The accuracy of robotic-assisted zygomatic implant placement: a systematic review and meta-analysis

BACKGROUND: This is the first systematic review and meta-analysis aimed at assessing the current status of robotic-assisted implant surgery (r-CAIS) in zygomatic implant (ZI) placement, with a particular focus on deviations between planned and placed implant positions. MATERIALS AND METHODS: The review protocol was specified and registered in PROSPERO (CRD42024616949). All primary studies were considered eligible, including in vitro studies, clinical studies, and hybrid experimental-clinical studies. Electronic and manual literature searches were conducted through April 2025 in PubMed/MEDLINE, Scopus, the Cochrane Library, and Web of Science. The primary outcome was planned/placed deviation with or without other implant placement techniques. RESULTS: Ten studies (seven in vitro, two clinical, and one hybrid experimental-clinical) involving 185 ZIs in 83 models /patients were included. Of these, nine studies were eligible for quantitative synthesis, contributing 161 ZIs placed using r-CAIS and 97 using dynamic CAIS (d-CAIS) to the pooled mean meta-analysis. The pooled mean ZI deviations from the r-CAIS group were 1.04 mm (95% CI: 0.74-1.35 mm) at the entry point and 1.47 mm (95% CI: 1.07-1.87 mm) at the exit point, and angular deviations were 1.22° (95% CI: 0.82-1.62°). The pooled mean ZI deviations from the d-CAIS group were 1.30 mm (95% CI: 1.00-1.60 mm) at the entry point and 2.02 mm (95% CI: 1.81-2.23 mm) at the exit point, and angular deviations were 2.00° (95% CI: 1.33-2.67°). Significant differences in deviation were observed at the exit and angular levels in favor of r-CAIS. CONCLUSIONS: r-CAIS demonstrates significantly superior accuracy compared with d-CAIS in ZIs placement. However, as r-CAIS remains at an early stage of clinical integration and only limited clinical studies have been reported, its long-term applicability requires further validation through cadaveric and well-designed prospective clinical investigations.