Automation in Dentistry with Mechanical Drills and Lasers for Implant Osteotomy: A Narrative-Scoping Review

Abstract

The popularity of implants is increasing with the aging population requiring oral-dental rehabilitation. There are several critical steps in the implant workflow, including case selection, implant design, surgical procedure, biological tissue responses, and functional restoration. Among these steps, surgical osteotomy procedures are a crucial determinant of clinical success. This brief review was aimed at outlining the current state of the field in automation-assisted implant surgical osteotomy technologies. A broad search of the literature was performed to identify current literature. The results are outlined in three broad categories: semi-automated static (image-guided) or dynamic (navigation-assisted) systems, and fully-automated robotic systems. As well as the current mechanical rotary approaches, the literature supporting the use of lasers in further refinement of these approaches is reviewed. The advantages and limitations of adopting autonomous technologies in practical clinical dental practices are discussed. In summary, advances in clinical technologies enable improved precision and efficacious clinical outcomes with implant dentistry. Hard-tissue lasers offer further advancements in precision, improved biological responses, and favorable clinical outcomes that require further investigation.

Keywords: automation; implants; lasers; osteotomy; robotics.

Figure 1

Workflow outlining the literature search and review performed in this work. Although this workflow simulated a routine systematic review process (PICO), a narrative and scoping review is presented due to a lack of relevant literature available for analysis on this subject.

Figure 2

Automated implant osteotomy. (A) Procedural steps in implant osteotomy automation workflow. (B) Broad categorization of various approaches for discrete levels of automation. (C) Performance characteristics of various automated implant osteotomy approaches in the literature.

Figure 3

Digital planning (A). Digital planning for dental implants was conducted using 3D modeling imaging on an IOS (iTero^®—Align Technology, Inc., San Jose, CA, USA) platform. (B). Computer-aided design (CAD) was utilized to plan a digital surgical guide for the edentulous mandible, incorporating five implants and four mini-implants for anchorage. (C). The surgical guide, printed after the virtual planning phase, is now prepared for use.

Figure 4

Procedural steps during the digital treatment-planning stage for implant placement. The use of precise implant lengths, based on the key anatomical landmarks and bone volume, is depicted.

Figure 5

(A) Dynamic axial orientation guidance of the head of the handpiece and the bur tip. (B) Coordinate registration of the surgical site with a fiduciary to a non-motile site off the site of surgery. (C) Coordinate registration for the bur tip and the handpiece with fiduciary before initiation of the procedure-planning software with spatial orientation and anatomical landmarks. (D) Visual depiction of the 6-dimensional sensing and rotational degrees of freedom offered by the robotic arms. (E) The fully automated YOMI robot with handpiece.

Figure 6

A comparison of conventional radiographs (left) and automated AI-enhanced radiographs (right) discretely outlying the anatomical features that can aid in improved diagnosis, prognosis, and accurate follow-up care. The highlighted area (green circle) show diagnostic enhanced region of interest.