Dynamic navigation-guided robotic placement of zygomatic implants

Objectives: To assess the feasibility and accuracy of a new prototype robotic implant system for the placement of zygomatic implants in edentulous maxillary models. Methods: The study was carried out on eight plastic models. Cone beam computed tomographs were captured for each model to plan the positions of zygomatic implants. The hand-eye calibration technique was used to register the dynamic navigation system to the robotic spaces. A total of 16 zygomatic implants were placed, equally distributed between the anterior and the posterior parts of the zygoma. The placement of the implants (ZYGAN®, Southern Implants) was carried out using an active six-jointed robotic arm (UR3e, Universal Robots) guided by the dynamic navigation coordinate transformation matrix. The accuracy of the implant placement was assessed using EvaluNav and GeoMagicDesignX® software based on pre- and post-operative CBCT superimposition. Descriptive statistics for the implant deviations and Pearson's correlation analysis of these deviations to force feedback recorded by the robotic arm were conducted. Results: The 3D deviations at the entry and exit points were 1.80 ± 0.96 mm and 2.80 ± 0.95 mm, respectively. The angular deviation was 1.74 ± 0.92°. The overall registration time was 23.8 ± 7.0 min for each side of the model. Operative time excluding registration was 66.8 ± 8.8 min for each trajectory. The exit point and angular deviations of the implants were positively correlated with the drilling force perpendicular to the long axis of the handpiece and negatively correlated with the drilling force parallel to the long axis of the handpiece. Conclusion: The errors of the dynamic navigation-guided robotic placement of zygomatic implants were within the clinically acceptable limits. Further refinements are required to facilitate the clinical application of the tested integrated robotic-dynamic navigation system. Clinical significance: Robotic placement of zygomatic implants has the potential to produce a highly predictable outcome irrespective of the operator's surgical experience or fatigue. The presented study paves the way for clinical applications.