Dynamic Vs Robotic Accuracy In All-On-Four Implant Surgery

To evaluate whether robotic-computer assisted implant surgery (R-CAIS) offers higher placement accuracy than dynamic navigation-computer assisted implant surgery (D-CAIS) in All-on-Four rehabilitation for edentulous jaws, with particular emphasis on the challenges of tilted implant placement inherent to this technique. This in vitro study involved the placement of 512 implants in 64 maxillary and 64 mandibular edentulous resin models. Each model received two anterior axial implants and two posterior tilted implants, replicating the All-on-Four protocol. Two systems were compared: a dynamic navigation system (Yizhime, DCARER) and a robotic-assisted system (Remebot, Beijing Baihui Weikang Technology Co., Ltd.). Postoperative CBCT images were registered to preoperative plans, and deviations at entry, exit, and angular levels were quantified. Mann–Whitney U tests and linear mixed-effects models (LMM) were used for statistical analysis, with significance set at p < 0.05. R-CAIS demonstrated significantly lower median entry deviation (0.66 mm vs. 0.80 mm, p < 0.01) and angular deviation (0.87° vs. 1.97°, p < 0.01) compared to D-CAIS. No significant difference was found in exit deviation (p = 0.35). Tilted implants showed significantly greater entry deviation than axial implants (p = 0.002), particularly in the D-CAIS group. Robotic-assisted surgery provides superior reliability and accuracy in All-on-Four implant placement, particularly in the context of tilted implant positioning, demonstrating its potential advantage in complex full-arch rehabilitations.