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

Current Status and Future Perspectives of Robot-Assisted Dental Implant Surgery

Dental implant surgery is now a well versed approach for tooth replacement, addressing various limitations of fixed bridges and removable dentures, thereby reinstating both the form and function of missing teeth. However, it is technically sensitive and highly dependent on the clinical experience and the expertise of the dentist. With breakthrough progress in robot-assisted surgery for a variety of systemic diseases, robot-assisted dental implant surgery has emerged as a new way to potentially enhance the efficacy of dental implant procedures. Widely researched by dental researchers, it is progressively revealing advantages in the treatment of dentition defects or edentulism. This article summarizes the current research status of robot-assisted dental implant surgery and provides a perspective grounded in the ongoing research landscape.

Autonomous Robot-Assisted Endodontic Microsurgery on First Molar in Complex Anatomical Scenarios: A Case Series

Endodontic microsurgery (EMS) is an important approach for preserving teeth with failed root canal treatment. However, implementing minimally invasive osteotomies and accurate apicoectomies can be challenging in anatomically complex areas, especially posterior teeth close to critical structures. The introduction of autonomous robotic (ATR) system into EMS represents a pioneering advancement aimed at enhancing digital endodontic surgery. Robot-assisted endodontic microsurgery (RA-EMS) integrates cone-beam computed tomography (CBCT) and intraoral optical scanning data to plan three-dimensional surgical paths, adopting infrared optical motion-tracking technology and robot autonomous drive, enabling precise apicoectomy. This report presents the successful application of RA-EMS in four complex molar cases, during which adjacent vital anatomical structures were preserved. Immediate radiographic examination revealed accurate root-end resections. All patients demonstrated satisfactory healing during follow-up visits at 1 to 6 months, with periapical radiolucent area decreased in radiographic examination. RA-EMS is a safe and feasible clinical procedure that minimizes the risk of human error and mitigates technique sensitivity. Meanwhile, it provides a valuable alternative for assisting anatomically challenging EMS.

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.

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.

Development and validation of a robotic system for milling individualized jawbone cavities in oral and maxillofacial surgery

OBJECTIVES

This study aimed to develop and validate a robotic system capable of performing accurate and minimally invasive jawbone milling procedures in oral and maxillofacial surgery.

METHODS

The robotic hardware system mainly includes a UR5E arm (Universal Robots, Denmark) and the binocular positioning system (FusionTrack 250, Atracsys LLC, Switzerland). The robotic software (Dental Navi 3.0.0, Yakebot Technology Ltd., China) is capable of generating cutting tool paths based on three-dimensional shape description files, typically in the stereolithography format, and selected cutting tool parameters, as well as designing surgical accessories. Fully impacted supernumerary tooth models in the maxilla were fabricated using software and three-dimensional printing. Following the planning of a customized cavity to fully expose the tooth, maxillary bone milling was performed on both the robot and static guide groups (n = 8). After milling, all models underwent scanning for assessment.

RESULTS

In the experiment with fully buried supernumerary tooth models in the maxilla, the root mean square, translation error, over-removal rate, and maximum distance were significantly smaller in the robot group compared to the static guide group. Moreover, the overlap ratio and Dice coefficient were significantly greater in the robot group. No statistically significant differences were observed between the two groups in terms of the rotation error (P = 0.80) or under-removal rate (P = 0.92).

CONCLUSIONS

This study has developed a robotic system for milling individualized jawbone cavities in oral and maxillofacial surgery, and its accuracy has been preliminarily verified to meet clinical requirements.

CLINICAL SIGNIFICANCE

The robotic system can achieve precise, minimally invasive, individualized jawbone milling in a variety of oral and maxillofacial surgeries, including tooth autotransplantation, surgical reshaping for zygomatic fibrous dysplasia, removal of fully impacted supernumerary or impacted teeth, and endodontic microsurgery, among other relevant clinical applications.

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.