Abstract
Robotic assistance can help in physically guiding the drilling trajectory during zygomatic
implant positioning. A new robot-assisted strategy for a flapless zygomatic implant
placement protocol is reported here. In this protocol, a preoperative computed tomography
scan is used to plan the surgical path. After surface registration, the ROSA robot
(Zimmer Biomet Robotics) guides several steps, which are performed with shared control.
The surgeon performs the drilling and tapping, guided by the robotic arm, which is
positioned according to the planned trajectory. Placement of the zygomatic implant
is done manually. Immediate intraoperative 3D verification is performed by cone beam
computed tomography (flat-panel detector, Medtronic O-arm II). Four zygomatic implants
were placed in the case patient according to the flapless protocol, with a mean vector
error of 1.78 mm (range 0.52–4.70 mm). A screw-retained temporary prosthesis was placed
on the same day. No significant complications were observed. The application of this
robot-assisted surgical protocol, which guarantees a very high degree of precision,
may reduce inaccuracies in the positioning of zygomatic implants that could deviate
from the surgeon’s plan. This appears to be a potentially safe flapless surgery technique.
Drill slipping on the crest or on the maxillary wall is the main source of error in
this procedure, emphasizing the usefulness of the assisted surgical guidance with
haptic feedback.
Keywords
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Article info
Publication history
Published online: December 12, 2022
Accepted:
December 7,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
