The International Journal of Oral & Maxillofacial Implants 2024

Accuracy and Precision of Haptic Robotic-Guided Implant Surgery in a Large Consecutive Series

Jay M. Neugarten, DDS, MD, FACS

Dr. Neugarten’s landmark study finds that Yomi robotic dental implant placement is the most accurate and precise treatment modality.

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Key findings

In a study conducted between 2020 and 2022 by Dr. Jay M. Neugarten1, 108 patients received 273 individual endosteal implants using haptic robotic guidance. Compared to the depth and angular deviations of other studies, this study demonstrates that:

Haptic robotic guidance (Yomi) offers the most accurate implant placement compared to any published data, particularly in reducing angular deviation.

Yomi significantly outperforms freehand, static computer-guided, and dynamic computer-guided placement in precision.

The haptic constraints provided by Yomi mitigate skiving and wandering of the drilling tool, contributing to superior angular accuracy.

The improved accuracy may lead to better protection against implant placement in vital structures (e.g., nerves, sinuses).

Results

The study finds that, with a SD (deg) of 1.53, haptic robotic-guided implant surgery has a lower SD for angular deviation than all other modalities studied. It also has a low global angular deviation (α), signed depth deviation (sdd), global coronal deviation (c), global apical deviation (a) relative to other modalities.

Accuracy Metrics:
Mean Signed Depth Deviation (sdd): 0.14 ± 0.87 mm
Global Angular Deviation (α): 1.42 ± 1.53 degrees (95% CI: 1.24 – 1.60 degrees)
Global Coronal Deviation (c): 1.10 ± 0.69 mm
Global Apical Deviation (a): 1.12 ± 0.69 mm

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	Coronal depth (mm)	Angular Deviation (deg)	Coronal Deviation (mm)	Apical Deviation (mm)
Robotic guidance *shows 95% confidence levels Neugarten JM. IJOMI (2024)¹	0.14 (0.04–0.25)	1.42 (1.24–1.60)	1.10 (1.02–1.18)	1.12 (1.04–1.20)
Freehand Younes F, et al Cl. Oral Impl Res (2018)²	N/A	6.99	1.45	2.11
Static guide Tahmaseb A, et al. IJOMI (2018)³	0.20 (-0.25–0.57)	3.50 (3.00–3.96)	1.20 (1.04–1.44)	1.40 (1.28–1.58)
Navigation Block MS, et al J Oral Maxillofac Surg (2017)⁴	0.76 ± 0.60	2.97 ± 2.09	1.16 ± 0.59	1.29 ± 0.65

Superiority explained

Programmed physical constraints, haptic feedback, and visual guidance combine to provide real-time 3D guidance while preventing off-plan movement.
Elimination of fulcrum effect seen in static guides, leading to more consistent placement throughout the implant’s length.

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Study design

Data Set

Prospective, single-arm clinical study.
108 patients  (41 men, 67 women; 57 avg. age)
273 implants placed

Inclusion Criteria

Implant procedure performed with Yomi entirely
Successful registration of pre-operative scan using a splint and fiducial markers
Implant guided at least 50% to planned depth by the robotic arm
Postoperative CBCT obtained on day of surgery

Exclusion Criteria

Off-label use or system modifications
Implants hand-driven to more than 50% of planned depth
Unstable splint during the procedure

Implant Distribution

Evenly distributed across maxilla (47%) and mandible (53%)
Varied implant brands used

Preoperative Planning

CBCT scan and virtual surgical plan created (Neocis software)

Day of Surgery

Single-use splint for registration of virtual plan to the patient’s anatomy
Splint affixed with either UEFI Gel, O-Bite, or bone screws
CBCT scan with fiducial markers to merge virtual plan with patient’s anatomy

Postoperative Assessment

CBCT scan for 3D voxel-to-voxel analysis of implant placement accuracy
Accuracy metrics: global angular deviation (α), signed depth deviation (sdd), global coronal deviation (c), global apical deviation (a)

Jay M. Neugarten DDS, MD, FACS (2024). Accuracy and Precision of Haptic Robotic-Guided Implant Surgery in Large Consecutive Series. The International Journal of Oral & Maxillofacial Implants, 39(1), 99-106
Younes F, Cosyn J, De Bruyckere T, Cleymaet R, Bouckaert E, Eghbali A. A randomized controlled study on the accuracy of free-handed, pilot-drill guided and fully guided implant surgery in partially edentulous patients. J Clin Periodontol. 2018 Jun;45(6):721-732. doi: 10.1111/jcpe.12897. Epub 2018 May 10. PMID: 29608793.
Tahmaseb A, Wu V, Wismeijer D, Coucke W, Evans C. The accuracy of static computer-aided implant surgery: A systematic review and meta-analysis. Clin Oral Implants Res. 2018 Oct;29 Suppl 16:416-435. doi: 10.1111/clr.13346. PMID: 30328191.
Block MS, Emery RW, Cullum DR, Sheikh A. Implant Placement Is More Accurate Using Dynamic Navigation. J Oral Maxillofac Surg. 2017 Jul;75(7):1377-1386. doi: 10.1016/j.joms.2017.02.026. Epub 2017 Mar 14. PMID: 28384461.