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 system into EMS represents a pioneering advancement aimed at enhancing digital endodontic surgery. Robot-assisted EMS (RA-EMS) integrates cone-beam computed tomography 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 4 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 the follow-up visits at 1-6 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.