Robotics in Dental Implantology

Advances of surgical robotics: image-guided classification and application

Surgical robotics application in the field of minimally invasive surgery has developed rapidly and has been attracting increasingly more research attention in recent years. A common consensus has been reached that surgical procedures are to become less traumatic and with the implementation of more intelligence and higher autonomy, which is a serious challenge faced by the environmental sensing capabilities of robotic systems. One of the main sources of environmental information for robots are images, which are the basis of robot vision. In this review article, we divide clinical image into direct and indirect based on the object of information acquisition, and into continuous, intermittent continuous, and discontinuous according to the target-tracking frequency. The characteristics and applications of the existing surgical robots in each category are introduced based on these two dimensions. Our purpose in conducting this review was to analyze, summarize, and discuss the current evidence on the general rules on the application of image technologies for medical purposes. Our analysis gives insight and provides guidance conducive to the development of more advanced surgical robotics systems in the future.

Accuracy of immediate anterior implantation using static and robotic computer-assisted implant surgery: A retrospective study

OBJECTIVES

To investigate the accuracy of immediate anterior implantation using static computer-assisted implant surgery (s-CAIS) and robotic computer-assisted implant surgery (r-CAIS).

MATERIALS AND METHODS

One hundred and six implants were immediately inserted in the anterior zone of 69 patients using a freehand technique, s-CAIS or r-CAIS. Postoperative cone-beam computed tomography scans were matched with preoperative plans to evaluate the deviations between the planned and placed implant positions.

RESULTS

The global coronal deviations in the freehand, s-CAIS, and r-CAIS groups were 1.29 ± 0.52 mm, 1.01 ± 0.41 mm, and 0.62 ± 0.28 mm, respectively. Significant differences were observed in the r-CAIS group compared to both the s-CAIS group and the freehand group (p < 0.05). However, no significant differences were found between the s-CAIS group and the freehand group (p > 0.05). The global apical deviations in the freehand, s-CAIS and r-CAIS groups were 1.78 ± 0.59 mm, 1.24 ± 0.52 mm and 0.65 ± 0.27 mm, respectively, while the angular deviations in the freehand, s-CAIS and r-CAIS groups were 6.46 ± 2.21°, 2.94 ± 1.71° and 1.46 ± 0.57°, respectively. Significant differences were observed in both the global apical deviations and angular deviations among the three groups (p < 0.05).

CONCLUSIONS

The accuracy of immediate anterior implantation with r-CAIS was better than that with s-CAIS. This difference is attributed to better control of the coronal, vertical and axial errors during r-CAIS.

CLINICAL SIGNIFICANCE

This study provides significant evidence to support the use of r-CAIS as a potential alternative in immediate anterior implantation.

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.

Computer-assisted and robotic implant surgery: Assessing the outcome measures of accuracy and educational implications

OBJECTIVE

This scoping review aimed to (1) critically evaluate the outcomes measures used to assess the accuracy of implant placement with Computer Assisted Implant Surgery (CAIS) and (2) review the evidence supporting the efficient implementation of CAIS in training and education of clinicians.

METHODS

A scoping literature review was conducted aiming to identify (a) clinical trials assessing accuracy of implant placement with CAIS, and (b) clinical trials or simulation/cadaver studies where CAIS was utilised and assessed for the training/education of clinicians. Studies since 1995 were assessed for suitability and data related to the outcomes measures of accuracy and educational efficacy were extracted and synthesised.

RESULTS

Accuracy of CAIS has been mainly assessed through surrogate measures. Individual clinical trials have not shown any difference between static and dynamic CAIS, but recent meta-analyses suggest an advantage of dynamic CAIS in reducing angular deviation. The combination of static and dynamic CAIS might offer higher accuracy than each of the two used alone. Dynamic CAIS is suitable for novice surgeons and might even have added value as an education tool for implant surgery, although mastering the technique requires longer training than static.

CONCLUSION

Meta-analyses of large samples, new and diverse outcomes measures, as well as benchmarking of levels of accuracy with specific clinical outcomes will help to better understand the potential and limitations of CAIS. Dynamic CAIS is suitable for novice operators, but educational interventions distributed over longer periods of time will be required for mastery of the process.

Advancements in dental implantology: The alveolar ridge split technique for enhanced osseointegration

The alveolar ridge split (ARS) technique is a pivotal advancement in dental implantology, addressing the limitation of insufficient bone width for implant placement. This review traces the historical development of ARS from its initial conceptualization to current practices and future directions. Emphasizing the technique's development, indications, procedural overview, and osteotomy variations, we highlight its minimally invasive nature, which reduces patient morbidity and treatment time. This article reviews various osteotomy methods within ARS, examining their applications, benefits, and limitations. Furthermore, it discusses the technique's role in expanding treatment options for patients with compromised alveolar structures, underpinned by a high implant survival rate and the potential for immediate implant placement. We also cover the necessity of meticulous surgical technique, the importance of patient-specific factors, and the promising future of ARS facilitated by advancements in biomaterials and regenerative medicine. In summary, this review provides a comprehensive overview of ARS, offering valuable insights for dental professionals and informing future clinical practices and research in implantology.

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.

Robot-assisted dental implant surgery procedure: A literature review

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

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

OBJECTIVES

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

High-precision all-in-one dual robotic arm strategy in oral implant surgery

INTRODUCTION

Dental implantation has emerged as an efficient substitute for missing teeth, which is essential for restoring oral function and aesthetics. Compared to traditional denture repair approaches, dental implants offer better stability and sustainability. The position, angle, and depth of dental implants are crucial factors for their long-term success and necessitate high-precision operation and technical support.

METHOD

We propose an integrated dual-arm high-precision oral implant surgery navigation positioning system and a corresponding control strategy. Compared with traditional implant robots, the integrated dual-arm design greatly shortens the preparation time before surgery and simplifies the operation process. We propose a novel control flow and module for the proposed structure, including an Occluded Target Tracking Module (OTTM) for occlusion tracking, a Planting Plan Development Module (PPDM) for generating implant plans, and a Path Formulation Module (PFM) for controlling the movement path of the two robot arms.

RESULT

Under the coordinated control of the aforementioned modules, the robot achieved excellent accuracy in clinical trials. The average angular error and entry point error for five patients who underwent implant surgery using the proposed robot were 2.1° and 0.39 mm, respectively.

CONCLUSION

In essence, our study introduces an integrated dual-arm high-precision navigation system for oral implant surgery, resolving issues like lengthy preoperative preparation and static surgical planning. Clinical results confirm its efficacy, emphasizing its accuracy and precision in guiding oral implant procedures.

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.

Robot-Assisted and Haptic-Guided Endodontic Surgery: A Case Report

There has been a significant increase in robot-assisted dental procedures in the past decade, particularly in the area of robot-assisted implant placement. The objective of this case report was to assess the initial use of the Yomi Robot's assistance and haptic guidance during endodontic microsurgery. The robot was used during the osteotomy and root-end resection of the first and second upper left premolars. The report aims to inform clinicians of the initial implementation of this cutting-edge technology in endodontics and its potential to enhance endodontic microsurgery. The Yomi Robot was used in performing osteotomy and root-end resection during apical surgery in a patient presenting with symptomatic upper left first and second premolars. The treatment procedure was decided after clinical examination, chart data, and radiographic examinations, which showed periapical lesions on both premolars, taking into consideration the failed endodontic retreatment on the first premolar, the post and ceramic coronal restorations on both teeth, and the desire of the patient to save them. The Yomi Robot system provides auditory, visual, and physical guidance to clinicians during surgery while using a cone-beam computed tomography scan for precision planning with greater accuracy and minimized potential for human error. Further studies are needed to prepare a protocol for robotic-guided procedures in endodontics.

Navigating the future of guided dental implantology: A scoping review

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

In vitro and in vivo accuracy of autonomous robotic vs. fully guided static computer-assisted implant surgery

OBJECTIVES

To assess the accuracy of autonomous robotic and fully guided static computer-assisted implant surgery (sCAIS) performed on models and patients.

MATERIALS AND METHODS

This study was divided into in vitro and in vivo sections. In vitro, 80 operators were assigned to two groups randomly. Forty operators performed forty autonomous robotic implant (ARI group) surgeries and the remaining forty operators carried out forty fully guided sCAIS (FGI group) surgeries on maxillary models, respectively. Each operator placed an implant in one maxillary model. In vivo, 60 patients with 113 implants from 2019 to 2023 (ARI group: 32 patients, 58 implants; FGI group: 28 patients, 55 implants) receiving implant surgeries were incorporated in this retrospective research. The preoperative and postoperative cone beam computer tomographs (CBCTs) were utilized to estimate the linear deviations and angular deviations in two-dimensional (2D) and three-dimensional (3D) space. The Pearson's chi-square test, Shapiro-Wilk test, Student's t test, Mann-Whitney U test and mixed models were applied, and p <0.05 was considered statistically significant.

RESULTS

In vitro, a total of 80 implants were enrolled and significant differences were found between the two groups (p < 0.001): The 3D deviation at the platform of ARI and FGI group was 0.58 ± 0.60 mm and 1.50 ± 1.46 mm, respectively, at the apex was 0.58 ± 0.60 mm and 1.78 ± 1.35 mm, respectively, and angle was 1.01 ± 0.87° and 2.93 ± 1.59°, respectively. Also, except for mesiodistal deviation at the implant platform, the rest linear and angular deviations in the ARI group were significantly lower than those in the FGI group in 2D space (p < 0.001). In vivo, a significantly lower mean of angular deviation (0.95 ± 0.50°, p < 0.001) and the linear deviation at both platform (0.45 ± 0.28 mm, p < 0.001) and apex (0.47 ± 0.28 mm, p < 0.001) were observed in ARI group when compared to the FGI group (4.31 ± 2.60°; 1.45 ± 1.27 mm; 1.77 ± 1.14 mm).

CONCLUSIONS

The use of autonomous robotic technology showed significantly higher accuracy than the fully guided sCAIS.

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.

Correlation between intraosseous thermal change and drilling impulse data during osteotomy within autonomous dental implant robotic system: An in vitro study

OBJECTIVES

This study aims at examining the correlation of intraosseous temperature change with drilling impulse data during osteotomy and establishing real-time temperature prediction models.

MATERIALS AND METHODS

A combination of in vitro bovine rib model and Autonomous Dental Implant Robotic System (ADIR) was set up, in which intraosseous temperature and drilling impulse data were measured using an infrared camera and a six-axis force/torque sensor respectively. A total of 800 drills with different parameters (e.g., drill diameter, drill wear, drilling speed, and thickness of cortical bone) were experimented, along with an independent test set of 200 drills. Pearson correlation analysis was done for linear relationship. Four machining learning (ML) algorithms (e.g., support vector regression [SVR], ridge regression [RR], extreme gradient boosting [XGboost], and artificial neural network [ANN]) were run for building prediction models.

RESULTS

By incorporating different parameters, it was found that lower drilling speed, smaller drill diameter, more severe wear, and thicker cortical bone were associated with higher intraosseous temperature changes and longer time exposure and were accompanied with alterations in drilling impulse data. Pearson correlation analysis further identified highly linear correlation between drilling impulse data and thermal changes. Finally, four ML prediction models were established, among which XGboost model showed the best performance with the minimum error measurements in test set.

CONCLUSION

The proof-of-concept study highlighted close correlation of drilling impulse data with intraosseous temperature change during osteotomy. The ML prediction models may inspire future improvement on prevention of thermal bone injury and intelligent design of robot-assisted implant surgery.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Robot-assisted augmented reality surgical navigation based on optical tracking for mandibular reconstruction surgery

PURPOSE

This work proposes a robot-assisted augmented reality (AR) surgical navigation system for mandibular reconstruction. The system accurately superimposes the preoperative osteotomy plan of the mandible and fibula into a real scene. It assists the doctor in osteotomy quickly and safely under the guidance of the robotic arm.

METHODS

The proposed system mainly consists of two modules: the AR guidance module of the mandible and fibula and the robot navigation module. In the AR guidance module, we propose an AR calibration method based on the spatial registration of the image tracking marker to superimpose the virtual models of the mandible and fibula into the real scene. In the robot navigation module, the posture of the robotic arm is first calibrated under the tracking of the optical tracking system. The robotic arm can then be positioned at the planned osteotomy after the registration of the computed tomography image and the patient position. The combined guidance of AR and robotic arm can enhance the safety and precision of the surgery.

RESULTS

The effectiveness of the proposed system was quantitatively assessed on cadavers. In the AR guidance module, osteotomies of the mandible and fibula achieved mean errors of 1.61 ± 0.62 and 1.08 ± 0.28 mm, respectively. The mean reconstruction error of the mandible was 1.36 ± 0.22 mm. In the AR-robot guidance module, the mean osteotomy errors of the mandible and fibula were 1.47 ± 0.46 and 0.98 ± 0.24 mm, respectively. The mean reconstruction error of the mandible was 1.20 ± 0.36 mm.

CONCLUSIONS

The cadaveric experiments of 12 fibulas and six mandibles demonstrate the proposed system's effectiveness and potential clinical value in reconstructing the mandibular defect with a free fibular flap.

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

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

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.

Semi-autonomous two-stage dental robotic technique for zygomatic implants: An in vitro study

OBJECTIVE

To assess the feasibility and accuracy of a semi-autonomous two-stage dental robotic technique for zygomatic implants.

METHODS

Twenty-six zygomatic implants were designed and randomly divided into two groups using 10 three-dimensionally printed resin models with severe maxillary atrophy. In one group, the conventional drilling technique was used, in the other group, the drilling process for the alveolar ridge section (first stage) was completed, after which drilling for the zygoma section (second stage) was done. Based on preoperative planning combined with postoperative cone-beam computed tomography (CBCT), coronal, apical, depth, and angle deviations were measured. Zygomatic implant placement technique-related deviations (sinus slot, intrasinus, and extrasinus) were also recorded and analyzed.

RESULTS

The two-stage technical group's coronal, apical, depth, and angle deviations were 0.57 ± 0.19 mm, 1.07 ± 0.48 mm, 0.30 ± 0.38 mm, and 0.91 ± 0.51°, respectively. The accuracy of the two-stage technique was significantly higher than that of the conventional one-stage technique (p < 0.05). The apical deviation in the intrasinus group was 1.12 ± 0.56 mm, which was significantly better than that in the other two groups (p < 0.05). The angle deviation in the sinus slot group was 1.96 ± 0.83°, which was significantly worse than that in the other two groups (p < 0.05).

CONCLUSION

Using the semi-autonomous two-stage dental robotic technique for zygomatic implants is feasible and is more accurate than using the conventional one-stage technique.

CLINICAL SIGNIFICANCE

The two-stage technique enabled the semi-autonomous robot to overcome the mouth-opening restriction for zygomatic implants and improved accuracy.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

AUTONOMOUS ROBOTIC SURGERY SEEMS PROMISING AS AN ACCURATE TECHNOLOGY FOR SINGLE-TOOTH IMPLANT PLACEMENT IN THE ESTHETIC ZONE

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Yang S, Chen J, Li A, Deng K, Li P, Xu S. Accuracy of autonomous robotic surgery for single-tooth implant placement: a case series. J Dent. 2023;132:104451. doi:10.1016/j.jdent.2023.104451. Epub 2023 Feb 11. PMID: 36781099.

SOURCE OF FUNDING

This case series study was supported by grants from the Guangdong Basic and Applied Basic Research Foundation, Science and Technology Projects in Guangzhou, Science Research Cultivation Program, and Clinical Research Initiation Plan of the Stomatological Hospital, Southern Medical University, China.

TYPE OF STUDY/DESIGN

Case series. No a priori power calculation or pilot data. Nonconsecutive participant recruitment.

Future of Using Robotic and Artificial Intelligence in Implant Dentistry

The integration of robotic technology and artificial intelligence (AI) in implant dentistry has ushered in a new era of precision and efficiency. This abstract aims to understand the integration, implications, potential, and challenges of robotic technology and AI in implant dentistry. Robotic systems offer unparalleled accuracy in implant placement, reducing human error and improving treatment outcomes. AI algorithms analyze extensive patient data to assist in diagnosis, treatment planning, and implant design, optimizing the overall process. Successful case studies demonstrate improved implant survival rates and patient satisfaction. However, ethical considerations and the balance between human expertise and reliance on technology must be addressed. Ongoing research aims to enhance these technologies and integrate them with digital workflows. Collaboration and knowledge sharing among practitioners, researchers, and industry experts are essential to drive progress and ensure responsible implementation. The future of implant dentistry lies in harnessing the potential of robotics and AI while upholding the highest standards of patient care and ethical practice.

Accuracy Analysis of Computer-Assisted and Guided Dental Implantology by Comparing 3D Planning Data and Actual Implant Placement in a Mandibular Training Model: A Monocentric Comparison between Dental Students and Trained Implantologists

The aim of this study was to investigate how precisely implantation can be realized by participants on a phantom head according to preliminary planning. Of particular interest here was the influence of participants' previous knowledge and surgical experience on the precision of the implant placement. The placed implants were scanned using an intraoral scanner, saved as STL files, and superimposed with the 3D-planned implant placement. Deviations from the planning were indicated in millimeters and degrees. We were able to show that on average, the deviations from computer-assisted 3D planning were less than 1 mm for implantologists, and the students also did not deviate more than 1.78 mm on average from 3D planning. This study shows that guided implantology provides predictable and reproducible results in dental implantology. Incorrect positioning, injuries to anatomical structures, and implant positions that cannot be prosthetically restored can thus be avoided.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

Effect of the number and distribution of fiducial markers on the accuracy of robot-guided implant surgery in edentulous mandibular arches: An in vitro study

OBJECTIVES

Robot-guided implant placement based on the screw marker-assisted registration technique has been applied in dentistry. This study aimed to identify the optimal number and distribution of fiducial markers for robot-guided implant placement in edentulous mandibular phantoms.

METHODS

Four implants were digitally planned and placed in edentulous mandibular phantoms under robotic guidance. Different numbers of fiducial markers (3, 4, 5, or 6) and distribution patterns (dispersed or localized) were used to register the robotic system. Platform, apex, and angular deviations were measured between the planned and actual implant positions using different numbers and distributions of fiducial markers.

RESULTS

Inserting six fiducial markers resulted in optimal implant position accuracy at the platform (0.53 ± 0.19 mm) and apex (0.59 ± 0.2 mm) deviations. However, the angular deviation did not differ significantly between different numbers of fiducial markers. Furthermore, the implant position accuracy did not differ significantly between the dispersed and localized distributions of fiducial markers.

CONCLUSION

In robot-guided implant placement for edentulous mandibular arches, the insertion of six fiducial markers significantly increases the implant placement accuracy.

CLINICAL SIGNIFICANCE

The findings of this in vitro study may serve as a reference for clinicians to determine the optimal placement of fiducial markers and to facilitate the clinical application of robot-guided systems for implant placement in edentulous patients. Further clinical studies are necessary to confirm these findings.

Implant placement with an autonomous dental implant robot: A clinical report

Ideal implant placement is the basis for long-term implant survival and satisfactory restoration outcomes. Static and dynamic computer-assisted guidance have been used to improve the accuracy of implant placement, but both have shortcomings that robots can overcome. This clinical report describes the use of an autonomous implant robot to complete the placement of 2 adjacent implants with immediate postoperative restoration.

The effect of implant surgery experience on the learning curve of a dynamic navigation system: an in vitro study

BACKGROUND

Dynamic navigation systems have a broad application prospect in digital implanting field. This study aimed to explore and compare the dynamic navigation system learning curve of dentists with different implant surgery experience through dental models.

METHODS

The nine participants from the same hospital were divided equally into three groups. Group 1 (G1) and Group 2 (G2) were dentists who had more than 5 years of implant surgery experience. G1 also had more than 3 years of experience with dynamic navigation, while G2 had no experience with dynamic navigation. Group 3 (G3) consisted of dentists with no implant surgery experience and no experience with dynamic navigation. Each participant sequentially placed two implants (31 and 36) on dental models according to four practice courses (1-3, 4-6, 7-9, 10-12 exercises). Each dentist completed 1-3, 4-6 exercises in one day, and then 7-9 and 10-12 exercises 7 ± 1 days later. The preparation time, surgery time and related implant accuracy were analyzed.

RESULTS

Three groups placed 216 implants in four practice courses. The regressions for preparation time (F = 10.294, R² = 0.284), coronal deviation (F = 4.117, R² = 0.071), apical deviation (F = 13.016, R² = 0.194) and axial deviation (F = 30.736, R² = 0.363) were statistically significant in G2. The regressions for preparation time (F = 9.544, R² = 0.269), surgery time (F = 45.032, R² = 0.455), apical deviation (F = 4.295, R² = 0.074) and axial deviation (F = 21.656, R² = 0.286) were statistically significant in G3. Regarding preparation and surgery time, differences were found between G1 and G3, G2 and G3. Regarding implant accuracy, differences were found in the first two practice courses between G1 and G3.

CONCLUSIONS

The operation process of dynamic navigation system is relatively simple and easy to use. The linear regression analysis showed there is a dynamic navigation learning curve for dentists with or without implant experience and the learning curve of surgery time for dentists with implant experience fluctuates. However, dentists with implant experience learn more efficiently and have a shorter learning curve.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Clinical Advantages of Immediate Posterior Implants With Custom Healing Abutments: Up to 8-Year Follow-Up of 115 Cases

PURPOSE

Proper management of the soft tissues around dental implants is crucial to their long-term function and esthetics. The purpose of this article is to report the survival rate of immediate posterior implants when using an immediate chair-side technique for custom healing abutments.

MATERIALS AND METHODS

The investigator implemented a retrospective case series analysis of a sample of 115 consecutive patients with 1 posterior dental implant placed between February 1, 2012 and December 9, 2014, in the author's private practice who underwent the previously published technique for immediate custom chair-side healing abutment fabrication. In this descriptive analysis, the primary outcome variable was implant survival. Other variables included patient gender and age.

RESULTS

Of the 115 patients in this cohort, 66 were female and 49 were male, with a mean age of 58 years, with 73% of the sites being first molars and 27% second molars. This study sample had a 98.26% overall implant survival rate with 3 implant failures. Median follow-up time was 1 year with identical 1-year and 5-year survival rates. Follow-up at up to 8 years demonstrated a 98.26% overall survival rate with 100% survival in the maxilla and 96.08% in the mandible.

CONCLUSIONS

This case series demonstrates that the Anatomic Harmony Abutment technique, by applying principles of flapless posterior immediate implant surgery with immediate custom healing abutment placement, can lead to highly successful implant outcomes.

The Feasibility of Robot-Assisted Chin Osteotomy on Skull Models: Comparison with Surgical Guides Technique

Surgical robotic technology is characterized by its high accuracy, good stability, and repeatability. The accuracy of mandibular osteotomy is important in tumor resection, function reconstruction, and abnormality correction. This study is designed to compare the operative accuracy between robot-assisted osteotomy and surgical guide technique in the skull model trials which simulated the genioplasty. In an experimental group, robot-assisted chin osteotomy was automatically performed in 12 models of 12 patients according to the preoperative virtual surgical planning (VSP). In a control group, with the assistance of a surgical guide, a surgeon performed the chin osteotomy in another 12 models of the same patients. All the mandibular osteotomies were successfully completed, and then the distance error and direction error of the osteotomy plane were measured and analyzed. The overall distance errors of the osteotomy plane were 1.57 ± 0.26 mm in the experimental group and 1.55 ± 0.23 mm in the control group, and the direction errors were 7.99 ± 1.10° in the experimental group and 8.61 ± 1.05° in the control group. The Bland-Altman analysis results revealed that the distance error of 91.7% (11/12) and the direction error of 100% (12/12) of the osteotomy plane were within the 95% limits of agreement, suggesting the consistency of differences in the osteotomy planes between the two groups. Robot-assisted chin osteotomy is a feasible auxiliary technology and achieves the accuracy level of surgical guide-assisted manual operation.

Autonomous Robotic Surgery for Immediately Loaded Implant-Supported Maxillary Full-Arch Prosthesis: A Case Report

Robotic systems have emerged in dental implant surgery due to their accuracy. Autonomous robotic surgery may offer unprecedented advantages over conventional alternatives. This clinical protocol was used to show the feasibility of autonomous robotic surgery for immediately loaded implant-supported full-arch prostheses in the maxilla. This case report demonstrated the surgical protocol and outcomes in detail, highlighting the pros and cons of the autonomous robotic system. Within the limitations of this study, autonomous robotic surgery could be a feasible alternative to computer-assisted guided implant surgery.

Accuracy of intraoral real-time navigation versus static, CAD/CAM-manufactured pilot drilling guides in dental implant surgery: an in vitro study

Background

Nowadays, 3D planning and static for dynamic aids play an increasing role in oral rehabilitation of the masticatory apparatus with dental implants. The aim of this study is to compare the accuracy of implant placement using a 3D-printed drilling guide and an intraoral real-time dynamic navigation system.

Methods

A total of 60 implants were placed on 12 partially edentulous lower jaw models. 30 were placed with pilot drilling guides, the other half with dynamic navigation (DENACAM^®). In addition, implant placement in interdental gaps and free-end situations were investigated. Accuracy was assessed by cone-beam computed tomography (CBCT).

Results

Both systems achieved clinically acceptable results, yet more accurate results regarding the offset of implant base and tip in several spatial dimensions were achieved using drilling guides (each p < 0.05). With regard to angulation, real-time navigation was more precise (p = 0.0016). Its inaccuracy was 3°; the template-guided systems was 4.6°. Median horizontal deviation was 0.52 mm at base and 0.75 mm at tip using DENACAM^®. When using the pilot drill guide, horizontal deviation was 0.34 mm in the median and at the tip by 0.59 mm. Regarding angulation, it was found that the closer the drill hole was to the system's marker, the better navigation performed. The template did not show this trend (p = 0.0043; and p = 0.0022).

Conclusion

Considering the limitations of an in vitro study, dynamic navigation can be used be a tool for reliable and accurate implantation. However, further clinical studies need to follow in order to provide an evidence-based recommendation for use in vivo.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40729-022-00430-6.

Collaborative Control Method and Experimental Research on Robot-Assisted Craniomaxillofacial Osteotomy Based on the Force Feedback and Optical Navigation

Surgical robot has advantages in high accuracy and stability. But during the robot-assisted bone surgery, the lack of force information from surgical area and incapability of intervention from surgeons become the obstacle. The aim of the study is to introduce a collaborative control method based on the force feedback and optical navigation, which may optimally combine the excellent performance of surgical robot with clinical experiences of surgeons.

Present Status and Future Directions - Surgical Endodontics

Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.

Microrobotics for Precision Biofilm Diagnostics and Treatment

Advances in small-scale robotics and nanotechnology are providing previously unimagined opportunities for new diagnostic and therapeutic approaches with high precision, control, and efficiency. We designed microrobots for tetherless biofilm treatment and retrieval using iron oxide nanoparticles (NPs) with dual catalytic-magnetic functionality as building blocks. We show 2 distinct microrobotic platforms. The first system is formed from NPs that assemble into aggregated microswarms under magnetic fields that can be controlled to disrupt and retrieve biofilm samples for microbial analysis. The second platform is composed of 3-dimensional (3D) micromolded opacifier-infused soft helicoids with embedded catalytic-magnetic NPs that can be visualized via existing radiographic imaging techniques and controlled magnetically inside the root canal, uninterrupted by the soft and hard tissues surrounding the teeth in an ex vivo model. These microrobots placed inside the root canal can remove biofilms and be efficiently guided with microscale precision. The proof-of-concept paradigm described here can be adapted to target difficult-to-reach anatomical spaces in other natural and implanted surfaces in an automated and tether-free manner.

Dental Implant Navigation System Based on Trinocular Stereo Vision

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

Robotic and Microrobotic Tools for Dental Therapy

Robotic and microrobotic tools such as dental operating microscopes and dental endoscopes are being used extensively in dental therapy, which have a significant impact on dental therapy and education. Herein, this paper reviews the state of the art of robotic and microrobotic tools for dental therapy. This article starts with a brief introduction of current robotic and microrobotic tools for dental therapy and then displays their applications in various dental problems; strengths and weaknesses are also surveyed. Lastly, the conclusion and outlook are discussed, referring to the emerging dental clinic problems and demands. This review is expected to provide guidelines for the therapeutic application of robotic and microrobotic tools and to promote the development of robots in dentistry.

Augmented, Virtual and Mixed Reality in Dentistry: A Narrative Review on the Existing Platforms and Future Challenges

The recent advancements in digital technologies have led to exponential progress in dentistry. This narrative review aims to summarize the applications of Augmented Reality, Virtual Reality and Mixed Reality in dentistry and describes future challenges in digitalization, such as Artificial Intelligence and Robotics. Augmented Reality, Virtual Reality and Mixed Reality represent effective tools in the educational technology, as they can enhance students’ learning and clinical training. Augmented Reality and Virtual Reality and can also be useful aids during clinical practice. Augmented Reality can be used to add digital data to real life clinical data. Clinicians can apply Virtual Reality for a digital wax-up that provides a pre-visualization of the final post treatment result. In addition, both these technologies may also be employed to eradicate dental phobia in patients and further enhance patient’s education. Similarly, they can be used to enhance communication between the dentist, patient, and technician. Artificial Intelligence and Robotics can also improve clinical practice. Artificial Intelligence is currently developed to improve dental diagnosis and provide more precise prognoses of dental diseases, whereas Robotics may be used to assist in daily practice.

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

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

An image-guided hybrid robot system for dental implant surgery

PURPOSE

Dental implant surgery is an effective method for remediating the loss of teeth. Robot is expected to increase the accuracy of dental implant surgery. However, most of them are industrial serial robot, with low stiffness and non-unique inverse kinematic solution, which may reduce the success rate and safety of robotic surgery. Compared to serial robot, parallel robot is more stiffness and has unique inverse kinematic. However, its workspace is small, which may not meet surgical requirements. Therefore, a novel hybrid robot dedicated to dental implant is proposed.

METHODS

The hybrid robot is composed of three translation joints, two revolute joints, and Stewart parallel manipulator. Stewart is used for performing surgical operation, while the joints are used for enlarging the workspace of Stewart. In order to ensure the safety of robot motion, physical human-robot interaction based on a variable admittance controller is applied in the robotic system. In addition, considering the small workspace of Stewart, an optimal model is proposed to minimize the joint movement of Stewart in adjusting the orientation of drill bit.

RESULTS

Phantom experiments were carried out based on the prototype robot. In the experiments, the optimal model could be solved after 20 iterations, finding an ideal joint configuration. The proposed variable admittance controller could enhance comfort level effectively. The accuracy of robot is evaluated by angle, entry and exit deviation, which are 0.74 ± 0.25°, 0.93 ± 0.28 mm, and 0.96 ± 0.23 mm, respectively.

CONCLUSION

The phantom experiments validate the functionality of the proposed hybrid robot. The satisfactory performance makes it more widely used in the practical dental implant surgery in the future.

Robot technology in dentistry, part one of a systematic review: literature characteristics

OBJECTIVES

To provide dental practitioners and researchers with a comprehensive and transparent evidence-based overview of the characteristics of literature regarding initiatives of robot technology in dentistry.

DATA

All articles in which robot technology in dentistry is described, except for non-scientific articles and articles containing secondary data (reviews). Amongst others, the following data were extracted: type of study, level of technological readiness, authors' professional background and the subject of interaction with the robot.

SOURCES

Bibliographic databases PubMed, Embase, and Scopus were surveyed. A reference search was conducted. The search timeline was between January 1985 and October 2020.

STUDY SELECTION

A total of 911 articles were screened on title and abstract of which 161 deemed eligible for inclusion. Another 71 articles were excluded mainly because of unavailability of full texts or the sole use of secondary data (reviews). Four articles were included after hand searching the reference lists. In total, 94 articles were included for analysis.

CONCLUSIONS

Since 2013 an average of six articles per year concern robot initiatives in dentistry, mostly originating from East Asia (57%). The vast majority of research was categorized as either basic theoretical or basic applied research (80%). Technology readiness levels did not reach higher than three (proof of concept) in 55% of all articles. In 84%, the first author of the included articles had a technical background and in 36%, none of the authors had a dental or medical background. The overall quality of literature, especially in terms of clinical validation, should be considered as low.

Robot technology in dentistry, part two of a systematic review: an overview of initiatives

OBJECTIVES

To provide dental practitioners and researchers with a comprehensive and transparent evidence-based overview of physical robot initiatives in all fields of dentistry.

DATA

Articles published since 1985 concerning primary data on physical robot technology in dentistry were selected. Characteristics of the papers were extracted such as the respective field of dentistry, year of publication as well as a description of its usage.

SOURCES

Bibliographic databases PubMed, Embase, and Scopus were searched. A hand search through reference lists of all included articles was performed.

STUDY SELECTION

The search timeline was between January 1985 and October 2020. All types of scientific literature in all languages were included concerning fields of dentistry ranging from student training to implantology. Robot technology solely for the purpose of research and maxillofacial surgery were excluded. In total, 94 articles were included in this systematic review.

CONCLUSIONS

This study provides a systematic overview of initiatives using robot technology in dentistry since its very beginning. While there were many interesting robot initiatives reported, the overall quality of the literature, in terms of clinical validation, is low. Scientific evidence regarding the benefits, results and cost-efficiency of commercially available robotic solutions in dentistry is lacking. The rise in availability of open source control systems, compliant robot systems and the design of dentistry-specific robot technology might facilitate the process of technological development in the near future. The authors are confident that robotics will provide useful solutions in the future but, strongly, encourage an evidence-based approach when adapting to new (robot) technology.

Dental Robotics: A Disruptive Technology

Robotics is a disruptive technology that will change diagnostics and treatment protocols in dental medicine. Robots can perform repeated workflows for an indefinite length of time while enhancing the overall quality and quantity of patient care. Early robots required a human operator, but robotic systems have advanced significantly over the past decade, and the latest medical robots can perform patient intervention or remote monitoring autonomously. However, little research data on the therapeutic reliability and precision of autonomous robots are available. The present paper reviews the promise and practice of robots in dentistry by evaluating published work on commercial robot systems in dental implantology, oral and maxillofacial surgery, prosthetic and restorative dentistry, endodontics, orthodontics, oral radiology as well as dental education. In conclusion, this review critically addresses the current limitations of dental robotics and anticipates the potential future impact on oral healthcare and the dental profession.

Digital Approach for the Rehabilitation of the Edentulous Maxilla with Pterygoid and Standard Implants: The Static and Dynamic Computer-Aided Protocols

A full-arch rehabilitation of the edentulous upper jaw without grafting procedures exploits the residual alveolar or the basal bone, with the necessity of long implants placed with a particular orientation. The precision in planning and placing the fixtures is fundamental to avoid clinical problems and to allow an acceptable connection with the prosthesis. The computer-aided implantology resulted in more accuracy than the traditional one, with a high standard of correspondence between the virtual project and the real outcome. This paper reports about the two different digital protocols, static and dynamic, as support to implant-borne prosthetic rehabilitation of edentulous maxillae. Two pterygoid and two/four anterior standard implants were seated in both cases by two different operators, without flap raising, and immediately loaded. This approach avoided the posterior cantilever by-passing the maxillary sinus and was adequately planned and realized without any surgical or prosthetic error. The two digital flow-charts were described step by step, underlining each other’s advantages and drawbacks compared to a free-hand approach.