Endodontic Microsurgery of Mandibular Molars with an Autonomous Robotic System

Minimally invasive osteotomy and precise root-end resection are key factors in endodontic microsurgery (EMS), particularly in the mandibular molars. Autonomous robotic (ATR) systems facilitate accurate presurgical planning and real-time robot-guided osteotomy and root resection. Integrating the ATR technique with EMS can enhance the accuracy and effectiveness of the treatment. This report presents 2 cases diagnosed with symptomatic apical periodontitis in the mandibular left and right first molar. Cone-beam computed tomography and intraoral scanning data were used to design the surgical plan via planning software. The ATR system guided the robotic arm to autonomously perform precise osteotomy and root resection based on the presurgical plan. At 3-12 months of follow-up, both patients were asymptomatic and radiographic examination revealed complete healing. The ATR technique enabled precise root-end resection despite thick and intact cortical plates, contributing to successful EMS outcomes during the 3- to 12-month follow-up period. This feasibility demonstration warrants further validation in clinical trials with extended follow-ups to assess its potential role in surgical endodontics.