Accuracy And Effectiveness Of Robotic Implant Placement Compared To Static And Dynamic Navigation Systems: An Umbrella Review

Abstract

Background: Robot-assisted computer-aided implant surgery (R-CAIS) is an emerging advancement in digital implantology, proposed to enhance placement precision beyond established computer-assisted modalities such as static guides (s-CAIS) and dynamic navigation (d-CAIS). However, the rapid expansion of systematic evidence necessitates higher-order synthesis to clarify comparative accuracy and clinical implications.

Objective: To evaluate the accuracy and effectiveness of robotic implant placement compared with static guidance, dynamic navigation, and freehand techniques using an umbrella review of systematic evidence.

Methods: An umbrella review was conducted following PRIOR guidelines, with protocol registration in PROSPERO (CRD420251066754). PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar were searched through June 2025. Eligible studies were systematic reviews with meta-analysis that evaluated R-CAIS (semi-active or autonomous systems) versus s-CAIS, d-CAIS, or freehand placement and reported quantitative accuracy outcomes (coronal, apical, and/or angular deviations). Overlap was quantified using Corrected Covered Area (CCA). Methodological quality was appraised using AMSTAR-2, and certainty of evidence was assessed using GRADE where feasible.

Results: From 1,226 records, eight systematic reviews with meta-analysis (2023-2025) were included [19-26]. Collectively, they synthesized 195 unique primary studies and approximately 18,100 implant placements (9,066 in vitro; 9,044 clinical). Across reviews, R-CAIS showed consistently lower coronal and apical deviations and reduced angular deviation (≈1.5-1.8°), with pooled angular mean differences favoring robotics ranging from −1.22° to −1.58° versus navigated comparators. Overlap was moderate (CCA 6.8%). Five reviews were high quality by AMSTAR-2, and GRADE certainty (available for two reviews) ranged from low to moderate.

Conclusions: Current synthesized evidence indicates that R-CAIS provides superior implant placement accuracy compared with s-CAIS, d-CAIS, and freehand techniques, although higher-certainty clinical trials with standardized outcomes and broader effectiveness endpoints are needed to guide implementation.