Transcrestal Sinus Floor Elevation Using Dental Implant Robot and Osseodensification Drills: A Preliminary Case...

This study aims to evaluate the application of an autonomous dental implant robot combined with osseodensification drills for transcrestal maxillary sinus floor elevation (ADIR-OD-TSFE) and simultaneous implant placement. The following parameters, such as maxillary sinus elevation volume (MSV), maxillary sinus elevation area (MSA), membrane elevation height (MEH), implant protrusion length (IPL), implant placement accuracy, intraoperative Schneiderian membrane perforation rate, and operative time, were evaluated. In addition, the force feedback characteristics associated with different maxillary sinus floor morphologies were preliminarily investigated.

This study enrolled patients treated at the Stomatological Hospital of Chongqing Medical University between January and November 2024, with a residual bone height (RBH) of 4.00-8.00 mm, who underwent simultaneous implant placement using ADIR-OD-TSFE. Postoperative CBCT scans were imported into the design software to evaluate implant placement accuracy. The software's AI segmentation function was used to calculate the sinus floor augmentation outcome immediately after surgery (P1) and at 6 months postoperatively (P2). Force feedback characteristics were analyzed for two sinus floor morphologies (flat and sloped). The total operative time for osteotomy, sinus floor elevation, and implant placement performed with robotic assistance was recorded; the surgeon's learning curve was plotted, and the intraoperative complications were documented.

A total of 18 implants were placed, with 9 in flat sinus floors and 9 in sloped sinus floors. The mean preoperative RBH was 5.92 ± 1.01 mm. Schneiderian membrane perforation occurred in 1 case (5.6%). The mean surgery time was 25.5 ± 9.8 min, and the surgeon's learning curve plateaued as case numbers increased. The coronal global deviation (CG), apical global deviation (AG), and angular deviation (AD) were 0.69 ± 0.36, 0.76 ± 0.41, and 1.64° ± 0.91°, respectively. The maxillary sinus floor elevation volume was 351.54 ± 151.74 mm³ immediately after surgery (P1) and 253.68 ± 160.60 mm³ at 6 months postoperatively (P2). Force feedback analysis showed that the breakthrough force was higher in flat sinus floors (F_f0) than in sloped sinus floors (F_s0), with a mean difference of 6.86 N, a 95% CI of 0.82 to 12.90 N, and a large effect size (Hedges' g = 1.08).

The ADIR-OD-TSFE technique is effective for sinus floor elevation and implant placement, with the learning curve improving as the surgeon's experience increases. It demonstrates high implant placement accuracy and maintains relatively stable bone augmentation outcomes at 6 months postoperatively. Flat sinus floors require significantly higher breakthrough forces compared to sloped sinus floors. Overall, the ADIR-OD-TSFE system proves to be a safe and clinically reliable approach.