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

Area of Science:

• Dental Implantology
• Surgical Navigation
• Robotic Surgery

Background:

• Precise digital planning is crucial for successful dental implant restorations, impacting aesthetics and long-term stability.
• Various guided surgical approaches exist, including robotic surgery (RS), dynamic navigation (DN), and static guides (SG), each with potential benefits and drawbacks.

Purpose of the Study:

• To compare the accuracy and clinical outcomes of dental implant placement using robotic surgery (RS), dynamic navigation (DN), and 3-dimensional printed static guides (SG).
• To evaluate implant positional accuracy, wound healing, microcirculation, patient-reported outcomes, and surgeon preferences across the three guided approaches.

Main Methods:

• A randomized controlled trial involving 45 patients with missing premolar/molar teeth.
• Patients were assigned to RS, DN, or SG groups for implant placement.
• Outcomes measured included implant positional accuracy (platform and apex deviation, angular deviation), early wound healing, soft tissue microcirculation, patient-reported outcomes, and surgeon preference by blinded examiners.

Main Results:

• Robotic surgery (RS) exhibited significantly smaller differential deviations at the platform and apex compared to static guides (SG).
• Static guides (SG) resulted in significantly shorter surgery times and better 3-day postoperative recovery.
• Dynamic navigation (DN) was perceived by surgeons as offering easier access to the surgical site. No significant differences in soft tissue microcirculation or oxygen saturation were observed. Patient-reported outcomes were comparable, with SG patients reporting better oral health-related quality of life at 3 days.

Conclusions:

• Robotic surgery (RS) demonstrated near-zero 3-dimensional systematic error in implant positioning, whereas dynamic navigation (DN) and static guides (SG) showed a centrifugal error pattern.
• All three guided approaches resulted in uneventful wound healing and acceptable patient-reported outcomes, each with distinct cost-benefit profiles.
• Further research with larger sample sizes and longer follow-up is recommended to analyze the cost-effectiveness of these guided surgical techniques after technical advancements.