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

Accuracy of Two Robotic Computer-Aided Implant System Registration Methods for Dental Implantation: A Prospective Study

BACKGROUND

Robot-assisted implant surgery has been shown to achieve high levels of accuracy. However, there is currently a paucity of clinical studies evaluating the accuracy of marker-based intraoral scanner (IOS) registration (IR) methods.

PURPOSE

The purpose of this study was to compare the accuracy of the marker-based cone beam computed tomography (CBCT) registration (CR) method and the IR method in the dental implant in the robotic computer-aided implant system (R-CAIS).

MATERIALS AND METHODS

This retrospective study included 20 participants, with 10 undergoing implant surgery using the CR method within a robotic system, and the remaining 10 receiving implants using the IR method. Preoperative CBCT images used for implant planning were aligned with the postoperative CBCT images to assess and quantify positional deviations in implant placement. The primary outcome measures were FRE, entry deviation, apical deviation, and angular deviation. A Student's t-test was performed to compare differences between the two groups, with a p-value of < 0.05 considered statistically significant.

RESULTS

The mean ± standard deviation values for FRE were 0.027 ± 0.007 mm for the CR group and 0.031 ± 0.006 mm for the IR group (p = 0.149). The mean ± standard deviation values for entry deviation were 0.58 ± 0.11 mm for the CR group and 0.53 ± 0.15 mm for the IR group (p = 0.072). The mean ± standard deviation values for apical deviation were 0.52 ± 0.12 mm for the CR group and 0.50 ± 0.14 mm for the IR group (p = 0.730). The mean ± standard deviation values for apical deviation were 1.10 ± 0.34 mm for the CR group and 1.17 ± 0.23 mm for the IR group (p = 0.730).

CONCLUSIONS

In R-CAIS, the IR method demonstrated accuracy comparable to that of the CR method, with both methods yielding clinically satisfactory outcomes.

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.

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.

Influencing factors and survival rates in immediate vs. delayed dental implant placement: a six-year retrospective analysis

Objective

This retrospective cohort study aimed to compare survival rates between immediate (≤24 h post-extraction) and delayed (3-4 months post-extraction) dental implants and to identify patient- and site-specific risk factors for implant failure, with emphasis on anatomical site, sex, and osteoporosis.

Methods

We analyzed 1,500 implants (300 immediate, 1,200 delayed) from patients treated at the Guangdong Provincial Hospital of Traditional Chinese Medicine (2005-2023). Kaplan-Meier analysis evaluated cumulative survival rates over 72 months, with Cox regression modeling to assess predictors of failure. Propensity score matching (PSM) addressed baseline covariate imbalances.

Results

Delayed implants exhibited significantly higher survival rates than immediate implants at 72 months (81.1% vs. 53.2%, p < 0.0001). Survival divergence intensified after 24 months, with delayed implants retaining 979 patients at risk vs. 202 for immediate implants. Mandibular sites consistently outperformed maxillary sites in both strategies (delayed: 88.5% vs. 72.2%; immediate: 70.5% vs. 40.7%, p < 0.0001). Male sex (HR: 1.64, 95% CI: 1.28-1.88; p < 0.001) and osteoporosis (HR: 2.50, 95% CI: 1.17-4.52; p = 0.024) emerged as independent risk factors, while tobacco use, diabetes, and hypertension showed no significant associations. PSM resolved most baseline imbalances, with post-matching standardized mean differences (SMD) <0.1 for key covariates.

Conclusions

Delayed implantation at 3-4 months post-extraction provides superior intermediate-term survival, particularly in mandibular sites. Male patients and individuals with osteoporosis face elevated failure risks, warranting tailored clinical protocols. While both strategies remain viable, delayed placement is recommended for high-risk populations to optimize long-term outcomes.

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.

Robot-Assisted Endodontic Retreatment: A Case Report with Clinical Considerations

Fiber posts present significant challenges for nonsurgical endodontic retreatment, as improper removal may result in iatrogenic root perforation or even root fracture. Recently, robotic technology has attracted considerable attention in dentistry and active dental robotic (ADR) systems can perform procedures based on preset instructions, minimizing reliance on the dentist's experience. This case report describes the application of an ADR system for fiber post removal through an existing zirconia crown. A 26-year-old female was diagnosed with previously treated, symptomatic apical periodontitis of the mandibular left second premolar. Based on cone-beam computed tomography (CBCT) and intraoral scanning, the ADR system was used to achieve precise fiber post removal through a zirconia crown with minimally invasive coronal access under rubber dam isolation. The robotic arm executed flexible pumping motions to simulate the hand movements of dentists. This was achieved by establishing preset force and distance thresholds tailored to the characteristics of the materials being drilled. Residual gutta-percha was removed, followed by canal preparation and obturation. The tooth was then restored with a fiber post and composite resin. At the 2.5-month follow-up, the patient was completely asymptomatic, and the radiograph displayed evidence of periradicular healing. In this case, robotic technology proved effective and feasible for the endodontic retreatment of a mandibular second premolar, suggesting its potential for similar applications in other teeth where there is adequate inter-arch space. Further research is needed to simplify procedures for robot-assisted endodontic retreatment.

The impact of jawbone regions (molar area, premolar area, anterior area) and bone density on the accuracy of robot-assisted dental implantation: a preliminary study

Robotic-assisted dental implantation represents a transformative innovation in modern dentistry, offering enhanced surgical precision and reduced variability. Despite its clinical adoption, the impact of anatomical and bone-related factors on placement accuracy remains underexplored. This retrospective study evaluated 54 implants placed in 30 patients using cone-beam computed tomography (CBCT) and virtual planning software to analyze deviations in crown position, apex position, and angulation. Significant regional variations in accuracy were observed, with higher angular deviations in the anterior maxilla (mean ± SD: 3.21° ± 2.22°) and greater positional deviations in the posterior mandible (1.09 mm ± 0.51 mm) (p < 0.05). Implant diameter significantly influenced global deviation (p = 0.019), while implant length and bone density (classified by Misch's system) showed no significant effects (p > 0.05). However, denser bone types (D1) exhibited a trend toward increased deviations, potentially due to insertion resistance. These findings underscore the need for region-specific and bone-quality considerations in robotic-assisted implantation. Refining robotic navigation and feedback mechanisms is critical to optimizing accuracy, particularly in anatomically complex regions.

Exploring the Learning Curve of Dental Implant Placement Using a Task-Autonomous Robotic System Among Young Dentists From Different Specialties-A Pilot Module Study

BACKGROUND

The learning curve effect of dynamic computer-assisted implant surgery (D-CAIS) was observed among inexperienced novice surgeons. The learning curves can provide valuable information for novice surgeons and valid comparisons between new and conventional techniques. Recently, robotic computer-assisted implant surgery (R-CAIS) has shown promise as a novel dental implant surgical technique for both partially and edentulous patients. However, its learning curve remains unknown.

PURPOSE

The aim of this study was to explore the learning curve of dental implant placement surgery with a task-autonomous robotic system among young dentists with different specialties.

METHODS AND MATERIALS

Four young dentists (mean age: 25.3 ± 1.5 years at the beginning of their first attempt) with equal representation of males and females and with different specialties participated in this study. None of the participants had prior experience in R-CAIS. Each operator placed eight implants over eight attempts using a semi-active task-autonomous robotic system. Among the eight implants, four were straight lateral incisor implants, and four were 30°-tilted premolar implants. The implants were placed in each dental quadrant of the maxillary and mandibular jaw modules. The operation time was recorded. Coronal, apical, and angular deviations between the planned and actual sites of implant placement were measured by merging preoperative and postoperative cone-beam computed tomography (CBCT) scans. The data were analyzed with repeated-measures ANOVA (α = 0.05).

RESULTS

The mean time for implant placement was associated with the number of attempts (p < 0.01). The time taken for the second attempt was significantly shorter than that of the first attempt (33.26 vs. 30.47 min; p < 0.001) then it plateaued. Three-dimensional (3D) angular (p = 0.31), coronal deviation (p = 0.26), and apical deviation (p = 0.06) did not differ significantly among attempts. The mean values and standard deviations of 3D coronal deviation, 3D apical deviation, and 3D angular deviation were 0.71 ± 0.31 mm, 0.72 ± 0.30 mm, and 0.94 ± 0.58°, respectively. Neither the position of the jaw (p > 0.59) nor the tilt angle of the implant (straight or 30°-tilted, p > 0.85) was related to implant placement accuracy.

CONCLUSIONS

Dentists quickly learned the basic workflow of R-CAIS and thus facilitated the clinicians in the mastery of implant placement on edentulous jaw modules, leading to a comparable operating speed and high precision. Moreover, the accuracy of placement of straight and tilted implants in both the maxilla and mandible with R-CAIS was satisfactory.

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.

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.

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.

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.

Comparative analysis of dental implant placement accuracy: Semi-active robotic versus free-hand techniques: A randomized controlled clinical trial

BACKGROUND

Robot-assisted implant surgery has emerged as a novel digital technology, and the accuracy need further assessment.

PURPOSE

This study aimed to compare the accuracy of single dental implant placement between a novel semi-active robot-assisted implant surgery (RAIS) method and the conventional free-hand implant surgery (FHIS) method through a multicenter, randomized controlled clinical trial.

MATERIALS AND METHODS

Patients requiring single dental implant placement were recruited and randomized into RAIS and FHIS group. Deviations at the platform, apex, and angle between the planned and final implant positions were assessed in both groups. Additionally, the evaluation of instrument and surgical complications was examined.

RESULTS

A total of 140 patients (median age: 35.35 ± 12.55 years; 43 males, 97 females) with 140 implants from four different research centers were included, with 70 patients (70 implants) in the RAIS group and 70 patients (70 implants) in the FHIS group. In the RAIS and FHIS groups, the median platform deviations were 0.76 ± 0.36 mm and 1.48 ± 0.93 mm, respectively (p < 0.001); median apex deviations were 0.85 ± 0.48 mm and 2.14 ± 1.25 mm, respectively (p < 0.001); and median angular deviations were 2.05 ± 1.33° and 7.36 ± 4.67°, respectively (p < 0.001). Similar significant difference also presented between RAIS and FHIS group in platform vertical/horizontal deviation, apex vertical/horizontal deviation. Additionally, implants with self-tapping characteristics exhibited significantly larger deviations compared with those without self-tapping characteristics in the RAIS group. Both RAIS and FHIS methods demonstrated comparable morbidity and safety pre- and post-operation.

CONCLUSIONS

The results indicated that the RAIS method demonstrated superior accuracy in single dental implant placement compared with the FHIS method. Specifically, RAIS exhibited significantly smaller deviations in platform, apex, and angular positions, as well as platform and apex vertical/horizontal deviations. This clinical trial was not registered prior to participant recruitment and randomization. https://www.chictr.org.cn/showproj.html?proj=195045.

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.

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.

Influence of dental implant clinical experience on the accuracy of robot-assisted immediate implant placement: an in vitro study

OBJECTIVES

To assess the accuracy and effectiveness among operators with different levels of experience in a robot-assisted immediate implant surgery.

MATERIALS AND METHODS

The study included four participants who had received dental training at the same institution but have varying levels of clinical experience in implant dentistry, denoted as undergraduate student (UG), dental resident (DR), specialist with no robot experience (IS) and specialist with robot experience (RS). Following comprehensive theoretical training in robot-assisted implant operation, each operator participated in five robotic-assisted implant procedures at 21 sites, resulting in the implant surgery of a total of 20 implants. Subsequently, the accuracy of the implants was assessed by analyzing the preoperative planning and the postoperative CBCT scans, and the time required for each procedure was also recorded.

RESULTS

Angular deviation in UG, DR, IS and RS group was 0.82 ± 0.27°, 0.55 ± 0.27°, 0.83 ± 0.27°, and 0.56 ± 0.36°, respectively. The total deviation of the implant platform point was 0.28 ± 0.10 mm, 0.26 ± 0.16 mm, 0.34 ± 0.08 mm and 0.31 ± 0.06 mm, respectively. The total deviation of the apical point was 0.30 ± 0.08 mm, 0.25 ± 0.18 mm, 0.31 ± 0.09 mm, and 0.31 ± 0.05 mm, respectively. The time spent was 10.37 ± 0.57 min, 10.56 ± 1.77 min, 9.93 ± 0.78 min, and 11.76 ± 0.78 min for each operator. As the number of operations increased, the operation time decreased, but there was no significant difference in implant accuracy between the different groups.

CONCLUSIONS

Within the scope of this study, robot-assisted implant surgery demonstrated high accuracy, with no significant differences in performance between operators with varying levels of clinical experience or implant robot-user experience. Furthermore, the learning curve for robotic implant surgery is steep and consistent.

CLINICAL RELEVANCE

Robot-assisted implant surgery demonstrates consistent high accuracy across operators of varying clinical and robotic experience levels, highlighting its potential to standardize procedures and enhance predictability in clinical outcomes.

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 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.

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.

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.

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).

Clinical evaluation of autonomous robotic-assisted full-arch implant surgery: A 1-year prospective clinical study

OBJECTIVES

This prospective clinical study aimed to evaluate the accuracy and 1-year clinical follow-up performance of dental implant placement with an autonomous dental implant robot (ADIR) system in full-arch implant surgery.

MATERIALS AND METHODS

Twelve patients with edentulous arches or final dentition received 102 implants using the ADIR system. Global platform deviation, global apex deviation, and global angular deviation between the planned and actual implants were calculated after surgery. Data were statistically analyzed for factors including jaws, implant positions, patient sequences, implant systems, and implant length. Surgery duration was recorded. Patients were followed for 3 months and 1 year after surgery. Periodontal parameters, buccal bone thickness (BBT), and facial vertical bone wall peak (IP-FC) were recorded.

RESULTS

Among the 102 implants, the mean (SD) global platform deviation, global apex deviation, and global angular deviation were 0.53 (0.19) mm, 0.58 (0.17) mm, and 1.83 (0.82)°, respectively. The deviation differences between the mandible and maxilla did not show statistical significance (p > .05). No statistically significant differences were found for the jaws, implant positions, patient sequences, implant systems, and implant length to the deviations (p > .05). The periodontal parameters, the BBT, and IP-FC remained stable during 1-year follow-up.

CONCLUSION

The ADIR system showed excellent positional accuracy. The 1-year follow-up after full-arch implant surgery indicated that the ADIR system could achieve promising clinical performance. Additional clinical evidence is requisite to furnish guidelines for the implementation of the ADIR system in full-arch implant surgery.

Effect of implant shape and length on the accuracy of robot-assisted immediate implant surgery: An in vitro study

OBJECTIVES

To compare the accuracy of immediate implant placement of cylindrical implants (CI) and tapered implants (TI) of different lengths using a robotic dental implant system.

MATERIALS AND METHODS

CI and TI of three lengths (8, 10, and 12 mm) each were digitally planned and placed in a three-dimensional printed extraction socket model under robotic guidance. There were six groups with three samples in each group, resulting in a total of 18 samples. Implant angular deviation, platform point deviation (total, lateral, depth), and implant apical point deviation (total, lateral, depth) were recorded and compared between the different groups.

RESULTS

The angular deviations for CI 8 mm, CI 10 mm, CI 12 mm, TI 8 mm, TI 10 mm, and TI 12 mm were 1.32° ± 0.19°, 1.03° ± 0.56°, 1.31° ± 0.38°, 1.27° ± 0.64°, 1.10° ± 0.43° and 1.05° ± 0.45°, respectively. The total deviations of platform and apical points for CI 8 mm, CI 10 mm, CI 12 mm, TI 8 mm, TI 10 mm, and TI 12 mm were 0.79 ± 0.18 mm, 0.77 ± 0.33 mm; 0.64 ± 0.21 mm, 0.55 ± 0.17 mm; 0.64 ± 0.37 mm, 0.65 ± 0.34 mm; 0.68 ± 0.26 mm, 0.71 ± 0.20 mm; 0.70 ± 0.12 mm, 0.66 ± 0.23 mm; and 0.71 ± 0.15 mm, 0.77 ± 0.29 mm, respectively, and had no significant differences.

CONCLUSIONS

Within the limitation of this study, acceptable accuracy can be achieved for both TI and CI using robotic systems. Our study demonstrated that the implant shape and length did not affect the accuracy of immediate implant placement under robotic guidance in vitro. However, further trials are required to confirm their efficacy in clinical practice.

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.

How does dental implant macrogeometry affect primary implant stability? A narrative review

PURPOSE

The macrogeometry of a dental implant plays a decisive role in its primary stability. A larger diameter, a conical shape, and a roughened surface increase the contact area of the implant with the surrounding bone and thus improve primary stability. This is considered the basis for successful implant osseointegration that different factors, such as implant design, can influence. This narrative review aims to critically review macro-geometric features affecting the primary stability of dental implants.

METHODS

For this review, a comprehensive literature search and review of relevant studies was conducted based on formulating a research question, searching the literature using keywords and electronic databases such as PubMed, Embase, and Cochrane Library to search for relevant studies. These studies were screened and selected, the study quality was assessed, data were extracted, the results were summarized, and conclusions were drawn.

RESULTS

The macrogeometry of a dental implant includes its surface characteristics, size, and shape, all of which play a critical role in its primary stability. At the time of placement, the initial stability of an implant is determined by its contact area with the surrounding bone. Larger diameter and a conical shape of an implant result in a larger contact area and better primary stability. But the linear relationship between implant length and primary stability ends at 12 mm.

CONCLUSIONS

Several factors must be considered when choosing the ideal implant geometry, including local factors such as the condition of the bone and soft tissues at the implant site and systemic and patient-specific factors such as osteoporosis, diabetes, or autoimmune diseases. These factors can affect the success of the implant procedure and the long-term stability of an implant. By considering these factors, the surgeon can ensure the greatest possible therapeutic success and minimize the risk of implant failure.