Comparison of dental implant placement accuracy between robotic and static or dynamic computer-assisted surgeries: A systematic review and meta-analysis

Abstract

BACKGROUND: Robotic computer-assisted implant surgery (rCAIS) has been developed to enhance implant placement accuracy compared to static (sCAIS) and dynamic (dCAIS) computer-assisted implant surgeries. The aim of this systematic review and meta-analysis aimed to evaluate and compare the accuracy of rCAIS to other CAIS approaches. MATERIAL AND METHODS: Electronic searches were conducted in PubMed, Embase, Cochrane Library and CNKI up to September 2024. Additionally, a manual search of relevant journals and reference lists was performed. Clinical and preclinical studies comparing rCAIS with sCAIS or dCAIS were included. Primary outcomes were global platform deviation, global apex deviation, and angular deviation between planned and actual implant positions. Two independent reviewers extracted data and assessed risk of bias using RoB 2 for randomized trials, the ROBINS-I tool for non-randomized studies, the SYRCLE tool for animal studies, and the QUIN tool for in vitro studies. RESULTS: Eleven studies met the inclusion criteria. In clinical studies, rCAIS (157 implants) demonstrated significantly lower deviations compared to sCAIS (166 implants): Global platform MD=-0.73mm (95% CI: -1.00 to -0.45; p<0.00001), apex deviation MD=-0.84mm (95% CI: -1.12 to -0.56; p<0.00001), and angular deviation MD=-1.51° (95% CI: -2.71 to -0.32; p=0.01). In preclinical studies, rCAIS also outperformed dCAIS (both 270 implants): Platform deviation MD=-0.15mm (95% CI: -0.24 to -0.07; p=0.0002), apex deviation MD=-0.19mm (95% CI: -0.27 to -0.10; p<0.0001), and angular deviation MD=-1.03° (95% CI: -1.70 to -0.37; p=0.002). CONCLUSIONS: rCAIS demonstrates superior accuracy compared to sCAIS or dCAIS. However, the magnitude of observed differences is small, and thus the improvements may not be clinically relevant despite the statistical significance. Further well-designed and large-scale studies are warranted to explore the influencing factors and optimize the clinical application of rCAIS.