Autonomous robotics vs dynamic navigation: the precision match in the posterior zone

In implant surgery, the quest for millimetric precision in the posterior mandibular zone remains a daily challenge, dictated by the proximity of critical anatomical structures and the requirements of the prosthetic axis. While dynamic navigation has already provided valuable assistance, the emergence of autonomous robotic systems raises a fundamental question: which technology offers the best fidelity to the initial treatment plan?

This experimental study, conducted on 80 custom-designed resin models, compares the clinical efficacy of the autonomous "robotic arm" mode versus the conventional "dynamic navigation" mode. The primary objective was to evaluate the placement accuracy of 120 implants in the posterior mandibular sectors, systematically measuring the deviations between the preoperative planning and the actual position obtained by Cone Beam (CBCT).

The authors test here the hypothesis that the rigid and automated control of the robotic arm would minimize entry, apex, and angular deviations more effectively than the visual guidance of dynamic navigation. This technological comparison aims to determine whether robotic autonomy represents a significant gain in safety and reproducibility for the practitioner in cases of unilateral mandibular defects.

Methodology: Autonomous Robotics vs. Dynamic Navigation

This in vitro experimental study evaluated the effectiveness of two guidance systems for implant placement in the posterior mandibular sector. The protocol was based on the use of 80 custom-designed resin models, simulating different types of unilateral posterior mandibular defects.

The models were equally divided into two distinct groups for the placement of a total of 120 implants:

• Experimental group (n=40 models): Implant placement assisted by an autonomous dental robot in "robotic arm mode".
• Control group (n=40 models): Implant placement under conventional dynamic navigation (dynamic navigation mode).

The analysis protocol used postoperative Cone-Beam Computed Tomography (CBCT) imaging to compare actual implant positions with preoperative planning. Accuracy was quantified according to three deviation variables: the entry point (mm), the endpoint (apical point, mm), and the angular deviation (°). This methodology allowed for the isolation of the impact of the guidance mode on the control of surgical precision in various mandibular defect configurations.

Results: Superiority of autonomous robotic assistance

The analysis of the 120 implants placed on the 80 resin models reveals a marked difference in precision between the two operating modes. Although both approaches allow for implant placement in posterior mandibular defect areas, the "robotic arm" mode consistently outperforms dynamic navigation across all deviation parameters measured by postoperative CBCT.

The data highlights several key points regarding control precision:

• Angular precision: The autonomous robotic arm reduces angular error by nearly 50% compared to dynamic navigation (1.24° vs. 2.36°).
• Positioning control: Deviations at the entry point and apex remain below 0.8 mm with the robotic arm, while they consistently exceed one millimeter in dynamic navigation mode.
• Statistical significance: The authors report that the precision of the robotic arm mode is significantly superior (p < 0.05) to that of the navigation mode, confirming a clear advantage for the automated control of the surgical procedure.

Postoperative CBCT imaging validated that these results are consistent, regardless of the type of unilateral posterior mandibular defect treated. This study highlights that while dynamic navigation remains a viable option, the autonomy of the robotic arm offers superior repeatability and positioning precision in the posterior sectors.

Performance analysis: Robotic arm vs Dynamic navigation

The data from this experimental study, involving 120 implants placed on 80 resin models, reveal a statistical superiority of the "robotic arm" mode compared to traditional dynamic navigation. With a deviation at the entry point of 0.68 ± 0.22 mm and an angular error limited to 1.24 ± 0.50°, the autonomous robot achieves sub-millimetric precision. For comparison, the dynamic navigation group shows significantly larger discrepancies, with 1.02 ± 0.31 mm at entry and 2.36 ± 0.71° of inclination.

Clinically, this gain in precision is major for securing the posterior mandibular sectors. In these areas where the proximity of the inferior alveolar nerve imposes a reduced margin of error, the robotic arm seems to overcome the intrinsic limitations of dynamic navigation, which remains dependent on the surgeon's eye-hand coordination and manual stability facing the screen. This study suggests that robotic autonomy reaches a further milestone by substituting physical control of the drilling for simple visual guidance.

However, a crucial limitation lies in the in vitro design. The use of resin models eliminates real clinical variables such as the presence of saliva, patient movements, or restricted mouth opening. While the literature confirms the effectiveness of both modes for posterior edentulism, autonomous robotic control offers a competitive advantage here in terms of reproducibility and final trajectory control.

Summary of results

This study on 80 mandibular models (120 implants) demonstrates that the autonomous robotic arm offers superior precision compared to dynamic navigation: the entry point deviation is reduced to 0.68 ± 0.22 mm (versus 1.02 ± 0.31 mm) and the angular error is almost halved (1.24° versus 2.36°). Although both methods are clinically viable, robotic automation significantly minimizes spatial deviations compared to traditional visual guidance.

In concrete terms, for the practitioner:

• Privilégiez le mode bras robotisé pour les cas complexes en secteur postérieur mandibulaire, où la proximité du nerf alvéolaire inférieur exige une précision sous-millimétrique.
• Integrate automation to eliminate eye-hand coordination errors inherent in dynamic navigation, ensuring increased fidelity to the initial implantology project.
• Consider that while dynamic navigation remains a robust option, the autonomous robot now constitutes the new standard of precision for securing narrow prosthetic corridors.

Technical lexicon of the study

Robotic arm mode: Operating mode of an autonomous robot where the mechanical arm executes drilling and implant placement sequences with automated control of pre-planned trajectories.

Dynamic navigation (Dynamic navigation mode): Surgical guidance system using real-time imaging, where the practitioner manually manipulates the instruments while visualizing their position on a screen relative to the CBCT plan.

Entry point deviation: Linear deviation measured in millimetres between the centre of the implant neck planned during virtual planning and its actual position after placement.

Endpoint deviation: Measurement of spatial inaccuracy (in mm) at the terminal tip of the implant, calculated between the planned theoretical position and the actual position observed postoperatively.

Angular deviation: Difference expressed in degrees between the ideal insertion axis defined on the planning software and the final longitudinal axis of the inserted implant.

Autonomous dental implant robot: Robotic device capable of adjusting its trajectory in real time and performing surgical procedures semi-independently to reach planned targets.

Information intended for healthcare professionals. This content may contain errors or truncated summaries. We recommend always verifying with the original source article. Delynov disclaims all responsibility for the use of this information. This document is not intended for patients or the general public.