Surgical protocol affecting robotic implant accuracy: Ex-vivo study

A randomized controlled study was conducted to compare the accuracy of three different robotic-computer aided implant surgical protocols (fully guided surgery, partially guided surgery performed by a novice surgeon, and partially guided surgery conducted by an experienced surgeon) under the same conditions.

A total of n = 81 implants were placed in porcine ribs according to three different protocols (n = 27 implants per group). All cases were digitally planned, and the final implant positions were captured through cone-beam computed tomography and compared to the planned positions. The primary outcome variable was angular deviation. The secondary outcome variables were global, horizonal, and vertical deviations at the coronal and apical levels.

In terms of implant insertion, the novice surgeon exhibited significantly larger angular deviation compared to both the experienced surgeon and the robot, with no significant difference observed between the latter two. Regarding vertical deviation, the robot showed worse performance than both surgeons, though no significant difference was found between the novice and experienced surgeons.

For novice surgeons, using the robot to guide the whole process of implantation can obtain smaller angular deviation, while the vertical deviation may increase; for experienced surgeons, using the robot to guide only the osteotomy process and adopting a freehand implant insertion manner can obtain smallest angular and vertical deviation.

This study highlights the potential of improving angular precision for novice surgeons through a fully guided surgical protocol, while a partially guided approach may optimize both angular and vertical precision for experienced surgeons, offering tailored strategies based on surgical expertise.