Does machine-vision-assisted dynamic navigation improve the accuracy of digitally planned prosthetically guided immediate implant placement? A randomized controlled trial

Accuracy of Anterior Immediate Versus Delayed Implant Placement With an Autonomous Robotic System: A Retrospective Study

OBJECTIVE

This study aimed to compare the accuracy of an autonomous robotic system for anterior immediate and delayed implant placement.

METHODS

This retrospective study included patients who underwent anterior dental implant surgery from September 2022 to March 2025 using an autonomous robotic system. Osteotomies performed with the autonomous robotic system in this study were modified by using precision and side-cutting drills, along with repeated lifting of drills to minimize deviations. Linear and angular deviations in two- and three-dimensional space were assessed by matching preoperative planning with postoperative cone beam computed tomography. Postoperative pain and surgical satisfaction were recorded using a 100-mm visual analog scale. The Shapiro-Wilk test, Student's t-test, Mann-Whitney U-test, Pearson's Chi-Square test, and Fisher's exact test were used, and p < 0.05 was considered statistically significant.

RESULTS

This retrospective study included 53 patients (65 implants) who underwent anterior dental implant surgery with the autonomous robotic system (immediate implant placement group: 19 patients, 21 implants; delayed implant placement group: 34 patients, 44 implants). Comparison of deviations in immediate and delayed implantation using the autonomous robotic system showed a mean (± SD) coronal deviation of 0.57 ± 0.19 mm versus 0.49 ± 0.20 mm (p = 0.129), a mean apical deviation of 0.57 ± 0.19 mm versus 0.52 ± 0.21 mm (p = 0.373), and a mean angular deviation of 0.53° ± 0.18° versus 0.61° ± 0.28° (p = 0.742). Postoperative pain and surgical satisfaction were not significantly different between the two groups (p > 0.05).

CONCLUSIONS

The autonomous robotic system demonstrated high and comparable accuracy in both anterior immediate and delayed implantation, with overall patient satisfaction. This could reduce the technical sensitivity of anterior immediate implant placement, enhance precision, and broaden the clinical applications of the autonomous robotic system.

Beyond Accuracy: Clinical Outcomes of Computer Assisted Implant Surgery

OBJECTIVES

Computer Assisted Implant Surgery (CAIS) with different technologies and modalities is becoming increasingly utilized in clinical practice. The aim of this White Paper was to synthesize evidence, reported experience, and best practices with regard to clinically relevant outcomes of static, dynamic, and robotic CAIS.

MATERIALS AND METHODS

A review of the literature compiled existing evidence from clinical studies up to November 2024, which was later discussed and synthesized into clinically relevant questions with a panel of international experts.

RESULTS

There is overwhelming evidence for the superiority of static, dynamic, and robotic CAIS with regard to the accuracy of implant placement and some limited evidence of superior esthetic outcomes. At the same time, outcomes related to implant primary stability, survival rates, intra- and postoperative complications, marginal bone loss, and peri-implant tissue health appear similar between guided and non-guided implant surgery, while efficiency is poorly defined and studied. The importance of accuracy in the execution of a comprehensive, prosthetically driven treatment plan is not reflected in most studies, which focus mainly on the assessment of procedures rather than entire treatment workflows. Such inherent limitations of available research might conceal some of the potential of guided CAIS.

CONCLUSIONS

Guided CAIS can achieve at least as good clinical outcomes as non-guided implant surgery. Studies that can assess the benefits of CAIS as part of a treatment workflow, rather than isolated procedures, could improve our understanding of the potential of these technologies.

Freehand vs. computer-aided implant surgery: a systematic review and meta-analysis-part 1: accuracy of planned and placed implant position

OBJECTIVES

This systematic review aimed to investigate and compare the accuracy of free-hand and computer-aided implant surgery (CAIS) approaches in dental implant placement.

MATERIAL AND METHODS

The PICO question as follows: In patients receiving dental implants, does computer-aided implant surgery superior in accuracy compared to non-computer-aided implant surgery? The primary outcome was angular deviation between the planned and placed position of the implant. An electronic search was made to identify all relevant studies reporting the accuracy of CAIS approaches and freehand for dental implant placement. The data were extracted in the descriptive description, and a meta-analysis of single means was performed to estimate the deviations for each variable using a random-effects model.

RESULTS

Out of 1609 initial articles, 55 were selected for data extraction. The mean value of angular, entry, and apex deviations were 7.46°, 1.56 mm, and 2.22 mm for freehand, 5.94°, 1.13 mm, and 1.43 mm for pilot drill-sCAIS, 2.57°, 0.72 mm, 0.88 mm for fully guided-sCAIS (fg-sCAIS), and 3.67°, 1.01 mm, and 1.36 for dynamic CAIS (dCAIS), respectively. Significant differences were found between the freehand and CAIS approaches (p < 0.04). Fg-sCAIS was significantly more accurate than dCAIS systems at the entry (p < 0.001).

CONCLUSIONS

Compared to the freehand approach, both sCAIS and dCAIS improve implant placement accuracy, with angular deviations ranging from 2° to 6°. Detailed planning is crucial for CAIS, particularly for fg-sCAIS, which demonstrated the highest accuracy than others. As apex deviations of 1 to 2 mm have been observed in CAIS approaches, a 2-mm safety margin should be implemented to minimize surgical risks.

Progressive multi-task learning for fine-grained dental implant classification and segmentation in CBCT image

With the ongoing advancement of digital technology, oral medicine transitions from traditional diagnostics to computer-assisted diagnosis and treatment. Identifying dental implants in patients without records is complex and time-consuming. Accurate identification of dental implants is crucial for ensuring the sustainability and reliability of implant treatment, particularly in cases where patients lack available medical records. In this paper, we propose a multi-task fine-grained CBCT dental implant classification and segmentation method using deep learning, called MFPT-Net.This method, based on progressive training with multiscale feature extraction and enhancement, can differentiate minor implant features and similar features that are easily confused, such as implant threads. It addresses the problem of large intra-class differences and small inter-class differences of implants, achieving automatic, synchronized classification and segmentation of implant systems in CBCT images. In this paper, 437 CBCT sequences with 723 dental implants, acquired from three different centers, are included in our dataset. This dataset is the first instance of utilizing such a comprehensive collection of data for CBCT analysis. Our method achieved a satisfying classification result with accuracy of 92.98%, average precision of 93.15%, average recall of 93.31%, and average F1 score of 93.18%, which exceeded the second-best model by nearly 10%. Moreover, our segmentation Dice similarity coefficient reached 98.04%, which is significantly better than the current state-of-the-art method. External clinical validation with 252 implants proved our model's clinical feasibility. The result demonstrates that our proposed method could assist dentists with dental implant classification and segmentation in CBCT images, enhancing efficiency and accuracy in clinical practice.

Accuracy, Safety, and Efficiency in Robotic-Assisted vs. Freehand Dental Implant Surgery: A 6-Month Follow-Up Randomized Controlled Trial

OBJECTIVES

To assess the implant accuracy, safety, and efficiency between robotic-assisted and freehand dental implant placement with a half-year follow-up.

METHODS

Patients requiring single-tooth implant restorations were recruited and randomized into two groups: robotic-assisted surgery and freehand implant surgery. The accuracy of implant positioning was compared by assessing immediate postoperative CBCT scans against preoperative planning software. Intraoperative and postoperative complications were recorded, and data were analyzed using an intention-to-treat approach. The time required for implant placement in each group was documented. A 6-month follow-up measured the implant survival rates.

RESULTS

The study included 24 patients (median age 36, 18 female). In the robotic-assisted surgery group, the average platform global deviation, apex global deviation, and angular deviation were 0.70 ± 0.11 mm, 0.70 ± 0.12 mm, and 1.09° ± 0.67°, respectively. In the freehand implant surgery group, these measures were 1.24 ± 0.59 mm, 2.13 ± 1.26 mm, and 7.43° ± 6.12°, respectively, with statistically significant differences. Regarding the duration of surgery, the robotic-assisted surgery group required 18.8 ± 4.89 min. Intraoperative and postoperative complications were similar across both groups, and the implant survival rate was 100% in both groups at the 6-month follow-up.

CONCLUSIONS

This study found that robot-assisted implant placement offers higher accuracy in implant positioning compared to freehand placement, while requiring longer operation times. Future developments should focus on simplifying the registration and design of robot systems to enhance efficiency and facilitate their broader clinical adoption.

Accuracy in dental implant placement: A systematic review and meta-analysis comparing computer-assisted (static, dynamic, robotics) and noncomputer-assisted (freehand, conventional guide) approaches

STATEMENT OF PROBLEM

Computer-assisted implant placement has been reported to provide better accuracy, particularly in complex situations, while noncomputer-assisted approaches remain effective for more straightforward procedures. However, comprehensive evidence comparing these approaches across various clinical scenarios is limited. Evaluating factors such as cost-effectiveness, edentulous span, and clinician expertise is essential for optimizing treatment planning.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the accuracy of dental implant placement between computer-assisted and noncomputer-assisted workflows.

MATERIAL AND METHODS

A systematic search of the PubMed, Embase, and Scopus databases (up to August 2024) was conducted using keywords related to surgery, computer-assisted techniques, and dental implants. The primary outcomes were angular, 3-dimensional (3D)-coronal, and 3D-apical deviations. Studies were selected based on predefined inclusion and exclusion criteria, and quantitative meta-analysis was performed.

RESULTS

Forty-five studies met the inclusion criteria. In clinical studies, meta-analysis showed a mean difference (MD) of 0.65 mm (95% CI: 0.56 to 0.74; P<.001) for global coronal deviation, 1.10 mm (95% CI: 0.95 to 1.20; P<.001) for global apical deviation, and 3.87 degree (95% CI: 3.31 to 4.44; P<.001) for angular deviation, favoring the computer-assisted implant workflow, based on 22 studies. In in vitro studies, the MD was 0.45 (95% CI: 0.36 to 0.54; P<.001) for global coronal deviation, 0.63 mm (95% CI: 0.50 to 0.76; P<.001) for global apical deviation, and 3.60 degree (95% CI: 2.66 to 4.54; P<.001) for angular deviation, favoring the computer-assisted implant workflow, with data from 23 studies. Among the navigation systems, robotic-assisted implant surgery (r-CAIS) achieved the highest clinical accuracy across all metrics compared with noncomputer-assisted techniques.

CONCLUSIONS

Overall, computer-assisted implant workflows significantly improved the accuracy of implant placement, with r-CAIS demonstrating the highest accuracy in clinical scenarios. However, factors such as cost-effectiveness, edentulous span, and clinician expertise must be considered, as conventional methods remain suitable alternatives in certain straightforward situations. These findings highlight the importance of tailored treatment planning to optimize the outcomes of implant-supported prostheses.

Endoscopic Re-Instrumentation of Intrabony Defect-Associated Deep Residual Periodontal Pockets Is Non-Inferior to Papilla Preservation Flap Surgery: A Randomized Trial

BACKGROUND AND AIM

Clinical practice guidelines suggest access flap surgery for managing deep residual pockets after steps 1 and 2 of periodontal therapy. Papilla-preservation flap surgery (PPFS) is the least invasive approach to access and instrument biofilm-contaminated root surfaces. Endoscopic-assisted subgingival debridement (EASD) may enhance the outcomes of repeated instrumentation and provide a minimally invasive non-surgical alternative.

METHODS

This was a single-blind, controlled, randomized, parallel-group, non-inferiority 12-month trial comparing EASD with PPFS. Male and female adults with generalized stage III periodontitis and persistent periodontal pockets associated with an intrabony defect after steps 1 and 2 of periodontal therapy were recruited at Prince Philip Dental Hospital. Inter-group differences in clinical attachment level (CAL) changes at 12 months were the primary outcome. Secondary outcomes included pocket resolution (no pocket > 5 mm and no pocket > 4 with bleeding on probing), radiographic bone changes, treatment time, early wound healing and quality-of-life measurements.

RESULTS

Sixty-two subjects (30 EASD and 32 PPFS) were included in the intention-to-treat analysis. CAL gains were 2.0 ± 1.0 and 1.8 ± 1.0 mm for test and controls, respectively. The 95% CI of the inter-group difference was -0.3 to 0.8 mm and within the stipulated 1-mm non-inferiority margin. No inter-group differences were observed (i) in pocket resolution, which was achieved in more than 87% of cases for all groups/time points, and (ii) in radiographic bone healing. The treatment time was significantly shorter for EASD than for PPFS. Better early wound healing index scores were observed for EASD. No inter-group differences in pain, quality of life or safety were detected.

CONCLUSIONS

EASD was not inferior to PPFS for managing residual pockets associated with intrabony defects. The observed outcome profile supports additional developments and studies to validate EASD as an alternative to surgery for isolated persistent pockets (ChiCTR-INR-16008407).

A Comparative Prospective Study on the Accuracy and Efficiency of Autonomous Robotic System Versus Dynamic Navigation System in Dental Implant Placement

AIM

This study aimed to evaluate the efficiency of and discrepancies between planned and final implant positions using dynamic computer-assisted implant surgery (d-CAIS) and autonomous robotic computer-assisted implant surgery (r-CAIS) in clinical practice.

MATERIALS AND METHODS

The study included 83 patients, who received 135 implants between December 2022 and March 2024 (r-CAIS group: 43 patients with 71 implants; d-CAIS group: 40 patients with 64 implants). Cone-beam computed tomography scans taken before and after surgery assessed linear and angular deviations between the groups in both 2D and 3D spaces. The duration of surgery was also analysed.

RESULTS

The angular deviation between d-CAIS and r-CAIS was 3.61° ± 1.65° versus 1.62° ± 0.93° (p < 0.001), the platform deviation was 1.12 ± 0.51 mm versus 0.50 ± 0.19 mm (p < 0.001) and the apex deviation was 1.36 ± 0.57 mm versus 0.58 ± 0.21 mm (p < 0.001). The d-CAIS group experienced significantly longer drilling and implant placement times compared to the r-CAIS group (10.6 ± 3.8 vs. 8.3 ± 3.4 min, p < 0.01), while preparation time showed no statistical difference between the groups (7.2 ± 3.3 vs. 6.2 ± 2.7 min, p > 0.05).

CONCLUSIONS

The robotic system demonstrated higher accuracy and efficiency of implant placement than the dynamic navigation system in partially edentulous patients.

Comparative accuracy of dCAIS and freehand techniques for immediate implant placement in the maxillary aesthetic zone: An in vitro study

OBJECTIVE

To evaluate the accuracy of immediate implant placement in fresh extraction sockets in the maxillary aesthetic zone using a dynamic computer-assisted implant surgery system (dCAIS), with the evaluation of possible deviations versus freehand placement.

METHODS

A total of 18 implants were placed by an experienced surgeon in fresh extraction sockets of anterior teeth in 6 maxillary models. Nine implants were placed using the dCAIS system and 9 implants were placed using the conventional freehand technique. The following outcome parameters were measured and compared: positional deviation at entry, apex point and angular deviations between planned and placed implant position. Surgery time was measured for each procedure. Descriptive and statistical analyses were performed on all outcome parameters.

RESULTS

Global entry deviations were not significantly different between the two techniques (p = 0.078). dCAIS resulted in significantly more accurate implant placement in terms of global apex deviation with values of 1.28±0.36 mm and angular deviations with values of 1.29±0.64°, compared to 2.06±0.60 mm and 5.05±2.54° with freehand placement (p < 0.001). The dental implant placement time was approximately three times longer when using dCAIS (10.99 ± 3.43 min) versus freehand (3.25± 0.63 min) (p < 0.001).

CONCLUSIONS

dCAIS achieved more precise immediate implant placement in terms of apex deviation and angulation than freehand placement, but increased the surgery time.

CLINICAL SIGNIFICANCE

dCAIS provides greater accuracy in the placement of immediate implants in the maxillary aesthetic zone following prosthetic-driven digital planning compared to freehand surgery.

The Accuracy of Dental Implant Placement With Different Methods of Computer-Assisted Implant Surgery: A Network Meta-Analysis of Clinical Studies

OBJECTIVE

Computer-assisted implant surgery (CAIS) has been introduced as a tool to aid in reaching a more accurate implant position. The aim of this network meta-analysis was to compare all the available CAIS techniques and obtain collective evidence on the method that offers the highest accuracy compared to freehand implant placement.

MATERIALS AND METHODS

Database search was done in PubMed, Scopus, and Cochrane library in addition to extensive search in the gray literature and related systematic reviews, aiming to find clinical studies that compared any CAIS technique with another, or with freehand implant placement. The outcomes evaluated were angle, platform, and apex deviation. The search process ended on March 18, 2024.

RESULTS

Thirty-three studies were included. All CAIS techniques (static with partial or full guidance, dynamic with partial or full guidance, the combination of static and dynamic CAIS) showed significantly less deviation than freehand implant placement, except for the static CAIS with guidance for the pilot drill only. The combination of static and dynamic CAIS ranked best among all other methods. Based on the GRADE system, the certainty of evidence in the outcomes of the meta-analysis was judged as low or moderate.

CONCLUSIONS

The current study demonstrates that computer-assisted implant surgery provides significantly higher accuracy in implant placement, with the combination of static and dynamic CAIS being the most precise. Nevertheless, future studies are needed, considering the different types, locations, and extents of edentulism in the analyzed investigations, as well as the necessity of obtaining stronger evidence.

TRIAL REGISTRATION

PROSPERIO number: CRD42023482030.

Comparison of Implant Precision with Robots, Navigation, or Static Guides

Precise surgical positioning according to a digital plan is important for aesthetic and biologically stable dental implant restorations. This randomized controlled trial compared implant placement assisted by robotic surgery (RS), dynamic navigation (DN), or 3-dimensional printed static guide (SG). An overall 45 patients with a missing tooth in the premolar/molar region were randomly assigned to 1 of the 3 groups. Implant positional accuracy (primary outcome), early wound healing, soft tissue microcirculation, patient-reported outcome measures, and surgeon preference were measured by calibrated blind examiners. One adverse event occurred in DN and RS. In RS (n = 15), the global platform, apex deviation, and angular deviations (mean ± SD) were 1.1 ± 0.4 mm, 1.5 ± 0.6 mm, and 4.7° ± 2.5°, respectively. Similarly, deviations were 1.3 ± 0.6 mm, 1.9 ± 0.9 mm, and 5.5° ± 3.5° in the DN group (n = 14) and 1.1 ± 0.6 mm, 2.0 ± 1.2 mm, and 6.2° ± 4.0° in the SG group (n = 13). Significantly smaller differential deviations (mesial-distal) at the platform and apex levels were found in the RS group than the SG group (P < 0.05). Surgery was significantly shorter with a SG (P < 0.001), and this was associated with better postoperative recovery at 3 d. The surgeon assessed DN as providing easier access to reach the surgical site. No significant differences were found upon comparing soft tissue microcirculation and oxygen saturation immediately, 1 h, or 7 d after surgery. Patient-reported outcomes were comparable in the 3 groups, except that patients in the SG group reported better oral health-related quality of life 3 d after surgery. It can be concluded that RS showed near-zero 3-dimensional systematic error in implant position, while DN and SG demonstrated a centrifugal error pattern. All 3 guided approaches had uneventful wound healing and acceptable patient-reported outcomes. The 3 groups had specific cost-benefit profiles. After additional technical developments, future trials with larger sample sizes and longer follow-up periods should be performed to analyze the cost-effectiveness of different guided surgical approaches.

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.

[Strategies for prevention and treatment of vascular and nerve injuries in mandibular anterior implant surgery]

Important anatomical structures such as mandibular incisive canal, tongue foramen, and mouth floor vessels may be damaged during implant surgery in the mandibular anterior region, which may lead to mouth floor hematoma, asphyxia, pain, paresthesia and other symptoms. In severe cases, this can be life-threatening. The insufficient alveolar bone space and the anatomical variation of blood vessels and nerves in the mandibular anterior region increase the risk of blood vessel and nerve injury during implant surgery. In case of vascular injury, airway control and hemostasis should be performed, and in case of nerve injury, implant removal and early medical treatment should be performed. To avoid vascular and nerve injury during implant surgery in the mandibular anterior region, it is necessary to be familiar with the anatomical structure, take cone-beam computed tomography, design properly before surgery, and use digital technology during surgery to achieve accurate implant placement. This article summarizes the anatomical structure of the mandibular anterior region, discusses the prevention strategies of vascular and nerve injuries in this region, and discusses the treatment methods after the occurrence of vascular and nerve injuries, to provide clinical reference.

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.

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.

Accuracy of immediate dental implant placement with task-autonomous robotic system and navigation system: An in vitro study

OBJECTIVES

The aim of this study was to compare the accuracy of dental implant placement in a single tooth gap, including the postextraction site and healed site, using a task-autonomous robotic system and a dynamic navigation system.

MATERIALS AND METHODS

Forty partially edentulous models requiring both immediate and conventional implant placement were randomly divided into a robotic system group and a navigation system group. The coronal, apical, and angular deviations of the implants were measured and assessed between the groups.

RESULTS

The deviations in immediate implant placement were compared between the robotic system and dynamic navigation system groups, showing a mean (±SD) coronal deviation of 0.86 ± 0.36 versus 0.70 ± 0.21 mm (p = .101), a mean apical deviation of 0.77 ± 0.34 versus 0.95 ± 0.38 mm (p = .127), and a mean angular deviation of 1.94 ± 0.66° versus 3.44 ± 1.38° (p < .001). At the healed site, significantly smaller coronal deviation (0.46 ± 0.29 vs. 0.70 ± 0.30 mm, p = .005), apical deviation (0.56 ± 0.30 vs. 0.85 ± 0.25 mm, p < .001), and angular deviation (1.36 ± 0.54 vs. 1.80 ± 0.70 mm, p = .034) were found in the robotic system group than in the dynamic navigation group.

CONCLUSIONS

The position in both immediate and conventional implant placement was more precise with the task-autonomous robotic system than with the dynamic navigation system. Its performance in actual clinical applications should be confirmed in further trials.

Accuracy of different registration areas using active and passive dynamic navigation systems in dental implant surgery: An in vitro study

OBJECTIVES

To gauge the relative accuracy of the use of passive and active dynamic navigation systems when placing dental implants, and to determine how registration areas affect the performance of these systems.

MATERIALS AND METHODS

Eighty implants were assigned to be placed into 40 total resin mandible models missing either the left or right first molars using either passive or active dynamic navigation system approaches. U-shaped tube registration devices were fixed in the edentulous site for 20 models each on the left or right side. Planned and actual implant positions were superimposed to assess procedural accuracy, and parameters including 3D entry deviation, angular deviation, and 3D apex deviation were evaluated with Mann-Whitney U tests and Wilcoxon signed-rank tests.

RESULTS

Respective angular, entry, and apex deviation values of 1.563 ± 0.977°, 0.725 ± 0.268 mm, and 0.808 ± 0.284 mm were calculated for all included implants, with corresponding values of 1.388 ± 1.090°, 0.789 ± 0.285 mm, and 0.846 ± 0.301 mm in the active group and 1.739 ± 0.826°, 0.661 ± 0.236 mm, and 0.769 ± 0.264 mm in the passive group. Only angular deviation differed significantly among groups, and the registration area was not associated with any significant differences among groups.

CONCLUSIONS

Passive and active dynamic navigation approaches can achieve comparable in vitro accuracy. Registration on one side of the missing single posterior tooth area in the mandible can complete single-tooth implantation on both sides of the posterior teeth, highlighting the promise of further clinical research focused on this topic.

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.

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.

Accuracy of robotic surgery for dental implant placement: A systematic review and meta-analysis

OBJECTIVES

To systematically analyze the accuracy of robotic surgery for dental implant placement.

MATERIALS AND METHODS

PubMed, Embase, and Cochrane CENTRAL were searched on October 25, 2023. Model studies or clinical studies reporting the accuracy of robotic surgery for dental implant placement among patients with missing or hopeless teeth were included. Risks of bias in clinical studies were assessed. Meta-analyses were undertaken.

RESULTS

Data from 8 clinical studies reporting on 109 patients and 242 implants and 13 preclinical studies were included. Positional accuracy was measured by comparing the implant plan in presurgery CBCT and the actual implant position in postsurgery CBCT. For clinical studies, the pooled (95% confidence interval) platform deviation, apex deviation, and angular deviation were 0.68 (0.57, 0.79) mm, 0.67 (0.58, 0.75) mm, and 1.69 (1.25, 2.12)°, respectively. There was no statistically significant difference between the accuracy of implants placed in partially or fully edentulous patients. For model studies, the pooled platform deviation, apex deviation, and angular deviation were 0.72 (0.58, 0.86) mm, 0.90 (0.74, 1.06) mm, and 1.46 (1.22, 1.70)°, respectively. No adverse event was reported.

CONCLUSION

Within the limitation of the present systematic review, robotic surgery for dental implant placement showed suitable implant positional accuracy and had no reported obvious harm. Both robotic systems and clinical studies on robotic surgery for dental implant placement should be further developed.

Autonomous robotic system for the assisted immediate placement of a maxillary anterior implant: A clinical report

Precise reproduction of the preoperatively designed 3-dimensional (3D) implant position is key to seating a prefabricated restoration and restoring esthetics. Static and dynamic computer-aided implant surgery (CAIS) based on the fusion of 3D imaging files have been used to improve implant accuracy. However, both techniques have shortcomings that can be remedied by a robotic system. This clinical report describes the immediate placement of an implant in the anterior esthetic zone by using an autonomous dental implant robotic system (ADIR).

The impacts of registration-and-fixation device positioning on the performance of implant placement assisted by dynamic computer-aided surgery: A randomized controlled trial

OBJECTIVES

To assess the efficacy of dynamic computer-aided surgery (dCAS) in replacing a single missing posterior tooth, we compare outcomes when using registration-and-fixation devices positioned anterior or posterior to the surgical site. Registration is performed on either the anterior or opposite posterior teeth.

METHODS

Forty individuals needing posterior single-tooth implant placement were randomly assigned to anterior or posterior registration. Nine parameters were analyzed to detect the deviations between planned and actual implant placement, using Mann-Whitney and t-tests for nonnormally and normally distributed data, respectively.

RESULTS

The overall average angular deviation for this study was 2.08 ± 1.12°, with the respective average 3D platform and apex deviations of 0.77 ± 0.32 mm and 0.88 ± 0.32 mm. Angular deviation values for individuals in the anterior and posterior registration groups were 1.58°(IQR: 0.98°-2.38°) and 2.25°(IQR: 1.46°-3.43°), respectively (p = .165), with 3D platform deviations of 0.81 ± 0.29 mm and 0.74 ± 0.36 mm (p = .464), as well as 3D apex deviations of 0.89 ± 0.32 mm and 0.88 ± 0.33 mm (p = .986). No significant variations in absolute buccolingual (platform, p = .659; apex, p = .063), apicocoronal (platform, p = .671; apex, p = .649), or mesiodistal (platform, p = .134; apex, p = .355) deviations were observed at either analyzed levels.

CONCLUSIONS

Both anterior and posterior registration approaches facilitate accurate dCAS-mediated implant placement for single missing posterior teeth. The device's placement (posterior-to or anterior-to the surgical site) did not affect the clinician's ability to achieve the planned implant location.

Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials

This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms "surgery", "computer-assisted", "dynamic computer-assisted", "robotic surgical procedures", and "dental implants". The outcome variables were discrepancies including the implant's 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02-1.19), and 1.40 mm (95% CI: 1.31-1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27-3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.

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.

Accuracy and efficiency of a calibration approach in dynamic navigation for implant placement: An in vitro study

Background/purpose

Computer-assisted dynamic navigation surgery could provide accurate implant placement. However, its low efficiency was always criticized by dental surgeons. The purpose of this study was to evaluate the accuracy and efficiency of a calibration approach with reflective wafers in dynamic navigation for implant placement.

Materials and methods

Eighty implants were placed in the standardized polyurethane mandibular models under dynamic navigation and divided into 2 groups according to the calibration methods (n = 40). The U-shaped tube (UT) group used a prefabricated U-shaped tube embedded with radiopaque markers. The reflective wafers (RW) group used a fixation with 3 round reflective wafers as markers. Postoperative cone beam computed tomography images were obtained for implants deviation analyses. The calibration time was used to evaluate the efficiency of the 2 methods.

Results

Significant differences were found in the trueness and efficiency between the 2 groups (P < 0.05). The 3D deviations at the implant platform and apex were smaller in UT group (0.89 ± 0.28 and 0.79 ± 0.30 mm, respectively) than in the RW group (0.99 ± 0.28 and 0.98 ± 0.30 mm, respectively). The angular deviation was larger in the UT group (2.16 ± 1.12°) than in the RW group (1.53 ± 0.88°). The calibration approach of RW group was more efficient than the UT group (2.05 ± 0.55 and 7.50 ± 0.71 min, respectively).

Conclusion

The calibration method of RW improved the efficiency significantly and achieved equivalent trueness with UT for dynamic navigation during implant placement.

Accuracy and patient-centered results of marker-based and marker-free registrations for dynamic computer-assisted implant surgery: A randomized controlled trial

OBJECTIVES

To compare implant placement accuracy and patient-centered results between the dynamic computer-assisted implant surgeries (d-CAISs) using marker-based and marker-free registration methods.

MATERIALS AND METHODS

A double-armed, single-blinded randomized controlled trial was conducted, in which 34 patients requiring single implant placement at the esthetic zone were randomly assigned to the marker-based (n = 17) or marker-free (n = 17) groups. The marker-based registration was performed using a splint containing radiopaque markers, while the marker-free registration used natural teeth. The primary outcome assessed implant positioning accuracy via angular and linear deviations between preoperative and postoperative implant positions in CBCT. Patients were also surveyed about the intraoperative experience and oral health impact profile (OHIP).

RESULTS

The global linear deviations at the implant platform (0.82 ± 0.28 and 0.85 ± 0.41 mm) and apex (1.28 ± 0.34 and 0.85 (IQR: 0.64-1.50) mm) for the marker-based and marker-free groups respectively showed no significant difference. However, the angular deviation of the marker-free group (2.77 ± 0.92° ) was significantly lower than the marker-based group (4.28 ± 1.58° ). There was no significant difference in the mean postoperative OHIP scores between the two groups (p = .758), with scores of 2.74 ± 1.21 for marker-based and 2.93 ± 2.18 for marker-free groups, indicating mild oral health-related impairment in both. Notably, patients in the marker-free group showed significantly higher satisfaction (p = .031) with the treatment procedures.

CONCLUSIONS

D-CAIS with a marker-free registration method for single implantation in the anterior maxilla has advantages in improving implant placement accuracy and patients' satisfaction, without generating a significant increase in clinical time and expenses.

Hybrid Navigation Technique for Improved Precision in Implantology

The hybrid navigation technique involves the merging of the Dynamic navigation (DN) system (Navident, Claronav, Canada) and static navigation technique (3Shape, Copenhagen, Denmark). Combining the advantages of both techniques, devising a protocol of hybrid navigation will be advantageous to eliminate the difficulties faced by operators in using either methods separately. Three patients requiring dental implants were included in this study. This requires the cone beam computed tomography (CBCT) (Digital Imaging and Communications in Medicine (DICOM) data) and intra-oral scan (Standard Tessellation Language (STL) format) data for the accurate planning of the implant positions in both the static and dynamic approaches. The steps carried out were repeated for each of the patients, the accuracy of the implant placement was verified postoperatively by merging the CBCT data pre and post through the Evalunav software (NaviDent, Claronav). The accuracy of the implants placed were assessed based on the mesio-distal, bucco-lingual, apical deviations in distance and in angulation. The semi-robotic DN and static guide combination as a hybrid technique is an interesting method to improve the accuracy of flapless implant surgeries and can be used in cases where the anatomical landmarks are determinant factors for the implant placement.

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 automatic and manual dynamic navigation registration techniques for dental implant surgery in posterior sites missing a single tooth: A retrospective clinical analysis

OBJECTIVES

To assess the relative accuracy of manual (U-shaped tube) and automatic (two-in-one) dynamic navigation registration techniques for implant surgery performed in posterior sites missing one tooth.

MATERIALS AND METHODS

This study included 58 partially edentulous patients with 58 implants, including 31 and 27 in the manual and automatic groups. Deviations between the planned and actual implant placement were assessed.

RESULTS

The angular deviation in the overall study cohort was 2.54 ± 1.21°, while the 3D deviations at the implant platform and apex were 0.90 ± 0.46 mm and 1.04 ± 0.47 mm, respectively. The respective angular deviations in the manual and automatic groups were 2.82 ± 1.17° and 2.21 ± 1.19° (p > .05), while platform deviations were 0.89 ± 0.48 mm and 0.91 ± 0.45 mm (p > .05), and apex deviations were 0.99 ± 0.48 mm and 1.11 ± 0.46 mm (p > .05). No significant differences in absolute buccolingual, mesiodistal, or apicocoronal deviations were detected between these groups at either level (p > .05) nor were did deviation distributions differ in the buccolingual, mesiodistal, or apicocoronal directions at the platform or apex levels (p > .05).

CONCLUSIONS

Manual and automatic dynamic navigation registration techniques can achieve excellent accuracy when placing implants in posterior sites missing a single tooth. The two-in-one automatic registration technique can reduce the amount of time and intraoperative steps necessary to complete the registration process relative to the manual U-shaped tube registration technique. Further follow-up studies are necessary to expand on these results.

Accuracy of dental implant placement with or without the use of a dynamic navigation assisted system: A randomized clinical trial

OBJECTIVES

To assess dental implant placement accuracy with a dynamic computer-assisted implant surgery (dCAIS) system and a freehand approach. Secondarily, to compare the patients' perception and quality of life (QoL) with the two approaches.

METHODS

A double-arm randomized clinical trial was conducted. Consecutive partially edentulous patients were randomly allocated to the dCAIS or standard freehand approach groups. Implant placement accuracy was evaluated by overlapping the preoperative and postoperative Cone Beam Computer Tomographs (CBCT) and recording linear deviations at the implant apex and platform (in mm) and angular deviations (in degrees). Questionnaires recorded self-reported satisfaction, pain and QoL during surgery and postoperatively.

RESULTS

Thirty patients (22 implants) were enrolled in each group. One patient was lost to follow-up. A significant difference (p < .001) in mean angular deviation was found between the dCAIS (4.02°; 95% CI: 2.85 to 5.19) and the FH (7.97°; 95% CI: 5.36 to 10.58) groups. Linear deviations were significantly lower in the dCAIS group, except for the apex vertical deviation, where no differences were found. Although dCAIS took 14 min longer (95% CI: 6.43 to 21.24; p < .001), patients in both groups considered the surgical time acceptable. Postoperative pain and analgesic consumption during the first postoperative week were similar between groups and self-reported satisfaction was very high.

CONCLUSION

dCAIS systems significantly increase the accuracy of implant placement in partially edentulous patients in comparison with the conventional freehand approach. However, they increase the surgical time significantly and do not seem to improve patient satisfaction or reduce postoperative pain.

Comparison of the accuracy of immediate implant placement using static and dynamic computer-assisted implant system in the esthetic zone of the maxilla: a prospective study

PURPOSE

This study aimed to compare the accuracy of fully guided between dynamic and static computer-assisted implant surgery (CAIS) systems for immediate implant placement in the esthetic zone.

METHODS

A total of 40 qualified patients requiring immediate implant placement in the esthetic zone were randomly and equally assigned to either static CAIS group (n = 20) or dynamic CAIS groups (n = 20). Global deviations at entry, apex, and angular deviation between placed and planned implant position were measured and compared as primary outcomes. Secondary outcomes were the deviation of implant placement at mesial-distal, labial-palatal, and coronal-apical directions.

RESULTS

For the immediate implant placement, the mean global entry deviations in static and dynamic CAIS groups were 0.99 ± 0.63 mm and 1.06 ± 0.55 mm (p = 0.659), while the mean global apex deviations were 1.50 ± 0.75 mm and 1.18 ± 0.53 mm (p = 0.231), respectively. The angular deviation in the static and dynamic CAIS group was 3.07 ± 2.18 degrees and 3.23 ± 1.67 degrees (p = 0.547). No significant differences were observed for the accuracy parameters of immediate implant placement between static and dynamic CAIS systems, except the deviation of the implant at entry in the labial-palatal direction in the dynamic CAIS group was significantly more labial than of the static CAIS (p = 0.005).

CONCLUSIONS

This study demonstrated that clinically acceptable accuracy of immediate implant placement could be achieved using static and dynamic CAIS systems. Trial registration ChiCTR, ChiCTR2200056321. Registered 3 February 2022, http://www.chictr.org.cn/showproj.aspx?proj=151348.