Substantiated by evidence-based medicine, full-arch immediate restoration has been confirmed as an effective and predictable approach to rehabilitate completely edentulous patients while satisfying the need for immediate aesthetics and speaking [1,2]. To reduce the number of visits and shorten the treatment procedure as much as possible, prefabricated provisional prostheses, which require implants to be precisely placed at the planned positions, are commonly used.

Efforts have been made to ensure accurate implant placement using static and dynamic computer-aided implant surgeries (s-CAIS and d-CAIS, respectively). Both techniques exhibit significantly better accuracy than traditional freehand surgery [3], [4], [5], [6], [7], [8], [9], [10], [11]. Although these techniques have mean deviations within the clinically acceptable range, their maximum values still exceed the recommended range of 2 mm for global deviation and 5º for angular deviation [10].

Furthermore, the s-CAIS has several limitations, such as the inability to modify the surgical plan intraoperatively, a significant requirement for mouth opening, an obstructed field of view, and inadequate water cooling throughout the procedure. Additionally, d-CAIS presents limitations ranging from an extended learning curve to a possibility of bringing in hand tremors.

Robotic computer-assisted implant surgery (r-CAIS) was previously introduced as a prospective alternative for accurate implant placement, while avoiding the aforementioned limitations. Its precise property has been historically demonstrated in various in-vitro and in-vivo studies [12], [13], [14], [15], [16], [17], [18], [19]. The clinical performance of r-CAIS in partially edentulous patients has been documented in several studies, revealing following mean values: a global coronal deviation from 0.29 to 0.74 mm, a global apical deviation from 0.36 to 0.73 mm, and an angular deviation from 1.11 to 2.81° [20], [21], [22]. Although these performances are considered promising, the application of r-CAIS in full-arch simultaneous immediate restoration has limited supporting evidence [23], [24], [25], [26], [27].

This study had two primary objectives. First, we evaluated the accuracy of the autonomous r-CAIS in flapless full-arch implant surgery and compared it with that of the s-CAIS. Our null hypothesis posits that the accuracy of the r-CAIS significantly surpasses that of the s-CAIS in full-arch cases. The accuracy of full-arch s-CAIS was measured based on global coronal and apical deviations of 1.4 mm and 1.5 mm, respectively, along with an angular deviation of 3.3° These criteria were derived from a comprehensive meta-analysis conducted by Tahmaseb in 2018 [4]. Additionally, we assessed the feasibility of r-CAIS for simultaneous immediate full-arch restoration.