# Endodontic microsurgery utilizing an autonomous robotic system for the maxillary second molar: a case report

## TL;DR

A robotic system successfully performed endodontic microsurgery on a maxillary second molar, offering precision and safety in a complex dental procedure.

## Contribution

Demonstrates the successful clinical application of an autonomous robotic system for endodontic microsurgery in a challenging anatomical region.

## Key findings

- The ATR system enabled precise autonomous resection of the mesiobuccal root without complications.
- Clinical and radiographic follow-up showed satisfactory outcomes six months post-surgery.
- The robotic system provided a reference for subsequent manual surgery on the distobuccal root.

## Abstract

Endodontic microsurgery (EMS) is a widely utilized technique for addressing periapical periodontitis that is unresponsive to conventional root canal treatment. Nevertheless, achieving precise root apex location and resection can pose significant challenges for surgeons, particularly in complex anatomical situations. The inherent difficulties in accessing and the restricted visualization typically render EMS infeasible in the second molar region. The autonomous robotic (ATR) system, characterized by its automation, precision, and stability, is anticipated to address the limitations inherent in manual operations within complex EMS scenarios. Herein, this report details the successful application of robot-assisted EMS in a maxillary second molar.

A 26-year-old female patient presented to our hospital with chronic periapical periodontitis following a previous history of root canal treatment in the left maxillary second molar. The patient data were imported into DentalNavi software to design the drilling path for precise resection while avoiding damage to the maxillary sinus. Through the integration of an optical pose tracking mechanism and the computerized operational system, the robotic arm completed the autonomous resection task of the mesiobuccal root according to the preoperative plan, providing a position reference for the freehand operation of the distobuccal root. No complications were reported during the surgery. Clinical and radiographic assessments at a six-month follow-up indicated satisfactory outcomes.

The ATR system offers an accurate, safe, and minimally invasive technique for osteotomy and apicoectomy. This technology demonstrates potential as a reliable and clinically effective technique for managing complex and anatomically challenging posterior EMS procedures.