Robotic Quad Zygomatic Implant Surgery Accuracy Ex Vivo With a New Semi-Autonomous Optically-Driven Haptic System

To evaluate ex vivo accuracy of robotic computer-assisted implant surgery (r-CAIS) for quad zygomatic implant (ZI) placement with a novel semi-autonomous, optically-driven, haptic-assisted system.

Two expert operators placed ZIs in human cadavers. Accuracy was evaluated by superimposing pre- and post-operative cone-beam computed tomography (CBCT) scans, measuring linear (mm) on the x-, y-, and z- axes and angular (degrees) deviations. Sample size was calculated. The main analysis focused on composite outcomes (global platform, global apical, and angular deviation), while extended analyses examined deviations on individual spatial axes (buccal-lingual, mesial-distal, depth, and non-depth) for both implant platform and apex. Three multivariate models were executed on global platform, global apical, and angular deviation considering implant position (anterior vs. posterior) and quadrant (left vs. right).

Forty ZIs were placed in 10 human cadavers. The mean global deviations at implant platform and apex were 1.16 mm (standard deviation (SD) 0.47) and 1.51 mm (SD 0.70), with mean angular deviation of 1.04° (SD 0.65°). In the multivariate models, implant position was found to be significant for global platform deviation (p = 0.0218), with posterior implants performing better, and for angular deviation (p = 0.0465), with anterior implants performing better.

The optically driven haptic-assisted robotic system demonstrated high accuracy in quad ZI surgery, with all implants placed without intraoperative complications or significant errors impacting adjacent anatomical structures. Mean global linear deviations of 1 and 1.5 mm at platform and apex, and 1° of angular deviation were experienced. Further research is necessary to validate these promising results in vivo.