Liu Chen, Wang Xin, Liu Yuchen, Ma Dan, Wu Zhonghong, Wang Hanguo, Bai Shizhu, Zhao Yimin
State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, People's Republic of China.
State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, People's Republic of China.
Int Endod J. 2025 Mar;58(3):529-540. doi: 10.1111/iej.14178. Epub 2024 Dec 4.
To compare the accuracy and treatment time of a robotic system (RS) and a dynamic navigation system (DNS) in osteotomy and root-end resection in an in vitro study.
In this study, four identical mandibular models were created using three-dimensional (3D) printing, each model including 18 teeth. In the surgical procedures, teeth #35, #33, #32, #42, #43 and #45, along with the mesiobuccal roots of teeth #36 and #46, were specifically selected for operation on each model. Cone-beam computed tomography (CBCT) and intraoral scans were performed on all models. DentalNavi software was used to plan a drilling path and depth as well as design surgical accessories. In the RS, osteotomy and root-end resection were performed with robotic assistance, whereas in the DNS, these procedures were performed using dynamic navigation. Post-operative CBCT scans were obtained. Global platform deviation, global apex deviation, angular deflection, and time were compared to evaluate the accuracy and treatment time of the surgeries. The treatment time was defined as the registration time and drilling time. Statistical analyses were performed using the Shapiro-Wilk and independent sample t-test.
The global platform deviation, global apex deviation and angular deflection in the RS group were significantly smaller than those in the DNS group (p <.05). The registration time in the RS group was significantly longer than that in the DNS group (p <.001), whereas the drilling time was significantly shorter (p <.001). The overall surgical time was significantly longer in the RS group than in the DNS group (p <.001). Subgroup accuracy analysis revealed that in both the anterior and posterior tooth regions, the RS group exhibited significantly smaller apical and angular deviations than the DNS group (p <.001). Additionally, in both the anterior and posterior tooth subgroups, the total time for the DNS group was significantly shorter than that for the RS group in the anterior tooth area (p <.01).
RS showed higher accuracy and shorter drilling time in osteotomy and root-end resection compared to DNS. The RS holds promise as a reliable technological advancement in endodontic microsurgery. However, future endeavours should prioritize the reduction in registration time.
在一项体外研究中比较机器人系统（RS）和动态导航系统（DNS）在截骨术和根尖切除术方面的准确性和治疗时间。
在本研究中，使用三维（3D）打印创建了四个相同的下颌模型，每个模型包含18颗牙齿。在手术过程中，每个模型上专门选择了35号、33号、32号、42号、43号和45号牙齿，以及36号和46号牙齿的近中颊根进行手术。对所有模型进行锥形束计算机断层扫描（CBCT）和口腔内扫描。使用DentalNavi软件规划钻孔路径和深度以及设计手术附件。在RS中，在机器人辅助下进行截骨术和根尖切除术，而在DNS中，这些操作使用动态导航进行。术后获得CBCT扫描图像。比较全局平台偏差、全局根尖偏差、角度偏差和时间，以评估手术的准确性和治疗时间。治疗时间定义为注册时间和钻孔时间。使用Shapiro-Wilk检验和独立样本t检验进行统计分析。
RS组的全局平台偏差、全局根尖偏差和角度偏差显著小于DNS组（p<.05）。RS组的注册时间显著长于DNS组（p<.001），而钻孔时间显著短于DNS组（p<.001）。RS组的总体手术时间显著长于DNS组（p<.001）。亚组准确性分析显示，在前牙区和后牙区，RS组的根尖和角度偏差均显著小于DNS组（p<.001）。此外，在前牙亚组和后牙亚组中，DNS组在前牙区的总时间均显著短于RS组（p<.01）。
与DNS相比，RS在截骨术和根尖切除术中显示出更高的准确性和更短的钻孔时间。RS有望成为牙髓显微外科可靠的技术进步。然而，未来的努力应优先减少注册时间。
