Int J Oral Maxillofac Implants. 2023 Nov 8;0(0):1-23. doi: 10.11607/jomi.10468. Online ahead of print.
PURPOSE: The purpose of this clinical study was to determine the accuracy of dental implant placement by using haptic robotic guidance in a large clinical series.
MATERIAL AND METHODS: In a prospective single-arm clinical study, 108 patients received 273 individual endosteal implants. A virtual preoperative restorative and surgical plan was created from a cone beam computed tomography (CBCT) scan and matched to the surgical workspace on the day of surgery via either a tooth-based or a bone-based fiducial splint. Intraoperatively, the surgeon manipulated a handpiece attached to haptic robotic guidance arm. A variety of drills and implants were used in this series. Both the osteotomy and the implant placement were guided by 3D haptic constraints according to the virtual plan. A postoperative CBCT scans permitted the calculation of the deviations of the actual implant placement compared to the plan for accuracy. Precision was calculated by comparing standard deviations from published literature.
RESULTS: The implants were evenly distributed by jaw with 47% placed in the maxilla and 53% in the mandible. The mean ± standard deviation signed depth deviation was 0.14 ± 0.87 mm proud. The global angular deviation averaged 1.42 ± 1.53 degrees with 95% confidence limits of 1.24 degrees and 1.60 degrees. The crown of the actual placed implant showed an average deviation from the plan of 1.10 ± 0.69 mm and the apex a deviation of 1.12 ± 0.69 mm. Haptic robotic-guidance showed greater precision than freehand, static computer-guided and dynamic computer-guided implant placement.
CONCLUSION: This large clinical series of 273 implants shows a high accuracy of implant placement in comparison to published accuracy for angular deviations for any technology as well as demonstrating statistically greater precision. Long-term clinical studies are necessary to establish the true effect of increased accuracy on clinical outcomes. Using haptic robotic guidance provides accurate implant placement while allowing additional benefits compared to computer-guided surgery, namely full visualization of the surgical field and the ability to change the plan intra-operatively.