Journal of Dental Science and Medicine
Open Access

Oral surgery, encompassing a wide range of procedures from dental implant placement to corrective jaw surgery, demands exceptional precision and skill. Traditionally, oral surgeons have relied on their experience, manual dexterity, and the support of basic surgical tools. However, advances in robotic technology are now revolutionizing this field, offering enhanced capabilities for minimally invasive surgeries, improved surgical outcomes, and reduced recovery times for patients [1, 2].

Robotics in oral surgery is particularly valuable in complex procedures that demand fine motor skills, such as implant placement, bone grafting, and resection of oral cancers. These procedures require high levels of precision and accuracy, where even minor errors can result in significant complications. The integration of robotics seeks to address these challenges by providing superior precision, real-time imaging, and the potential for greater consistency in surgical performance.

Technological Advancements in Robotic Surgery

Robotic Surgical Systems

Robotic surgery systems in oral surgery have evolved significantly in recent years. The most prominent robotic systems include the da Vinci Surgical System, the Yomi Robotic System, and Robodent. Each of these systems offers unique features that enhance surgical capabilities in different ways [3, 4]

da Vinci Surgical System: While more commonly associated with general surgery and urology, the da Vinci system’s precision and ability to scale movements have made it adaptable to oral surgery, particularly in complex reconstructive jaw surgeries and head and neck procedures.

Yomi Robotic System: Specifically designed for dental applications, Yomi is an FDA-approved robotic system used for dental implant surgeries. Yomi combines robotic guidance with the surgeon's hands-on skills to assist with precise placement of dental implants, enabling enhanced accuracy and predictable results.

Robodent: Another emerging system tailored for oral and maxillofacial surgery, Robodent offers assistance in bone reshaping and implant placement by providing real-time guidance during surgery.

Surgical Navigation Systems

Robotic surgery often relies on advanced imaging technologies to guide the surgeon during procedures. Surgical navigation systems use 3D imaging techniques, such as cone beam computed tomography (CBCT) and computed tomography (CT) scans, to map out the surgical area in high detail. These systems allow robotic arms to be guided with millimetre accuracy, ensuring optimal positioning of implants and other surgical elements.

Additionally, real-time intraoperative imaging plays a significant role in robotic surgery, offering continuous feedback during the procedure, which reduces the risk of mistakes and increases overall precision.

Applications of Robotics in Oral Surgery

Robotics is transforming several areas within oral surgery by enhancing both diagnostic and procedural capabilities. Some key applications of robotics in this field include [3, 4].

Dental Implant Surgery

One of the most prominent uses of robotics in oral surgery is dental implant placement. Traditionally, implant placement relies on the surgeon’s visual and tactile cues to place the implant at the correct angle and depth. However, robotic systems such as Yomi assist surgeons in precisely placing dental implants by using preoperative imaging and real-time navigation. The system helps create an individualized surgical plan for each patient, ensuring a higher success rate and reduced complications like nerve damage and misplacement.

Orthographic Surgery

Orthographic surgery, which involves repositioning the jaw, requires an immense level of precision, as the success of the procedure depends on correct alignment of the bones to restore both function and aesthetics. Robotic surgery systems enable precise measurement and positioning, with systems such as the Kaiser Robot System offering assistance in guiding the surgeon through difficult procedures, particularly in complex deformities.

Bone Grafting and Sinus Lift Surgery

In procedures like bone grafting and sinus lifts, accuracy is critical to ensuring proper healing and integration. Robotic systems, using advanced imaging techniques, can guide surgeons in placing bone grafts with high accuracy, reducing the risk of complications such as infection or graft failure. Additionally, robotic systems can be used to precisely reposition the maxillary sinus during sinus lift surgeries, improving the outcomes of these common procedures [5].

Oncology in Oral and Maxillofacial Surgery

Robotic systems have also found use in oral cancer surgeries, where precision and minimal invasiveness are paramount. Robotic-assisted surgeries can help in the resection of tumours, reconstruction of tissues, and re-alignment of the facial skeleton. The ability to perform these procedures with robotic assistance reduces the trauma to surrounding tissues, enhances recovery time, and improves cosmetic outcomes. In particular, robotic systems allow for more delicate tissue handling, which is crucial in the oral cavity, where access is limited and the structures are highly sensitive.

Minimally Invasive Procedures

Robotic surgery has introduced the potential for minimally invasive techniques, which significantly reduce the incision size and the trauma to surrounding tissues. This approach is beneficial in various procedures, such as the removal of impacted teeth, cysts, and small tumours, as well as in the extraction of wisdom teeth. Reduced incisions lead to less bleeding, smaller scars, and quicker healing times.

Benefits of Robotic Surgery in Oral Surgery

Enhanced Precision and Accuracy

One of the most significant advantages of robotic surgery is its ability to provide extremely accurate and consistent results. For dental implant placement, for example, the robotic systems guide the surgeon in positioning the implant to the exact degree necessary for optimal function and aesthetics. This level of precision significantly improves the long-term success rates of dental implants and reduces the likelihood of complications.

Reduced Risk of Human Error

While human skill remains essential in oral surgery, robotic assistance minimizes the impact of fatigue, tremors, or inconsistency in hand movements. Surgeons can perform procedures with the robotic system’s assistance, ensuring that the movements are steady, precise, and repeatable, even in long or complex surgeries [6-8].

Improved Surgical Planning

Robotic systems offer enhanced preoperative planning through 3D imaging and simulations. These systems allow surgeons to visualize the surgical site in detail before performing the procedure, which helps in strategizing the approach and anticipating potential complications. Additionally, with real-time feedback, adjustments can be made during the procedure to improve results.

Shorter Recovery Time and Reduced Pain

Minimally invasive surgeries facilitated by robotic systems tend to result in smaller incisions and reduced trauma to surrounding tissues, leading to less postoperative pain and a quicker recovery. This is a crucial advantage, particularly for patients undergoing complex surgeries such as bone grafting, jaw repositioning, or tumor resections.

Challenges and Limitations

Despite the many advantages, the integration of robotics into oral surgery faces several challenges:

High Cost

Robotic systems are expensive, both in terms of initial investment and ongoing maintenance. The high cost can be a significant barrier for many dental practices, especially smaller clinics or those in developing regions.

Training and Learning Curve

Surgeons must undergo specialized training to effectively use robotic systems, which can be time-consuming and resource-intensive. Although robotic systems are designed to be user-friendly, mastering their intricacies requires extensive practice and familiarity with the technology.

Limited Availability

Although robotic surgery systems have been increasingly adopted in some regions, they are not universally available. Access to advanced robotics remains limited, particularly in rural or less-resourced areas, making it harder for some patients to benefit from these innovations.

Technical Limitations

While robotic systems have made impressive strides in oral surgery, technical limitations remain. Robotic arms are confined by the boundaries of the equipment, which can make certain procedures more challenging. In addition, the lack of tactile feedback can hinder the surgeon’s ability to gauge the feel of tissues and make real-time adjustments based on haptic feedback.

Future Directions

Looking ahead, the role of robotics in oral surgery will likely continue to expand. Key areas of future development include:

Integration of Artificial Intelligence (AI): The combination of robotics with AI has the potential to revolutionize surgical planning, predicting complications, and customizing procedures for individual patients based on real-time data analysis.

Miniaturization of Robotic Systems: Future advancements may lead to more compact robotic systems that can be used for even less invasive surgeries, enabling access to more patients.

Enhanced Haptic Feedback: Technological improvements in sensory feedback could allow robotic systems to simulate the tactile sensations of traditional surgery, improving the surgeon’s ability to perform delicate procedures.

Broader Accessibility: As the cost of robotic systems decreases and their use becomes more widespread, it’s likely that access to robotic-assisted oral surgeries will increase, offering more patients the benefits of precision surgery [9, 10].

Conclusion

The integration of robotic technology into oral surgery marks a significant advancement in the field, offering numerous benefits including increased precision, reduced surgical risk, and enhanced patient recovery. While challenges such as cost and training remain, the potential for robotic systems to revolutionize the way oral surgeries are performed is undeniable. As technology continues to improve, robotics in oral surgery will become more accessible, refined, and ultimately indispensable, transforming the landscape of oral healthcare.

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