dogs in the animal experiment, and 60 participants who were recruited and randomly assigned to a freehand or a sa-RASS group in the clinical trial. The accuracy, surgical morbidity, complications, operator ratings of instrument safety, and satisfaction were recorded. Cone-beam computed tomography data were used to evaluate deviations between planned and placed implants. The data on deviations were analyzed using the Mann-Whitney U test. A linear regression model was established to analyze the variations in the deviations (α=.05).

RESULTS

The mean ±standard deviation of the platform, apex, and angulation deviations were 0.98 ±0.53 mm, 1.10 ±0.52 mm, and 1.45 ±0.60 degrees in the model test and 0.58 ±0.19, 0.59 ±0.22 mm, and 1.88 ±0.71 degrees in the animal experiment. In the clinical controlled study, the platform, apex, and angular deviations of the sa-RASS group and freehand group were 0.93 ±0.50 mm versus 1.45 ±0.86 mm (P<.01), 1.07 ±0.63 mm versus 2.05 ±1.16 mm (P<.001), and 3.10 ±1.68 degrees versus 7.94 ±3.55 degrees (P<.001). No complications, such as early implant failure, intraoperative hemorrhage, injuries to adjacent structures, or implant displacement beyond the apical anatomic limit, were observed in the sa-RASS group. The results of the linear regression model showed that age, sex, bone density, implant position, implant diameter, and length did not significantly influence the accuracy of implantation at the apex or the angulation (P>.05).

CONCLUSIONS

The sa-RASS was found to be more accurate than freehand placement, with high operational safety and low surgical morbidity.

Accuracy of robotic-assisted surgery for immediate implant placement in posterior teeth: a retrospective case series

BACKGROUND

Robotic computer-assisted implant surgery (r-CAIS) is a revolutionary innovation in oral implantation; however, the clinical feasibility of r-CAIS for immediate implant placement (IIP) in posterior teeth has not been verified. Thus, this study aimed to evaluate the accuracy of r-CAIS for IIP in posterior tooth regions.

METHODS

Patients with posterior teeth to be extracted and indicated to undergo r-CAIS were evaluated. The patients had positioning markers installed in the oral cavity and underwent cone-beam computed tomography (CBCT). Subsequently, minimally invasive tooth extractions were performed, and an individualised surgical plan was generated in the robotic software. After marker registration, implantation surgery was performed by the robotic arm under the supervision and assistance of the surgeons. Finally, the deviations between the planned and placed implants were evaluated based on preoperative and postoperative CBCT data.

RESULTS

A total of 12 patients were evaluated. No adverse events occurred during the surgery. The mean global coronal, global apical, and angular deviations were 0.46 ± 0.15 mm (95%CI:0.36 to 0.56 mm), 0.46 ± 0.14 mm (95%CI:0.37 to 0.54 mm), and 1.05 ± 0.55° (0.69 to 1.40°), respectively.

CONCLUSIONS

Under the limited conditions of this study, the r-CAIS exhibited high accuracy in posterior teeth IIP surgery. Further multicentre randomised controlled studies are required to confirm the feasibility of this technology.

Comparison of the positional accuracy of robotic guided dental implant placement with static guided and dynamic navigation systems: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The development of robotic computer assisted implant surgery (r-CAIS) offers advantages, but how the positional accuracy of r-CAIS compares with other forms of guided implant surgery remains unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the positional accuracy of r-CAIS and to compare the positional accuracy of r-CAIS with s-CAIS and d-CAIS.

MATERIAL AND METHODS

Five databases were systematically searched by 2 independent reviewers for articles published before May 2023. A manual search was also performed. Articles evaluating the positional accuracy of r-CAIS were included. The Cochrane risk of bias tool was used for the clinical studies, whereas the QUIN tool was used for the in vitro studies. A meta-analysis was performed to compare the positional accuracy of r-CAIS with d-CAIS.

RESULTS

Thirteen studies were included, with 9 in vitro studies, 4 clinical studies, and a total of 920 dental implants. A high risk of bias was noted in 6 studies and low to moderate in 7 studies. R-CAIS showed greater accuracy for the coronal, apical, and angular deviations compared with d-CAIS. (-0.17 [-0.24, 0.09], (P<.001); -0.21 [-0.36, -0.06] (P=.006), and -1.41 [-1.56, -1.26] (P<.001)) CONCLUSIONS: R-CAIS can provide improved positional accuracy compared with d-CAIS when considering coronal, apical, and angular deviations. However, evidence to compare the positional accuracy of r-CAIS with s-CAIS was insufficient. These results should be interpreted with caution because of the limited data and the bias noted in several studies.

Development and validation of a collaborative robotic platform based on monocular vision for oral surgery: an in vitro study

PURPOSE

Surgical robots effectively improve the accuracy and safety of surgical procedures. Current optical-navigated oral surgical robots are typically developed based on binocular vision positioning systems, which are susceptible to factors including obscured visibility, limited workplace, and ambient light interference. Hence, the purpose of this study was to develop a lightweight robotic platform based on monocular vision for oral surgery that enhances the precision and efficiency of surgical procedures.

METHODS

A monocular optical positioning system (MOPS) was applied to oral surgical robots, and a semi-autonomous robotic platform was developed utilizing monocular vision. A series of vitro experiments were designed to simulate dental implant procedures to evaluate the performance of optical positioning systems and assess the robotic system accuracy. The singular configuration detection and avoidance test, the collision detection and processing test, and the drilling test under slight movement were conducted to validate the safety of the robotic system.

RESULTS

The position error and rotation error of MOPS were 0.0906 ± 0.0762 mm and 0.0158 ± 0.0069 degrees, respectively. The attitude angle of robotic arms calculated by the forward and inverse solutions was accurate. Additionally, the robot's surgical calibration point exhibited an average error of 0.42 mm, with a maximum error of 0.57 mm. Meanwhile, the robot system was capable of effectively avoiding singularities and demonstrating robust safety measures in the presence of minor patient movements and collisions during vitro experiment procedures.

CONCLUSION

The results of this in vitro study demonstrate that the accuracy of MOPS meets clinical requirements, making it a promising alternative in the field of oral surgical robots. Further studies will be planned to make the monocular vision oral robot suitable for clinical application.

Digital workflow for complete arch immediate loading with a prefabricated interim prosthesis using autonomous robotic surgery: A dental technique

A fully digital workflow incorporating autonomous robotic surgery is described. A prefabricated interim prosthesis offers the potential to streamline the process and reduce chairside time. Adopting this digital workflow can simplify the treatment procedure and help minimize the overall time required for the provision of implant-supported prostheses.

The Use of Artificial Intelligence in Endodontics

Endodontics is the dental specialty foremost concerned with diseases of the pulp and periradicular tissues. Clinicians often face patients with varying symptoms, must critically assess radiographic images in 2 and 3 dimensions, derive complex diagnoses and decision making, and deliver sophisticated treatment. Paired with low intra- and interobserver agreement for radiographic interpretation and variations in treatment outcome resulting from nonstandardized clinical techniques, there exists an unmet need for support in the form of artificial intelligence (AI), providing automated biomedical image analysis, decision support, and assistance during treatment. In the past decade, there has been a steady increase in AI studies in endodontics but limited clinical application. This review focuses on critically assessing the recent advancements in endodontic AI research for clinical applications, including the detection and diagnosis of endodontic pathologies such as periapical lesions, fractures and resorptions, as well as clinical treatment outcome predictions. It discusses the benefits of AI-assisted diagnosis, treatment planning and execution, and future directions including augmented reality and robotics. It critically reviews the limitations and challenges imposed by the nature of endodontic data sets, AI transparency and generalization, and potential ethical dilemmas. In the near future, AI will significantly affect the everyday endodontic workflow, education, and continuous learning.

Accuracy of dental implant placement using different dynamic navigation and robotic systems: an in vitro study

Computer-aided implant surgery has undergone continuous development in recent years. In this study, active and passive systems of dynamic navigation were divided into active dynamic navigation system group and passive dynamic navigation system group (ADG and PDG), respectively. Active, passive and semi-active implant robots were divided into active robot group, passive robot group and semi-active robot group (ARG, PRG and SRG), respectively. Each group placed two implants (FDI tooth positions 31 and 36) in a model 12 times. The accuracy of 216 implants in 108 models were analysed. The coronal deviations of ADG, PDG, ARG, PRG and SRG were 0.85 ± 0.17 mm, 1.05 ± 0.42 mm, 0.29 ± 0.15 mm, 0.40 ± 0.16 mm and 0.33 ± 0.14 mm, respectively. The apical deviations of the five groups were 1.11 ± 0.23 mm, 1.07 ± 0.38 mm, 0.29 ± 0.15 mm, 0.50 ± 0.19 mm and 0.36 ± 0.16 mm, respectively. The axial deviations of the five groups were 1.78 ± 0.73°, 1.99 ± 1.20°, 0.61 ± 0.25°, 1.04 ± 0.37° and 0.42 ± 0.18°, respectively. The coronal, apical and axial deviations of ADG were higher than those of ARG, PRG and SRG (all P < 0.001). Similarly, the coronal, apical and axial deviations of PDG were higher than those of ARG, PRG, and SRG (all P < 0.001). Dynamic and robotic computer-aided implant surgery may show good implant accuracy in vitro. However, the accuracy and stability of implant robots are higher than those of dynamic navigation systems.

Robot-assisted surgery for dental implant placement: A narrative review

OBJECTIVE

To determine the current status and accuracy of robotic computer-assisted implant surgery (CAIS) applications by examining the associated clinical and experimental outcomes.

DATA AND SOURCES

PubMed, Medline, and Cochrane Library databases were searched for relevant studies published between January 2000 and November 2023, and focusing on robotic CAIS in dental implant surgery. All search results were then manually reviewed to identify only the pertinent articles. Only in vitro and clinical studies were included in this narrative review, with implant placement accuracy considered the main outcome.

RESULT

Based on our inclusion and exclusion criteria, we included 21 studies (with 1085 implant sites); of them, 8 were clinical studies, 12 were in vitro studies, and 1 included both an in vitro study and a case series. The ranges of the mean implant shoulder, apical, and angular deviations were respectively 0.43-1.04 mm, 0.53-1.06 mm, and 0.77°-3.77° in the clinical studies and 0.23-1.04 mm, 0.24-2.13 mm, and 0.43°-3.78° in the in vitro studies, respectively.

CONCLUSION

The accuracy of robotic CAIS in dental implant procedures appears to be within the clinically acceptable ranges. However, further relevant clinical trials validating the existing evidence are needed.

CLINICAL SIGNIFICANCE

Robotic CAIS can achieve clinically acceptable implant placement accuracy. This innovative technology may improve the precision and success rates of dental implant procedures, with benefit for surgeons and patients.

Accuracy analysis of robotic-assisted immediate implant placement: A retrospective case series

OBJECTIVES

This study aimed to investigate the accuracy of a robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement.

METHODS

Patients requiring immediate implant placement in the maxillary anterior region were enrolled for r-CAIS. Before surgery, the patients underwent a cone beam computed tomography (CBCT) scan with a positioning marker. Virtual implant placement position and drilling sequences were planned. Following spatial registration and calibration, the implants were placed with the robotic system under supervision. A postoperative CBCT was taken to control the actual implant positions. The DICOM data of the virtually planned and the actually placed implant were superimposed and registered through the accuracy verification software of the robotic system. The accuracy was calculated automatically. The deviation at the mesial-distal, labial-palatal, and apico-coronal directions were recorded.

RESULTS

Fifteen patients with 20 implants were included. No adverse surgical events or postoperative complications were reported. The global platform, apex, and angular deviation were 0.75 ± 0.20 mm (95 % CI: 0.65 to 0.84 mm), 0.70 ± 0.27 mm (95 % CI: 0.57 to 0.82 mm), and 1.17 ± 0.73° (95 % CI: 0.83 to 1.51°), respectively. Moreover, the vertical platform and apex deviation were 0.50 ± 0.31 mm, (95 % CI: 0.35 to 0.64 mm) and 0.48 ± 0.32 mm, (95 % CI: 0.33 to 0.63 mm), respectively. All the placed implant positions were further labial and apical than the planned ones, respectively.

CONCLUSIONS

High accuracy of immediate implant placement was achieved with the robotic system.

CLINICAL SIGNIFICANCE

Our study provided evidence to support the potential of the robotic system in implant placement, even in challenging scenarios.

Robot-assisted dental implant surgery procedure: A literature review

Robot-assisted dental surgery has gained significant attention in the field of dental implant therapy as an alternative to conventional free-hand surgery. It addresses challenges faced by human operators, such as limited visibility, operator fatigue, and lack of experience, which can lead to errors. Dental implant robots offer improved precision, efficiency, and stability, enhancing implant accuracy and reducing surgical risks. Accurate placement of dental implants is crucial to avoid complications during and after surgery. Robotic guidance in dental implant surgery provides several benefits. Firstly, the robotic arm offers haptic feedback, allowing physical guidance when placing the implant in the desired position. Secondly, a patient tracker integrated into the robotic system monitors patient movement and provides real-time feedback on a screen. This feature ensures that the surgeon is aware of any changes and can adjust accordingly. Lastly, the robotic system operates under human-robot collaboration, with the surgeon maintaining control and oversight throughout the procedure. Therefore, the objective of the current study is to review the dental implant robots, as well as accuracy and efficiency (e.g. operation and preparation time) of robot-assisted dental implant surgery procedures.

Accuracy of an autonomous dental implant robotic system in partial edentulism: A pilot clinical study

OBJECTIVES

Robots are increasingly being used for surgical procedures in various specialties. However, information about the accuracy of robot-assisted dental implant surgery is lacking. This pilot clinical study aimed to investigate the accuracy of an autonomous dental implant robotic (ADIR) system in partially edentulous cases.

MATERIAL AND METHODS

The ADIR system was used to place a total of 20 implants in 13 participants. Implant deviation from the planned positions was assessed to determine accuracy. The entry, apex, and angular deviations were described as means ± standard deviation. A two-sample t test was used to compare implant deviation between the flap and flapless groups and between maxillary and mandibular implants (α = .05).

RESULTS

The entry, apex, and angular deviations were 0.65 ± 0.32 mm, 0.66 ± 0.34 mm, and 1.52 ± 1.01°, respectively, with no statistically significant difference between the flap and flapless approaches (P > .05). No adverse events were encountered in any of the participants.

CONCLUSIONS

DIR accuracy in this clinical series was comparable to that reported for static and dynamic computer-assisted implant surgery. Robotic computer-assisted implant surgery may be useful for dental implant placement, potentially improving the quality and safety of the procedure.

CLINICAL RELEVANCE

The findings of this study showed that the ADIR system could be useful for dental implant surgery.

Accuracy of flapless surgery using an autonomous robotic system in full-arch immediate implant restoration: A case series

OBJECTIVES

This observational study aimed to evaluate the accuracy of robotic computer-assisted implant surgery (r-CAIS) for full-arch immediate restoration and to analyse possible factors contributing to deviations.

METHODS

Three edentulous patients (five arches) underwent r-CAIS. Osteotomies were performed using an autonomous robot under the surgeon's supervision, and implant placement was performed in a freehand or robotic manner. Prefabricated provisional prostheses were delivered immediately after surgery. Postoperative cone beam computed tomography scans were performed to assess the deviations between the planned and placed implants. Statistics were compared with deviations of s-CAIS outlined in a meta-analysis.

RESULTS

A sum of 28 implants were used. The mean global coronal and apical deviations measured 0.91 ± 0.43 mm and 1.01 ± 0.45 mm, respectively, and the mean angular deviation measured 1.21 ± 1.24 º. The r-CAIS showed significantly better precision than the s-CAIS in full-arch cases (P < 0.001). The implants inserted using the robotic arm exhibited fewer deviations than those placed in the freehand manner. Eighty percent of prefabricated provisional prostheses were successfully delivered.

CONCLUSIONS

Within the limitations of the present study, our data suggest that autonomous r-CAIS is a feasible approach for simultaneous immediate restoration in edentulous patients, showing better accuracy than s-CAIS. Further large-scale studies are necessary to verify the advantages and disadvantages of this novel technique and to explore possible factors that influence its accuracy.

CLINICAL SIGNIFICANCE

Autonomous r-CAIS can provide clinically acceptable implant placement accuracy in edentulous patients, significantly surpassing s-CAIS. This level of accuracy may represent a viable therapeutic approach for simultaneous immediate full-arch restoration.

Fully automatic AI segmentation of oral surgery-related tissues based on cone beam computed tomography images

Accurate segmentation of oral surgery-related tissues from cone beam computed tomography (CBCT) images can significantly accelerate treatment planning and improve surgical accuracy. In this paper, we propose a fully automated tissue segmentation system for dental implant surgery. Specifically, we propose an image preprocessing method based on data distribution histograms, which can adaptively process CBCT images with different parameters. Based on this, we use the bone segmentation network to obtain the segmentation results of alveolar bone, teeth, and maxillary sinus. We use the tooth and mandibular regions as the ROI regions of tooth segmentation and mandibular nerve tube segmentation to achieve the corresponding tasks. The tooth segmentation results can obtain the order information of the dentition. The corresponding experimental results show that our method can achieve higher segmentation accuracy and efficiency compared to existing methods. Its average Dice scores on the tooth, alveolar bone, maxillary sinus, and mandibular canal segmentation tasks were 96.5%, 95.4%, 93.6%, and 94.8%, respectively. These results demonstrate that it can accelerate the development of digital dentistry.

Artificial Intelligence in Endodontic Education

AIMS

The future dental and endodontic education must adapt to the current digitalized healthcare system in a hyper-connected world. The purpose of this scoping review was to investigate the ways an endodontic education curriculum could benefit from the implementation of artificial intelligence (AI) and overcome the limitations of this technology in the delivery of healthcare to patients.

METHODS

An electronic search was carried out up to December 2023 using MEDLINE, Web of Science, Cochrane Library, and a manual search of reference literature. Grey literature, ongoing clinical trials were also searched using ClinicalTrials.gov.

RESULTS

The search identified 251 records, of which 35 were deemed relevant to artificial intelligence (AI) and Endodontic education. Areas in which AI might aid students with their didactic and clinical endodontic education were identified as follows: 1) radiographic interpretation; 2) differential diagnosis; 3) treatment planning and decision-making; 4) case difficulty assessment; 5) preclinical training; 6) advanced clinical simulation and case-based training, 7) real-time clinical guidance; 8) autonomous systems and robotics; 9) progress evaluation and personalized education; 10) calibration and standardization.

CONCLUSIONS

AI in endodontic education will support clinical and didactic teaching through individualized feedback; enhanced, augmented, and virtually generated training aids; automated detection and diagnosis; treatment planning and decision support; and AI-based student progress evaluation, and personalized education. Its implementation will inarguably change the current concept of teaching Endodontics. Dental educators would benefit from introducing AI in clinical and didactic pedagogy; however, they must be aware of AI's limitations and challenges to overcome.

The evolution of robotics: research and application progress of dental implant robotic systems

The use of robots to augment human capabilities and assist in work has long been an aspiration. Robotics has been developing since the 1960s when the first industrial robot was introduced. As technology has advanced, robotic-assisted surgery has shown numerous advantages, including more precision, efficiency, minimal invasiveness, and safety than is possible with conventional techniques, which are research hotspots and cutting-edge trends. This article reviewed the history of medical robot development and seminal research papers about current research progress. Taking the autonomous dental implant robotic system as an example, the advantages and prospects of medical robotic systems would be discussed which would provide a reference for future research.

Navigating the future of guided dental implantology: A scoping review

BACKGROUND

The aim of this scoping review was to understand the development of robotics and its accuracy in placing dental implants when compared to other forms of guided surgery.

METHODS

An electronic search was conducted on the electronic databases of PubMed, Cochrane, and Science direct with the following queries: ((robotics) AND (dental implant)) AND (accuracy). The search timeline was between 2017 and 2022.

RESULTS

A total of 54 articles were screened for title and abstract, of which 16 were deemed eligible for inclusion. Thirty-one articles were excluded mainly because they were out of topic (not relevant) or not in English. In total, 16 articles were included for analysis.

CONCLUSIONS

This review thoroughly analyses 5 years of literature concerning the evolution of robotics in dental implant surgery, underscoring the necessity for additional research on nascent technologies reported and a comparative study with static and dynamic systems for clinical efficacy evaluation.

Accuracy of implant placement via dynamic navigation and autonomous robotic computer-assisted implant surgery methods: A retrospective study

OBJECTIVE

Optimal implant planning and placement allows the prosthesis to be well designed to achieve a satisfactory aesthetic and functional outcome. We aimed to compare deviations between implant planning and placement with the assistance of dynamic computer-assisted implant surgery (d-CAIS) or autonomous robotic computer-assisted implant surgery (r-CAIS) methods in a clinical setting.

METHODS

The retrospective analysis of medical records between 2021 July and 2022 December was conducted to compare the implantation accuracy of the d-CAIS and r-CAIS system in partially edentulous patients through cone-beam computed tomography. Patient-reported outcomes (PROs) were recorded using a visual analogue scale (VAS). The Kolmogorov-Smirnov test was used to check the data distribution. Student's t-test or Mann-Whitney U-test was used as appropriate, with a defined significant difference (p < .05).

RESULTS

Seventy-seven patients were analysed (124 implants), with 38 patients (62 implants) in the d-CAIS group and 39 patients (62 implants) in the r-CAIS group. The differences between d-CAIS and r-CAIS were 4.09 ± 1.79° versus 1.37 ± 0.92° (p < .001) in angular deviation; 1.25 ± 0.54 versus 0.68 ± 0.36 mm (p < .001) in coronal global deviation; 1.39 ± 0.52 versus 0.69 ± 0.36 mm (p < .001) in apical global deviation; the results of the PROMs showed no statistical difference between the two groups.

CONCLUSIONS

r-CAIS allows more accurate implant placement than the d-CAIS technology. And both groups achieved overall satisfactory outcomes via VAS (Chinese Clinical Trial Registry ChiCTR2300072004).

Improved positional accuracy of dental implant placement using a haptic and machine-vision-controlled collaborative surgery robot: A pilot randomized controlled trial

AIM

To compare the implant accuracy, safety and morbidity between robot-assisted and freehand dental implant placement.

MATERIALS AND METHODS

Subjects requiring single-site dental implant placement were recruited. Patients were randomly allocated to freehand implant placement and robot-assisted implant placement. Differences in positional accuracy of the implant, surgical morbidity and complications were assessed. The significance of intergroup differences was tested with an intention-to-treat analysis and a per-protocol (PP) analysis (excluding one patient due to calibration error).

RESULTS

Twenty patients (with a median age of 37, 13 female) were included. One subject assigned to the robotic arm was excluded from the PP analysis because of a large calibration error due to the dislodgement of the index. For robot-assisted and freehand implant placement, with the PP analysis, the median (25th-75th percentile) platform global deviation, apex global deviation and angular deviation were 1.23 (0.9-1.4) mm/1.9 (1.2-2.3) mm (p = .03, the Mann-Whitney U-test), 1.40 (1.1-1.6) mm/2.1 (1.7-3.9) mm (p < .01) and 3.0 (0.9-6.0)°/6.7 (2.2-13.9)° (p = .08), respectively. Both methods showed limited damage to the alveolar ridge and had similar peri- and post-operative morbidity and safety.

CONCLUSIONS

Robot-assisted implant placement enabled greater positional accuracy of the implant compared to freehand placement in this pilot trial. The robotic system should be further developed to simplify surgical procedures and improve accuracy and be validated in properly sized trials assessing the full spectrum of relevant outcomes.

Automation in Dentistry with Mechanical Drills and Lasers for Implant Osteotomy: A Narrative-Scoping Review

The popularity of implants is increasing with the aging population requiring oral-dental rehabilitation. There are several critical steps in the implant workflow, including case selection, implant design, surgical procedure, biological tissue responses, and functional restoration. Among these steps, surgical osteotomy procedures are a crucial determinant of clinical success. This brief review was aimed at outlining the current state of the field in automation-assisted implant surgical osteotomy technologies. A broad search of the literature was performed to identify current literature. The results are outlined in three broad categories: semi-automated static (image-guided) or dynamic (navigation-assisted) systems, and fully-automated robotic systems. As well as the current mechanical rotary approaches, the literature supporting the use of lasers in further refinement of these approaches is reviewed. The advantages and limitations of adopting autonomous technologies in practical clinical dental practices are discussed. In summary, advances in clinical technologies enable improved precision and efficacious clinical outcomes with implant dentistry. Hard-tissue lasers offer further advancements in precision, improved biological responses, and favorable clinical outcomes that require further investigation.

Preliminary study of a new macro-micro robot system for dental implant surgery: Design, development and control

BACKGROUND

This study aims to develop a new dental implant robotic system (DIRS) to relieve the burden and enhance the quality of dental implant surgery.

METHODS

The implanting actuator and system controller are two parts. The implanting actuator is designed on the basis of the RCM mechanism, with its kinematics modelled. Besides, a multi-DOF admittance control strategy and a hybrid position-admittance control strategy were designed, endowing the actuator with environmental compliance.

RESULTS

In force sensing, about 97% of mixed force/torque are eliminated. Then, 30 groups of implantation are done, of which 15 groups are simple implantation, while another 15 groups are force-based implantation. The results show that the average contact force/torque can be reduced by 73.03% and 62.66%, and the peak contact force/torque can be reduced by 68.26% and 50.46%.

CONCLUSIONS

The results of preliminary experiments validate the effectiveness of DIRS, which has great potential to assist dentists with higher efficiency, better quality, and lower burden.

Accuracy Comparison between Robot-Assisted Dental Implant Placement and Static/Dynamic Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis of In Vitro Studies

Background and Objectives: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to static computer-assisted implant surgery (SCAIS), dynamic computer-assisted implant surgery (DCAIS), and freehand procedures. This study aims to provide a comprehensive understanding of the precision of robot-assisted dental implant placement and its comparative efficacy in relation to other placement techniques. Methods: The guidelines recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to organize and compose this review. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane) were systematically searched for pertinent articles. Articles were selected following the inclusion and exclusion criteria. Qualitative and quantitative analyses of the selected articles were performed. Results: The initial electronic search resulted in 1087 hits. Based on the inclusion and exclusion criteria, five articles were selected for qualitative analysis, out of which three were considered for quantitative analysis. Three parameters were considered for accuracy evaluation (angular, coronal, and apical deviation). The mean angular deviation was -1.22 degrees (95% CI, -1.06--1.39), the mean coronal deviation was -0.15 mm (95% CI, -0.24--0.07), and the mean apical deviation was -0.19 mm (95% CI, -0.27--0.10). Conclusions: The robotic implant system was found to have significantly lower angular deviations and insignificantly lower coronal and apical deviations compared to DCAIS. Within the limitations of this review, it can be concluded that robot-assisted implant placement in resin models permits higher accuracy compared to DCAIS and SCAIS systems. However, due to the limited number of comparative studies with high heterogeneity, the findings of this review should be interpreted with caution. Further research is necessary to confirm the clinical application of robotics in implant surgery.

Advancing accuracy in guided implant placement: A comprehensive meta-analysis: Meta-Analysis evaluation of the accuracy of available implant placement Methods

OBJECTIVES

This meta-analysis aimed to determine the accuracy of currently available computer-assisted implant surgery (CAIS) modalities under in vitro conditions and investigate whether these novel techniques can achieve clinically acceptable accuracy.

DATA

In vitro studies comparing the postoperative implant position with the preoperative plan were included. Risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool) and a sensitivity analysis was conducted using funnel plots.

SOURCES

A systematic search was performed on April 18, 2023, using the following three databases: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials. No filters or restrictions were applied during the search.

RESULTS

A total of 5,894 studies were included following study selection. Robotic- and static CAIS (sCAIS) had the most accurate and clinically acceptable outcomes. sCAIS was further divided according to the guidance level. Among the sCAIS groups, fully guided implant placement had the greatest accuracy. Augmented reality-based CAIS (AR-based CAIS) had clinically acceptable results for all the outcomes except for apical global deviation. Dynamic CAIS (dCAIS) demonstrated clinically safe results, except for horizontal apical deviation. Freehand implant placement was associated with the greatest number of errors.

CONCLUSIONS

Fully guided sCAIS demonstrated the most predictable outcomes, whereas freehand sCAIS demonstrated the lowest accuracy. AR-based and robotic CAIS may be promising alternatives.

CLINICAL SIGNIFICANCE

To our knowledge, this is the first meta-analysis to evaluate the accuracy of robotic CAIS and investigate the accuracy of various CAIS modalities.

Accuracy of a Novel Semi-Autonomous Robotic-Assisted Surgery System for Single Implant Placement: a Case Series

OBJECTIVE

This study aimed to evaluate the accuracy of dental implant placement at single-tooth sites using a novel semi-autonomous robotic-assisted surgery system (sa-RASS).

METHODS

Patients with single missing teeth were included. Cone-beam computed tomography (CBCT) was performed prior to surgery using a U-shaped silicone tube to develop a virtual implant placement and drilling plan. The sa-RASS was used for implant osteotomy and placement in conjunction with a surgeon. Cone-beam computed tomography data were utilised to evaluate deviations between planned and placed implants using a three-dimensional Slicer software. Data were analysed using the t-test and analysis of variance. Statistical significance was considered at P<0.05.

RESULTS

Nineteen implants were placed using the sa-RASS. No adverse events or complications were observed during the surgery. Mean ± standard deviations between planned and postoperative implant positions were 0.90 ± 0.41 mm at the platform, 1.04 ± 0.47 mm at the apex, and 3.37 ± 1.51° for angulation. In a lateral direction, deviations were 0.72 ± 0.38 mm and 0.88 ± 0.47 mm at the platform and apex, respectively. Deviations in depth were all <1mm at both the platform (0.46 ± 0.33 mm) and apex (0.45 ± 0.32 mm). The apex deviation was greater than that at the platform (p = 0.036 < 0.05), mainly in the lateral distance (p = 0.037 < 0.05).

CONCLUSIONS

The current study illustrate that this robotic implant system is sufficiently accurate for single-tooth implant placement.

CLINICAL SIGNIFICANCE

This study provides significant evidence to support the use of sa-RASS as a potential alternative to static guided surgery and dynamic navigation, in dental implant surgery.

A systematic review of the accuracy of digital surgical guides for dental implantation

PURPOSE

This review aimed to reveal the influence of implant guides on surgical accuracy with regard to supporting types, manufacturing methods and design (including fixation screws and sleeves).

METHODS

A literature search related to accuracy of surgical guides for dental implantation was performed in Web of Science and PubMed. Studies with in vivo or in vitro deviation data published in recent 5 years (2018-2022) were included and assessed by Newcastle-Ottawa Scale with regard to risk of bias and reliability degree of clinical studies. Accuracy-related deviation data were summarized as forest plots and normal distributions.

RESULTS

Forty-one articles were included with high degree of credibility. Data showed that implant surgery accuracy can be achieved with mean distance deviation < 2 mm (most < 1 mm) and angular deviation < 8° (most < 5°).

CONCLUSIONS

Bilateral tooth-supported guides exhibited highest in vitro accuracy and similar in vivo accuracy to unilateral tooth-supported guides; mucosa-supported guides exhibit lowest in vivo accuracy, while its in vitro data showed low credibility due to mechanical complexity of living mucosa tissue. Milling exhibited higher in vivo accuracy of guides than 3d-printing, though further data support was needed. Design of fixation screws and sleeves of implant guides affected the surgical accuracy and might remain a research focus in near future. However, lack of universal evaluation standards for implantation accuracy remained a major problem in this field. The influence of implant guides on surgical accuracy revealed in this review might shed light on future development of dental implantology.

Accuracy and efficiency of robotic dental implant surgery with different human-robot interactions: An in vitro study

OBJECTIVES

This study aims to compare the surgical efficiency (preparation and operation time) and accuracy of implant placement between robots with different human-robot interactions.

METHODS

The implant robots were divided into three groups: semi-active robot (SR), active robot (AR) and passive robot (PR). Each robot placed two implants (#31 and #36) on a phantom, practising 10 times. The surgical efficiency and accuracy of implant placement were then evaluated.

RESULTS

Sixty implants were placed in 30 phantoms. The mean preparation times for the AR, PR and SR groups were 3.85 ± 0.17 min, 2.14 ± 0.06 mins and 1.65 ± 0.19 mins, respectively. The mean operation time of the PR group (3.76 ± 0.59 min) was shorter that of than the AR (4.89 ± 0.70 mins) and SR (4.59 ± 0.56 min) groups (all P < 0.001). The operation time of the AR group in the anterior region (4.47 ± 0.31 min) was longer than that of the SR group (4.07 ± 0.10 min) (P = 0.007). The mean coronal, apical and axial deviations of the PR group (0.40 ± 0.12 mm, 0.49 ± 0.13 mm, 0.96 ± 0.22°) were higher than those of the AR (0.23 ± 0.11 mm, 0.24 ± 0.11 mm, 0.54 ± 0.20 °) (all P < 0.001) and SR (0.31 ± 0.10 mm, 0.36 ± 0.12 mm, 0.43 ± 0.14 °) groups (P = 0.044, P = 0.002, and P < 0.001, respectively).

CONCLUSIONS

Human-robot interactions affect the efficiency of implant surgery. Active and semi-active robots show comparable implant accuracy. However, the implants placed by the passive robot show higher deviations.

CLINICAL SIGNIFICANCE

This in vitro study preliminarily demonstrates that implant placement is accurate when using implant robots with different human-robot interactions. However, different human-robot interactions have variable surgical efficiencies.

Accuracy of implant site preparation in robotic navigated dental implant surgery

BACKGROUND

Modern technological advancements have led to increase in the development of surgical robots in dentistry, resulting in excellent clinical treatment outcomes.

PURPOSE

This study aimed to determine the accuracy of automatic robotic implant site preparation for different implant sizes by correlating planned and posttreatment positions, and to compare the performance of robotic and human freehand drilling.

METHOD

Seventy-six drilling sites on partially edentulous models were used, with three different implant sizes (Ø = 3.5 × 10 mm, 4.0 × 10 mm, 5.0 × 10 mm). The robotic procedure was performed using software for calibration and step-by-step drilling processes. After robotic drilling, deviations in the implant position from the planned position were determined. The angulation, depth, and coronal and apical diameters on the sagittal plane of sockets created by human and robotic drilling were measured.

RESULTS

The deviation of the robotic system was 3.78° ± 1.97° (angulation), 0.58 ± 0.36 mm (entry point), and 0.99 ± 0.56 mm (apical point). Comparison of implant groups showed the largest deviation from the planned position for 5 mm implants. On the sagittal plane, there were no significant differences between robotic and human surgery except for the 5-mm implant angulation, indicating similar quality between human and robotic drilling. Based on standard implant measurements, robotic drilling exhibited comparable performance to freehand human drilling.

CONCLUSIONS

A robotic surgical system can provide the greatest accuracy and reliability regarding the preoperative plan for small implant diameters. In addition, the accuracy of robotic drilling for anterior implant surgery can also be comparable to that of human drilling.

Modular robot interface for a smart operating theater

This paper discusses the architecture and implementation of a modular component of the smart operating theater digital twin, designed to control robotic equipment-the robot interface module. This interface is designed to ensure equipment operation both in a real smart operating theater and in the virtual space of its digital twin-the computer simulation. Using such an interface in the digital twin will make it possible to use it in computer-assisted training of surgeons, preliminary planning, post-analysis, and simulation, preceding the operation of real equipment. An experimental implementation of a prototype robot interface to enable the KUKA LBR Med 14 R820 medical robot operation using the FRI protocol was developed, and experiments were performed on real equipment and its digital twin.

Accuracy and safety of a haptic operated and machine vision controlled collaborative robot for dental implant placement: A translational study

OBJECTIVES

Multiple generations of medical robots have revolutionized surgery. Their application to dental implants is still in its infancy. Co-operating robots (cobots) have great potential to improve the accuracy of implant placement, overcoming the limitations of static and dynamic navigation. This study reports the accuracy of robot-assisted dental implant placement in a preclinical model and further applies the robotic system in a clinical case series.

MATERIALS AND METHODS

In model analyses, the use of a lock-on structure at robot arm-handpiece was tested in resin arch models. In a clinical case series, patients with single missing teeth or edentulous arch were included. Robot-assisted implant placement was performed. Surgery time was recorded. Implant platform deviation, apex deviation, and angular deviation were measured. Factors influencing implant accuracy were analyzed.

RESULTS

The in vitro results showed that with a lock-on structure, the mean (SD) of platform deviation, apex deviation, and angular deviation were 0.37 (0.14) mm, 0.44 (0.17) mm, and 0.75 (0.29)°, respectively. Twenty-one patients (28 implants) were included in the clinical case series, 2 with arches and 19 with single missing teeth. The median surgery time for single missing teeth was 23 (IQ range 20-25) min. The surgery time for the two edentulous arches was 47 and 70 min. The mean (SD) of platform deviation, apex deviation, and angular deviation was 0.54 (0.17) mm, 0.54 (0.11) mm, and 0.79 (0.22)° for single missing teeth and for 0.53 (0.17) mm, 0.58 (0.17) mm, and 0.77 (0.26)° for an edentulous arch. Implants placed in the mandible had significantly larger apex deviation than those in the maxilla.

CONCLUSION

Cobot-assisted dental implant placement showed excellent positional accuracy and safety in both the in vitro study and the clinical case series. More technological development and clinical research are needed to support the introduction of robotic surgery in oral implantology. Trial registered in ChiCTR2100050885.

Accuracy of dental implant placement with a robotic system in partially edentulous patients: A prospective, single-arm clinical trial

OBJECTIVES

This clinical study aimed to assess the accuracy of implant positions using a robotic system in partially edentulous patients.

MATERIALS AND METHODS

Twenty-eight partially edentulous patients received 31 implants using the robotic system. Deviations between the planned and placed implants were calculated after surgery. The deviations were compared with objective performance goals (OPGs) from reported studies of fully guided static computer-assisted implant surgery (CAIS) and dynamic CAIS. A multiple linear regression analysis was performed to investigate the possible effects of the type and side of the arch, implant location, and implant dimensions on the deviations.

RESULTS

The evaluation of 31 implants resulted in a mean angle deviation of 2.81 ± 1.13° (95% confidence interval (CI): 2.40-3.23°), while the 3D deviations at the implant shoulder and apex were 0.53 ± 0.23 mm (95% CI 0.45-0.62 mm) and 0.53 ± 0.24 mm (95% CI 0.44-0.61 mm), respectively. The upper limits of the 95% CI of 3D deviations were lower than those of the corresponding OPGs; however, the angle deviation was similar to that of the OPG. No statistically significant differences were found for the type and side of the arch, implant location, and implant dimensions to the deviations (p > .05).

CONCLUSIONS

The robotic system appears to achieve higher accuracy in implant positions than static and dynamic CAIS in partially edentulous patients (Chinese Clinical Trial Registry ChiCTR2300067587).

Accuracy of autonomous robotic surgery for single-tooth implant placement: A case series

OBJECTIVES

This study aimed to investigate the accuracy of the autonomous robotic computer-assisted implant surgery (r-CAIS) for single-tooth implant placement.

METHODS

Patients with a single missing tooth were enrolled for the autonomous robotic implant surgery. The patients underwent a cone-beam computed tomography (CBCT) scan with a positioning marker. Virtual preoperative implant placement and a drilling plan were created before surgery. The robotic system automatically performed the implant osteotomy and placement intraoperatively under the surgeon's supervision. A postoperative CBCT scan was performed to evaluate the deviations between the planned and placed implants.

RESULTS

Ten patients with single dental implant placement were enrolled. No adverse surgical events and postoperative complications (i.e., infection and early implant failure) were reported. The autonomous robotic implant surgery exhibited a mean overall coronal deviation of 0.74 mm (95% CI: 0.53 to 0.94 mm), a mean overall apical deviation of 0.73 mm (95% CI: 0.53 to 0.93 mm), and an angular deviation of 1.11° (95% CI: 0.78 to 1.44°), respectively.

CONCLUSIONS

The high accuracy of autonomous r-CAIS technology in single-tooth implant placement was attributed to the control of the angular deviation and axial errors.

CLINICAL SIGNIFICANCE

The main findings of this study provide significant evidence to support the autonomous robotic implant surgery system as a potential alternative in dental implant surgery.

Robotics in Dentistry: A Narrative Review

BACKGROUND

Robotics is progressing rapidly. The aim of this study was to provide a comprehensive overview of the basic and applied research status of robotics in dentistry and discusses its development and application prospects in several major professional fields of dentistry.

METHODS

A literature search was conducted on databases: MEDLINE, IEEE and Cochrane Library, using MeSH terms: ["robotics" and "dentistry"].

RESULT

Forty-nine articles were eventually selected according to certain inclusion criteria. There were 12 studies on prosthodontics, reaching 24%; 11 studies were on dental implantology, accounting for 23%. Scholars from China published the most articles, followed by Japan and the United States. The number of articles published between 2011 and 2015 was the largest.

CONCLUSIONS

With the advancement of science and technology, the applications of robots in dental medicine has promoted the development of intelligent, precise, and minimally invasive dental treatments. Currently, robots are used in basic and applied research in various specialized fields of dentistry. Automatic tooth-crown-preparation robots, tooth-arrangement robots, drilling robots, and orthodontic archwire-bending robots that meet clinical requirements have been developed. We believe that in the near future, robots will change the existing dental treatment model and guide new directions for further development.

The accuracy of a novel image-guided hybrid robotic system for dental implant placement: An in vitro study

BACKGROUND

This in vitro study aims to evaluate the accuracy of dental implant placement by a novel image-guided hybrid robotic system for dental implant surgery (HRS-DIS).

METHODS

The HRS-DIS with a 5 degree of freedom (DOF) serial manipulator and a 6 DOF Stewart platform was developed. To evaluate the accuracy of repeated drilling, the holes were prepared twice with a 2.2 mm drill. To evaluate the accuracy of dental implant placement, the entry, exit and angle deviations of dental implants were measured.

RESULTS

Twenty-four holes were prepared twice, and mean (±SD) of diameters were measured as 2.2 ± 0.02 mm. A total of 160 dental implants were placed in 32 phantoms by HRS-DIS. The mean (±SD) of the entry, exit and angle deviation were 0.8 ± 0.54 mm, 0.87 ± 0.54 mm and 1.0 1 ± 0.44°, respectively.

CONCLUSIONS

The results of the in vitro study preliminarily validated that the HRS-DIS could provide a high accuracy for dental implant surgery.

Dental Implant Navigation System Based on Trinocular Stereo Vision

Traditional dental implant navigation systems (DINS) based on binocular stereo vision (BSV) have limitations, for example, weak anti-occlusion abilities, as well as problems with feature point mismatching. These shortcomings limit the operators’ operation scope, and the instruments may even cause damage to the adjacent important blood vessels, nerves, and other anatomical structures. Trinocular stereo vision (TSV) is introduced to DINS to improve the accuracy and safety of dental implants in this study. High positioning accuracy is provided by adding cameras. When one of the cameras is blocked, spatial positioning can still be achieved, and doctors can adjust to system tips; thus, the continuity and safety of the surgery is significantly improved. Some key technologies of DINS have also been updated. A bipolar line constraint algorithm based on TSV is proposed to eliminate the feature point mismatching problem. A reference template with active optical markers attached to the jaw measures head movement. A T-type template with active optical markers is used to obtain the position and direction of surgery instruments. The calibration algorithms of endpoint, axis, and drill are proposed for 3D display of the surgical instrument in real time. With the preoperative path planning of implant navigation software, implant surgery can be carried out. Phantom experiments are carried out based on the system to assess the feasibility and accuracy. The results show that the mean entry deviation, exit deviation, and angle deviation are 0.55 mm, 0.88 mm, and 2.23 degrees, respectively.

Preliminary study on the osseointegration effects of contactless automated implant cavity preparation via femtosecond laser ablation

Microrobots were used to control the femtosecond laser ablation of bone tissues to prepare implant cavities for dental implant surgery. The method was optimized through depth-of-cut experiments of ex vivo rabbit femurs, and the optimized method was used to prepare implant cavities on the left femurs of eight live rabbits. A power of 10 W and a scanning rate of 4000 mm/s were found to be optimal. After seven days of osteoinduction, the expression of collagen type I was significantly higher in the experimental group than in the control group (manually drilled implant cavities). The bone-implant contacts of the experimental group at 4 and 8 weeks were 9.65% and 23.08%, respectively.

Evaluation of a custom-designed human-robot collaboration control system for dental implant robot

BACKGROUND

The purpose of this study is to develop a methodology to better control a human-robot collaboration for robotic dental implant placement. We have designed a human-robot collaborative implant system (HRCDIS) which is based on a zero-force hand-guiding concept and a operational task management workflow that can achieve highly accurate and stable osteotomy drilling based on a surgeon's decision and robotic arm movements during implant surgery.

METHOD

The HRCDIS brings forth the robot arm positions, exact drilling location, direction and performs automatic drilling. The HRCDIS can also avoid complex programing in the robot. The purpose of the study is to evaluate the accuracy of drilling resulting from our developed operational task management method (OTMM). The OTMM can enable the robot to switch, pause, and resume drilling tasks. The force required for hand-guiding in a zero-force control mode of the robot was detected by a 6D force sensor. We compared our force data to those provided by the manufacturer's manual. The study was conducted on a phantom head with a 3D-printed jaw bone to verify the validity of our HRCDIS. We appraised the discrepancies between free-hand drillings and the HRCDIS controlled drillings at apical centre and head centre of the implant and implant angulation to the baseline data from a virtual surgical planning model.

RESULTS

The average required force used by hand-guiding to operate the robot with HRCDIS was near 7 Newton which is much less than the manufacturer's specification (30 Newton). The results from our study showed that the average error at implant head was 1.04 ± 0.37 mm, 1.56 ± 0.52 mm at the implant apex, and deviation of implant angle was 3.74 ± 0.67°.

CONCLUSIONS

The results from this study validate the merit of the human-robot collaboration control by the HRCDIS. Based on the improved navigation system using HRCDIS, a robotic implant placement can provide seamless drilling with ease, efficiency and accuracy.