Fully digital and robot-assisted workflow for mandibular molar autotransplantation: A proof-of-concept.

OBJECTIVES: To present a robot-assisted protocol for autogenous mandibular molar transplantation using an autonomous robotic system for shape-matched recipient socket preparation. METHODS: The novel workflow comprises the following steps: 1) Preoperative planning: Based on preoperative intraoral scans and cone-beam computed tomography (CBCT) data, the transplant position of the donor tooth was precisely planned, and the surgical path was generated. An intraoral registration device was designed and fabricated, and a donor tooth replica was 3D-printed. 2) Intraoperative execution: Following the preoperative plan, the robot performed supervised autonomous, layer-by-layer, incremental milling to prepare a personalized osteotomy socket that accurately matched the donor root morphology. All remaining surgical steps were completed by the surgeon. 3) Post-operative evaluation: Intraoperative post-operative CBCT was acquired for accuracy analysis and assessment. RESULTS: The procedure was completed successfully, with no intra- or post-operative complications reported. All positional and angular deviations of the transplanted tooth fell within clinically acceptable limits. CONCLUSIONS: A workflow for tooth autotransplantation using an autonomous robotic system was successfully implemented, preliminarily demonstrating its ability to achieve accurate morphologically matched socket preparation. CLINICAL SIGNIFICANCE: This study proposes and validates a complete digital and robot-assisted method for socket preparation in autotransplantation, offering a novel technical pathway toward personalized, high-precision tooth transplantation. The approach holds promise for improving procedural predictability and standardization; however, its clinical benefits require further validation through larger controlled studies.