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Robotic Computer-Assisted Dental Implant Surgery Versus Free-Hand and Guided Techniques: A Systematic Review and
Sultan Ainoosah1, Redhwan Saleh Al-Gabri2,3, Omar M Alaryani1
1Substitutive Dental Science Department, College of Dentistry, Taibah University, Madinah, Saudi Arabia.
Background:
Robotic computer-assisted implant surgery (r-CAIS) aims to improve implant placement trueness, but existing reviews include heterogeneous designs, and no review has exclusively synthesized RCTs to date. This review aimed to evaluate the positional trueness and clinical outcomes of r-CAIS compared with free-hand implant surgery (FHIS), dynamic computer-assisted implant surgery (d-CAIS), and static computer-assisted implant surgery (s-CAIS), through a systematic review and meta-analysis of RCTs.
Materials And Methods:
This systematic review was conducted according to PRISMA 2020 guidelines. Electronic searches were performed in major biomedical databases from inception to March 2026. Only RCTs were eligible. Risk of bias was assessed using the RoB 2 tool and certainty of evidence was rated using the GRADE framework. Meta-analyses were performed using a random-effects model where feasible.
Results:
Seven RCTs enrolling 529 implants were included. Moderate-certainty evidence demonstrated significantly improved positional trueness with r-CAIS over FHIS across all deviation parameters, with the largest effect observed for angular deviation (MD = -4.56°; 95% CI -6.25 to -2.86). High certainty evidence showed a significant angular deviation advantage of r-CAIS over d-CAIS (MD = -0.77°; 95% CI: -1.33 to -0.21), while platform and apical deviations did not differ significantly. All comparisons with s-CAIS were non-significant, rated low to very low certainty from a single small trial. Operative time evidence was very low certainty, precluding any directional conclusion. Early implant retention ranged from 93.3% to 100% across all modalities with no meaningful between-group differences.
Conclusions:
r-CAIS improves implant positional trueness compared with free-hand surgery, supported by moderate certainty evidence, with a high certainty angular deviation advantage over dynamic navigation. However, improved trueness has not been shown to translate into better clinical or patient-reported outcomes. Wider clinical use should depend on long-term, multicenter RCTs using standardized patient-centered outcomes.