Robotic-controlled laser osteotome versus manually controlled osteotomy for interdental osteotomies: a cadaveric study

Abstract

The purpose of this study was to explore the use of a cold ablation robot-guided laser osteotome (CARLO) to improve the accuracy of interdental osteotomies in orthognathic surgery. It was hypothesized that integrating CARLO during virtual preoperative planning and execution could enhance the accuracy and reproducibility of interdental osteotomies, thereby addressing challenges associated with maxillary segmentation. Ten fresh frozen human cadaveric heads were utilized to virtually plan interdental osteotomies between the lateral incisors and canines bilaterally. After surgical planning, the osteotomy on one side (randomized) was performed by CARLO, while the osteotomy on the other side was performed by one of two experienced maxillofacial surgeons using a piezoelectric saw. No significant difference in the axial distance deviations or coronal angular deviations between the virtual surgical plan and the surgical outcome were observed between the two methods. However, CARLO demonstrated significantly superior accuracy in maintaining the planned axial angulation (P = 0.025). Nonetheless, some deviations occurred, potentially due to calibration issues, suggesting further refinement is needed to reliably influence clinical practice. Collaborative approaches integrating robotics and surgeon intervention may optimize outcomes. These findings indicate that with further advancements, robot-assisted surgery could play a key role in improving accuracy in maxillofacial surgery.