The aim of the current study was to evaluate the learning curve and accuracy of implant placement by young professionals using a dynamic computer-assisted surgical system for dental implant placement. Ten students tried to place eight implants with a dynamic surgical system in predefined positions on two consecutive weekends, resulting in 160 implant placements in total. Postoperatively, the positions of the implants were scanned with an intraoral scanner and compared for deviations at the entry point, the apex, as well as angular deviations to the master model. The mean values of all measurements improved; statistical significance was found for the changes in the angle as well as for the position of the implants to the apex (p < 0.001). Furthermore, the young professionals indicated subjective improvement in handling the dynamic surgery system. Navigated surgical dental implant placement can be learned quickly and can support young professionals in everyday clinical practice, especially in difficult anatomic situations.

Background: The aim of the study is to evaluate the accuracy of a new implant navigation system on two different digital workflows. Methods: A total of 18 phantom jaws consisting of hard and non-warping plastic and resembling edentulous jaws were used to stimulate a clinical circumstance. A conventional pilot-drill guide was conducted by a technician, and a master model was set by using this laboratory-produced guide. After cone beam computed tomography (CBCT) and 3D scanning of the master models, two different digital workflows (marker tray in CBCT and 3D-printed tray) were performed based on the Digital Imaging Communication in Medicine files and standard tessellation language files. Eight Straumann implants (4.1 mm × 10 mm) were placed in each model, six models for each group, resulting in 144 implant placements in total. Postoperative CBCT were taken, and deviations at the entry point and apex as well as angular deviations were measured compared to the master model. Results: The mean total deviations at the implant entry point for MTC (marker tray in CBCT), 3dPT (3d-printed tray), and PDG (pilot-drill guide) were 1.024 ± 0.446 mm, 1.027 ± 0.455 mm, and 1.009 ± 0.415 mm, respectively, and the mean total deviations at the implant apex were 1.026 ± 0.383 mm, 1.116 ± 0.530 mm, and 1.068 ± 0.384 mm. The angular deviation for the MTC group was 2.22 ± 1.54°. The 3dPT group revealed an angular deviation of 1.95 ± 1.35°, whereas the PDG group showed a mean angular deviation of 2.67 ± 1.58°. Although there were no significant differences among the three groups (P > 0.05), the navigation groups showed lesser angular deviations compared to the pilot-drill-guide (PDG) group. Implants in the 3D-printed tray navigation group showed higher deviations at both entry point and apex. Conclusions: The accuracy of the evaluated navigation system was similar with the accuracy of a pilot-drill guide. Accuracy of both preoperative workflows (marker tray in CBCT or 3D-printed tray) was reliable for clinical use.

Robotic surgery has undergone steady evolution in recent years. Until now, there has been no suitable robotic system for plastic reconstruction. With the Symani Surgical System, anastomoses of free flaps in the head and neck region can be performed efficiently and accurately. This prospective single-centre study aims to describe and investigate the use of robotic reconstructions in the head and neck region by oral and maxillofacial surgeons for the first time. 93 patients after ablative tumor surgery who required a free flap for reconstruction in the head and neck region were included in the study; 73 had oral squamous cell carcinoma (78.5 %). Radial forearm flap 28 (30.1 %), ulnar forearm flap 28 (30.1 %), and fibula flap 22 (23.7 %) were used most frequently. Three revision surgeries were performed, and one free flap was lost. Robotic microsurgery has a steep learning curve and can be used effectively to perform anastomoses in free flap reconstructions. The surgical spectrum of microsurgical techniques has not yet been fully explored and should be further investigated. Supermicrosurgery could benefit from the Symani robotic system in the long term.

This case report presents an iatrogenic induced mediastinal emphysema after restorative treatment of the lower left second molar, aimed to highlight the potential life-threatening consequences, and providing diagnostics and treatment concepts of complicated dental induced emphysema based on literature review. A 74-year-old female patient was admitted to the emergency department due to a fall on her shoulder. Additional finding was a significant swelling of the face and neck. In the computer tomography of the head, neck, and thorax, a humerus fracture and pronounced soft tissue emphysema from the infraorbital region to the mediastinum was detected. The patient reported that she had been treated by her dentist 4 days earlier. The treatment had to be discontinued after beginning of a pronounced swelling. Other reasons for the emphysema could be excluded out on an interdisciplinary teamwork. The patient was monitored as an inpatient for 5 days and received intravenous antibiotic therapy. This case report shows the rare complication of pronounced mediastinal emphysema after root canal treatment. Emphysema should always be a differential diagnosis of soft tissue swelling and, in case of doubt, a general medical presentation should be made.

Background: Bone regeneration in the greater omentum is a promising strategy in facial skeleton reconstruction. This feasibility‐study aims to perform robot‐assisted scaffold implantation and second‐stage flap raising.Methods: Firstly, scaffolds were implanted into the greater omentum using the da Vinci Xi surgical system or conventional technique in five miniature pigs, respectively. After 3 months a free flap including the gastrocolic vascular pedicle was harvested and procedures were evaluated.Results: The average operation time was 59.2 min for open surgery and 73.8 min for robot‐assisted surgery. The average incision length of open surgery was 11.6 cm. Both techniques led to successful scaffold implantation without any complication. In all cases the scaffolds were integrated as intended and resulted in bone formation.Conclusions: Current study demonstrated that the implantation of scaffolds into the greater omentum and flap harvesting using da Vinci Xi surgical system is a promising minimally‐invasive approach in regenerative surgery.

The aim of the current study was to compare the accuracy of objectively graded microsurgery steps by young professionals using a microscope and a microsurgery robot. 40 students performed three exercises with a dental surgical operating microscope and a microsurgery robot. The exercises consisted of grasping and placing a needle, threading the needle, and performing a surgical knot. All students successfully completed the exercises with the microscope and the Symani. The microscope demonstrated significantly shorter operating times for grasping and placing a needle ( p = 0.003) and for a single-button suture of an anastomosis ( p < 0.001). Gaming, sewing, or knitting had a significant advantage for both the microscope and the Symani for grasping and placing a needle ( p < 0.001). Young professionals appear to be able to work adequately with both the microscope and the robot in the surgical model for anastomoses. The students demonstrated a strong interest in adopting robotic technologies, which is why implementing robotics in the clinics' teaching process is necessary. This could inspire the next generation of medical professionals for robotic surgery and microsurgery, as well as support their career path.