Robotic computer-assisted implant surgery: a systematic review and meta-analysis of positional accuracy and clinical implications

Transferring a digital implant plan accurately to the surgical field remains a persistent limitation in implant dentistry. Static computer-assisted implant surgery (static CAIS) improves plan transfer but provides limited intraoperative correction, and the clinical accuracy of robotic computer-assisted implant surgery (robotic CAIS) has not been comprehensively synthesized. To evaluate the positional accuracy of robotic CAIS and compare it with freehand implant placement and static CAIS. A PRISMA 2020-compliant systematic review and meta-analysis was conducted using PubMed, Embase, Scopus, and Web of Science from inception to December 2025. Eligible in vitro and in vivo studies reporting positional deviations (angular, coronal, and/or apical) between planned and placed implant positions were included. Separate single-arm and comparative meta-analyses were performed using random-effects models. Heterogeneity was assessed using the I² statistic. Reporting bias and potential small-study effects were evaluated through visual inspection of funnel plots. Risk of bias was assessed using ROB 2, ROBINS-I, and QUIN tools. In vitro studies showed low angular and linear deviations under controlled conditions. In clinical studies, pooled angular deviation was approximately 1–2°, with submillimeter coronal and apical deviations. Compared with freehand placement, robotic CAIS reduced angular and linear deviations, with an approximate 5° reduction in angular error and about 1 mm reduction in apical deviation. Comparisons with static CAIS showed smaller but consistent reductions in positional deviations across in vitro and clinical analyses, although the magnitude of difference was more limited. Robotic CAIS improves implant positioning accuracy compared with freehand placement and provides modest advantages over static CAIS. However, evidence regarding long-term clinical outcomes remains limited.