Robotic-Guided Dental Implant Placement in Fully Edentulous Patients

Robotic-Guided Dental Implant Placement in Fully Edentulous Patients

Preliminary Results of a Prospective Multi-Center Clinical Study

Digital workflows have improved dental implant placement accuracy and precision in fully edentulous patients with a goal of predictable restorations. Despite the introduction of CBCT-based planning software and fabricated surgical guides, challenges remain in efficiently and accurately transferring the plans at surgery. Limitations inherent in the static guide workflow include treatment delays related to guide fabrication, the risk of poorly fitting guides, and the physical bulk of the guide impeding surgical site access and visualization. Robotic guidance using haptic boundaries has been well-documented to enhance accuracy, precision, and flexibility across surgical fields.1 Recently, robotic haptic guidance with the novel Yomi platform (Neocis Inc., Miami, FL) has shown promise in partially edentulous patients.2 This study aimed to evaluate the platform in fully edentulous patients. In a preliminary subset of a prospective single-arm clinical study, 8 patients who qualified for and elected to have dental implants to restore full-arch dentition were treated using Yomi robotic guidance. A virtual preoperative restorative and surgical plan was created on Yomi Plan software (Neocis Inc., Miami, FL) prior to surgery. On the day of surgery, the Yomi edentulous patient splint was affixed to the anterior maxilla or mandible using self-tapping bone screws. A patient CBCT scan with a splint-mounted fiducial array was obtained and merged with the previously created virtual plan. The fiducial array was replaced with a patient tracker end effector allowing Yomi to track patient motion. Intraoperatively, the surgeons maneuvered a handpiece attached to the Yomi robotic guidance arm, which haptically constrained osteotomies and implant placement to the virtual plan. Splint affixation proceeded under local anesthesia and the implant procedure under either local or general anesthesia. Intraoperative outcomes captured included safety, efficacy, surgical time, and a Likert scale evaluation of user experience. A total of 58 implants were placed in 11 arches in 8 patients. Thirty-five implants were placed in the mandible and 23 in the maxilla, including 3 dual-arch cases. Eight patients were edentulated during surgery. Bone quality ranged from poor to very dense. Yomi edentulous patient splint affixation and removal times averaged 6.5 ± 3.9 and 1.1 ± 0.3 minutes, respectively. Surgical time per arch averaged 20.5 ± 10.3 minutes for osteotomies and 9.9 ± 7.9 minutes for implant placement. Three arches were considered candidates for and were treated using a flapless approach, and conservative tissue flaps were performed in all other cases. Two patients had been considered candidates for and were successfully provided with immediately loaded full-arch prostheses. No adverse events were reported, and user experience was rated highly with respect to the standard of care. First cases using Yomi robotic guidance in fully edentulous patients were notable for brief procedural times, compatibility with minimally invasive soft tissue management and access to immediate loading of restorations for candidate patients. These results may attest to quick integration of the Yomi edentulous protocol into the digital practitioner’s clinical workflow and the ease of employing robotic guidance to enhance edentulous patient treatment. Additionally, there was no wait for surgical guide fabrication and no physical guide impeding access or visualization. Robotic haptic guidance securely constrained the handpiece to the virtual restorative plan. Given the accuracy, precision, and intraoperative flexibility of robotic surgical platforms, these preliminary data support the promise of Yomi robotic guidance to augment dental implant therapy for fully edentulous arches. This study was approved by WIRB and the FDA as G190282 Edentulous Patient Splint.

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The Yomi edentulous patient splint was affixed anterior to the maxilla or mandible using self-tapping bone screws and intraoperatively connected to a patient tracker end effector, allowing the robotic system to track patient motion.

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The surgeons maneuvered a handpiece attached to the Yomi robotic guidance arm, which haptically constrained motion to the virtual plan. Full-arch osteotomies and dental implant placement proceeded under haptic guidance.

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Two patients had been considered candidates for and were successfully provided with immediately loaded full-arch prostheses. Successful early incorporation of immediately loaded prostheses indicates the ease with which robotic guidance may be employed to enhance restorative-driven protocols.

FCZ Implant Crown

FCZ Implant Crown

Patients, clinicians and dental laboratories all want restorations they can rely on.

The NobelProcera FCZ (full-contour zirconia) Implant Crown combines full-contour strength that’s tough enough for the posterior with restorative flexibility that’s hard to beat … and there’s no cement in sight. By Michael Stuart

CAD/CAM manufactured using high-strength translucent zirconia—and providing the opportunity to create angulated screw channels— the NobelProcera FCZ Implant Crown is designed for predictable strength, esthetics and function.

FCZ w_adapter

No cement, no chipping, no problems

Suitable for all tooth positions, the strength of the FCZ Implant Crown ensures predictability even under the high occlusal forces of the posterior, which makes it an ideal restoration for the molar region. There’s no need to worry about veneer chipping either, as the full-contour characteristics of the NobelProcera FCZ Implant Crown eliminate the need for veneering. The biocompatibility of the materials used represents an additional benefit by supporting biological stability in the areas where it matters most. Plus, being screw retained, the FCZ Implant Crown is completely cement-free, eliminating the risks associated with excess cement. Even the titanium adapter is mechanically retained. As it can be placed in the posterior, the FCZ Implant Crown gives clinicians the chance to increase the number of screw-retained restorations they place. This means more patients treated with a restorative solution that is easier to maintain and retrieve—and all without cement. The NobelProcera FCZ Implant Crown is designed for use with Nobel Biocare’s extensive range of conical connection implants. Combining Nobel Biocare components means that all the elements can be trusted to work together seamlessly for the perfect treatment outcome.

Not veneered, but engineered

Choose to use an angulated screw channel (ASC) and the screw access hole can be placed anywhere between 0° and 25° within a 360° radius. This means that it can be angled towards the front of the mouth for easy access even in tight posterior spaces; it also means that the access channel doesn’t need to be placed on the cusp of the tooth, where it might affect occlusion. Working on the restoration is further simplified with the associated Omnigrip Screwdriver. Its effective pick-up function and secure grip on the screw help the clinician to work safely and efficiently. Natural-looking tooth color is another benefit offered by the FCZ Implant Crown. Whichever of the eight available shades is used, the color will be uniform throughout the material. This means adjustments can be made without having to worry about discoloration. It’s also no problem to use cutbacks or staining to achieve the desired esthetic effect. For anyone looking for restorations they can rely on, the Nobel– Procera FCZ Implant Crown provides extraordinary strength for long-term predictability, and delivers restorative flexibility too. As a result, it’s well on its way to becoming “the crown that rules them all!”


*Arkansas Oral & Facial Surgery Center does not endorse NobelProcera® FCZ Implant Crown. For information purposes only.