Comparison of robotic system and dynamic navigation for zygomatic implant placement: An in vitro study

Objectives: To compare the accuracy of robotic and dynamic navigation systems in assisting zygomatic implant (ZI) using an in vitro model experiment. Methods: Preoperative cone-beam computed tomography (CBCT) images of patients who underwent ZI treatment between 2011 and 2023 were collected from local databases. Corresponding three-dimensional resin models were printed and assigned to two groups: the robotic and dynamic navigation system groups. Following preoperative plans, ZIs were placed in the models with the assistance of either a robotic or dynamic navigation system. Deviations in the in vitro navigation surgery were measured and compared between the groups. Results: A total of 110 ZIs were placed in 56 models, with 55 ZIs in each group. No significant differences were observed in entry and angle deviations between the groups (p>0.05). However, the exit deviation in the robotic system group (2.39+1.24 mm) was larger than that in the dynamic navigation group (1.83+1.25 mm) (p<0.05). On the exit side, the Z-axis deviation in the robotic group (left: -0.28+1.43 mm, right: -0.21+1.30 mm) was smaller than that in the dynamic navigation group (left: 0.76+1.11 mm, right: 0.85+1.52 mm) (p<0.05), while no significant differences were found in X- and Y-axis deviations (p>0.05). Conclusions: Compared with the dynamic navigation system, the robotic system can effectively prevent ZI overextension. However, its accuracy on the exit side is slightly lower than that of the dynamic navigation system. Clinical Significance: This preliminary in vitro study showed that the accuracy of the robotic system was slightly inferior to that of the dynamic navigation system in terms of exit deviation when used in ZI placement. Further clinical studies are required to confirm these findings.