Transcrestal Sinus Floor Elevation With Robotic Force Feedback And Vision

Osseodensification is a technique for transcrestal sinus floor elevation. It can densify bone and the water shock wave generated by drills can lift Schneiderian membrane. Autonomous dental implant robot is a newly computer-assisted implant system which combines the physical constraint of static guide and visualization of dynamic navigation, and has been widely used in clinic. A 24-year-old patient with upper left molar missing due to crown-root fracture 3months ago experienced insufficient residual bone height(RBH) and density. Autonomous dental implant robot (YaZhi, YakeRobot Technology Ltd) and osseodensification (Smart, Segma) kit were used for transcrestal sinus floor elevation(ADIR-OD-TSFE) and implantation. There was no membrane perforation, and the stability was excellent, with the angular error less than 2°. After 6months, CBCT revealed good osseointegration with 3-5mm height gain and 291.47mm³ volume augmentation. Preliminarily, ADIR-OD-TSFE is suitable for RBH≥3mm and no inflammation and tumor in maxillary sinus. Additionally, there are certain requirements for mouth opening. Membrane perforation is the most common complication in TSFE and related to membrane status, smoking, sinus floor septation, and intraoperative pressure. The visual and force feedback systems of ADIR provide the surgeon with "eyes" and "tactile sensation" during breakthrough process. And post-operative accuracy assessment showed its excellent control of depth, with the error of 0.29mm. This case presents a digital-guided surgery method using an ADIR for sinus floor elevation, osseodensification, and implantation in posterior maxillary tooth loss with low density and insufficient RBH.