The accuracy of robotic-assisted zygomatic implant placement: a systematic review and meta-analysis

This is the first systematic review and meta-analysis aimed at assessing the current status of robotic-assisted implant surgery (r-CAIS) in zygomatic implant (ZI) placement, with a particular focus on deviations between planned and placed implant positions.

The review protocol was specified and registered in PROSPERO (CRD42024616949). All primary studies were considered eligible, including in vitro studies, clinical studies, and hybrid experimental-clinical studies. Electronic and manual literature searches were conducted through April 2025 in PubMed/MEDLINE, Scopus, the Cochrane Library, and Web of Science. The primary outcome was planned/placed deviation with or without other implant placement techniques.

Ten studies (seven in vitro, two clinical, and one hybrid experimental-clinical) involving 185 ZIs in 83 models /patients were included. Of these, nine studies were eligible for quantitative synthesis, contributing 161 ZIs placed using r-CAIS and 97 using dynamic CAIS (d-CAIS) to the pooled mean meta-analysis. The pooled mean ZI deviations from the r-CAIS group were 1.04 mm (95% CI: 0.74-1.35 mm) at the entry point and 1.47 mm (95% CI: 1.07-1.87 mm) at the exit point, and angular deviations were 1.22° (95% CI: 0.82-1.62°). The pooled mean ZI deviations from the d-CAIS group were 1.30 mm (95% CI: 1.00-1.60 mm) at the entry point and 2.02 mm (95% CI: 1.81-2.23 mm) at the exit point, and angular deviations were 2.00° (95% CI: 1.33-2.67°). Significant differences in deviation were observed at the exit and angular levels in favor of r-CAIS.

r-CAIS demonstrates significantly superior accuracy compared with d-CAIS in ZIs placement. However, as r-CAIS remains at an early stage of clinical integration and only limited clinical studies have been reported, its long-term applicability requires further validation through cadaveric and well-designed prospective clinical investigations.