SCIENCE
Qin Wu, Yi-Min Zhao, Shi-Zhu Bai, Xiang Li
Application of robotics in stomatology
Abstract
The application of robots in oral treatment can not only
reduce the work intensity of clinicians but also improve the
accuracy of treatment. In this article, the application and
research status of robots in stomatology are reviewed.
Keywords: robotics, stomatology, digital medicine
Introduction
In recent years, with the development of advanced manufac-
turing technology and the increasing popularity of medical
three-dimensional (3D) imaging technology, the application
of robots has made great progress in the medical field and is
receiving more and more attention. The inherent advantages
of robots are their high accuracy, high work efficiency, and
stability.1 Up to now, three robotic systems have been
approved by the US Food and Drug Administration (FDA) for
clinical treatment – the Automated Endoscopic System for
Optimal Positioning (AESOP) robotic system,2 the ZEUS robot-
ic surgical system,3 and the Da Vinci Surgical System (DVS).4
The positioning accuracy of surgery with these three robotic
systems is at the sub-millimeter level, and they have been
widely applied in the fields of digestion, urology, and cardio-
thoracic surgery.
At present, robots are also emerging in the field of stoma-
tology, where initial progress has been made that has laid the
foundation for the future development of robotics in this area
of dentistry. In this article, the research and application of
robots in stomatology are summarized.
Prosthodontics
Precise dental preparation is important for the long-term suc-
cess of dental restorations. However, due to the narrow oral
space, the trembling of human hands, and the limitation of
clinicians’ technical skills, the shape of prepared teeth may
International Journal of Computerized Dentistry 2019;22(3):251–260
Fig 1 Intraoral actuator of LaserBot.
not be ideal. To solve this problem, Yuan et al5 and Wang et
al6 created a miniature laser manipulation robotic device for
tooth crown preparation, called LaserBot (Fig 1). The robot
can automatically control a special laser to cut the teeth in
three dimensions. It is composed of a miniature robotic end
effector that goes into the mouth, a CAD software program, a
femtosecond laser generator, a six-degree-of-freedom laser
guide arm, and a tooth locator. Experiments conducted on
human teeth in vitro and resin teeth (Fig 2) show that the
robot can replace manual teeth preparation, and the accura-
cy can reach clinical requirements.
The process of tooth arrangement in complete denture
manufacturing requires many fine adjustments to achieve a
perfect occlusal relationship. It takes much time and effort to
achieve this process manually, and the ultimate success of the
result depends on practitioner’s skill. To save human en -
deavor, a single-manipulator robotic system based on the
CRS-450 robot (Fig 3) was created by Lü et al7 and Jiang et al8,
which was used for tooth placement in the complete denture
manufacturing process. This robot can finely adjust the pos-
ition and placement of the artificial teeth through the
mechanical claws to achieve accurate tooth arrangement.
The software in this robotic system can display dental arches,
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a b

Fig 2 Shape of resin teeth before (a) and after (b) preparation by LaserBot.

CRS robot Electromagnetic gripper

Robot controller

Work table
Light source
Computer and
Light-sensitive glue control software
a b

Fig 3 Single-manipulator tooth-arrangement robot system for complete dentures. (a) Structure of the robot. (b) The robot arranging teeth.

Computer and motion Photoelectric

control software isolation board

Dental arch generator

Power supply b

Multimanipulator Fig 4 Multimanipulator tooth-arrangement robotic system.

tooth-arrangement robot (a) Structure of the robot. (b) A complete denture made using the
a
robot.

252 International Journal of Computerized Dentistry 2019;22(3):251–260


Motoman
UP6
Height of dental arch L
End effector
FixEd mount Alloy wire
a b
Fig 5 Archwire-bending robotic system built on the Motoman UP6 robot. (a) Structure of the robot. (b) An archwire bent using the
robot.
occlusal curves, and the dentition in a 3D model; it has expert
integrated tooth arrangement capabilities and can realize the
automatic virtual prearrangement of the teeth, which is then
readjusted by the clinician to create a final tooth arrange-
ment plan. The plan is then transmitted to the robot, which
arranges the teeth according to the plan.
Later, Zhang et al9 built a multimanipulator tooth arrange-
ment robotic system (Fig 4) that was driven by 50 stepper
motors. These authors also conducted several intensive stud-
ies on related technologies,10,11 and a dental arch curve gen-
erator12,13 was integrated into the system to improve the pre-
cision and efficiency of the tooth arrangement.
Orthodontics
Accurate archwire bending is the key technology for fixed
orthodontic treatment.14 Compared with the traditional man-
ual bending system, the accuracy and efficiency of archwire
bending can be improved by using the robot with its precise
posture control ability.15 In 2004, Butscher et al16 designed an
archwire-bending robot with two-handed jaws, called the
SureSmile archwire-bending robot, which can bend archwire
accurately and automatically.
International Journal of Computerized Dentistry 2019;22(3):251–260
Wu et al
y/mm
Width of dental arch W
Molar
offset
Canine
eminace
x/mm
In 2009, Zhang et al18 and Du et al19 set up an orthodontic
archwire-bending robot (Fig 5) composed of a Motoman UP6
robot, an archwire bending actuator, and relevant software.
They also optimized the bending process, speed, angle, and
turning point of the archwire.20,21 Four types of orthodontic
archwires can be bent using this robot.
In 2011, Gilbert22 developed a robotic system, known as
the LAMDA system (Fig 6), which was used to bend ortho-
dontic archwire precisely and rapidly. The robot adopts a
gantry design structure that has high bending precision and
efficiency. The price of the equipment is relatively low, but it
only bends a flat curve.
In 2013, Jiang23 constructed a robot that used the third-
order S addition and subtraction curve control method of the
motor to bend the archwire (Fig 7). Later, a study of the form-
ing control point of the archwire-bending process was car-
ried out. The final archwire forming precision was 4.6% to
10.5%.
In 2014, Xia et al25 and Guo et al26 designed an end effec-
tor for an orthodontic archwire-bending robot that could
change the pincer automatically, as needed, during the
orthodontic archwire-bending process. The rationality of this
mechanism was verified by a robot simulation platform
based on ROS and Gazebo.
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Fig 6 LAMDA archwire-bending robot. Structure of the robot.

Z-direction mobile
platform

Archwire-bending
X-direction mobile mechanism
platform

Archwire-supporting
mechanism

Forming archwire
Archwire-slewing Y-direction mobile
a mechanism platform b

Fig 7 Jiang’s archwire-bending robot. (a) Structure of the robot. (b) Using the robot to form archwire.

Control software w1 = 38.4 mm

l2 = 26.9 mm
l1 = 10.2 mm

h = 6.2
l3 = 45.4 mm

h = 6.1

Control unit
w2 = 54.3 mm
Y

w3 = 61.2 mm
Robot body
a b X

Fig 8 Archwire-bending robot based on LabVIEW and ATmega2560. (a) Structure of the robot. (b) A sample archwire bent using the
robot.

254 International Journal of Computerized Dentistry 2019;22(3):251–260


In 2016, Jiang et al27,28 built an archwire-bending robot
based on LabVIEW and ATmega2560 (Fig 8). The special char-
acteristics of this robot is that it is simple to operate, has high
automation capability, is very reliable, and the springback of
the archwire can be compensated for during the bending
process. This robot therefore further improved the precision
of archwire bending.
Endodontics
Endodontic therapy is a time-consuming and laborious pro-
cess and its efficacy is directly dependent on the practition-
er’s clinical skills, which are acquired through years of difficult
training. In order to improve the effectiveness and reliability
of root canal therapy, Dong et al29,30 made a multipurpose
endodontic microrobot in 2007. The robot can be fixed on the
patient’s tooth and can realize the automatic treatment pro-
cess through computer control, including probing, drilling,
cleaning, and filling.
Holding the dental drill for a prolonged period of time
during oral treatment leads to a decrease in the accuracy of
cavity preparation and can cause clinician fatigue. It can also
cause hand tremor in the clinician. Ortiz Simon et al31 devel-
oped a robot that helps the clinician to hold a dental drill. It
had been proven that this robot can effectively filter tremors
and assist the clinician to operate the drill to prepare cavities
accurately and smoothly, thereby minimizing iatrogenic inju-
ries.
Endodontic therapy requires a wide variety of instru-
ments that not only take up space on the operating table but
also reduce the accuracy of the clinician’s apparatus choice
and prolong treatment time. Nelson et al32 developed an
instrument transfer robot that can execute preprogrammed
instructions to automatically select and deliver the desired
treatment instruments. Experiments showed that this robot
reduced root canal treatment time by 4.4%.
Oral and maxillofacial surgery
Orthognathic surgery
The anatomy of the oral and maxillofacial region is complex
and the esthetic demand in this dental field is high. There-
fore, orthognathic surgery needs to be highly accurate and
International Journal of Computerized Dentistry 2019;22(3):251–260
Wu et al
performed with minimal trauma. Gui et al33 integrated the
industrial robotic arm with the surgical navigation system to
create a robot for orthognathic osteotomy. This robot can
automatically perform an osteotomy operation according to
a surgical plan and the Le Fort I osteotomy displayed on a
skull model. The positioning deviation was < 2 mm, and the
angular deviation was < 5 degrees.
Due to the irregular shape of the craniofacial bone, spe-
cial bone shapes often need to be cut during orthognathic
surgery. When using the mechanical bone saw in osteotomy,
it is difficult for the clinician to ensure that the shapes of the
bone blocks are cut accurately without cutting off too much
jawbone. Burgner et al34 built a robotic system with a short-
pulse CO2 laser for osteotomy, and successfully cut several
specific bone fragments on a pig’s isolated mandible. The
overall deviation was < 0.5 mm.
Several years later, Baek et al35 integrated a miniature
Er:YAG laser, an optical surgical navigation system, and a
KUKA LWR 4+ robot according to the principle of ergonomics
to form an osteotomy robotic system (Fig 9). Experiments on
the mandible of living miniature pigs showed that the robot
can be used under a variety of circumstances in maxillofacial
surgery for the convenience of the practitioner. The posture
memory function of the robot allows it to cooperate more
efficiently with the practitioner in the limited operation space
around the operating table, unlike the previous laser robot
made by Burgner et al.34
Palatorrhaphy
In recent years, the use of a robot for cleft palate repair has
attracted the attention of scholars, and preliminary research
results have been achieved. In 2016, Khan et al36 used the Da
Vinci surgical robot to perform a cleft palate simulation on an
airway model of a child, and then performed a robot-assisted
Heinz pharyngoplasty on the corpse. The results showed
that, compared with traditional surgery, using a robot to
repair cleft palate through the mouth can improve surgical
efficiency while reducing potential secondary injury to the
patient.
Nadjmi37 studied the feasibility of cleft palate repair with
a Da Vinci surgical robot and the optimal surgical posture of
human–machine (patient–robot) on the corpse, and then
used the robot to complete 10 cleft palate repairs in clinical
practice. There were no complications during or after the sur-
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a b
Fig 9 The Er:YAG laser osteotomy robot. (a) The robot working scene on a dummy. (b) Some specific shapes of bone defects made by
this robot.
gery. Although the hospitalization time was 1.4 days shorter
than with traditional surgery, the operation time was extend-
ed by an average of 35 min. Nadjmi suggested that the repair
of cleft palate by an oral robot can reduce the damage to the
blood vessels, nerves of the palate muscles, and mucous
membranes. After the surgery, the function of both the pal-
ate and the eustachian tube were improved. In addition, the
high-resolution 3D image provided excellent stereoscopic
depth perception, which improved surgical precision, facili-
tated intraoral suturing, and enhanced surgical safety. Com-
pared with the unnatural posture required by traditional
practitioners, robotic surgery was more ergonomic.
Head and neck tumor
In traditional resection of head and neck tumor, the surgical
incisions are often large in order to meet the needs of the
visual field. This not only seriously affects esthetics but also
has a potentially psychological effect on the patient. A surgi-
cal robot can remove the diseased tissue through a small inci-
sion to minimize the impact on esthetics. In 2011, Kayhan et
al38 performed the first Da Vinci surgical robot-assisted resec-
tion of an adenoid cystic carcinoma of the tongue root.
Through the oral approach, the tracheostomy, skin incision,
and mandible split were avoided. The postoperative recovery
time was shortened, and the resection greatly reduced the
impact on the face and improved the quality of life of the
patient after the operation. The robot can remove para-
pharyngeal space tumors through an oral approach, which
avoids a postoperative neck scar caused by traditional neck
256
Saddle
S
Implant
Lines
approach surgery. Therefore, in recent years, Da Vinci surgical
robots have been used in the surgical treatment of para-
pharyngeal space tumors such as pleomorphic adenomas,39
lipomas,40 and schwannomas.41 However, due to the lack of
the force feedback system, it is easy to cause rupture of the
tumor capsule during surgery. Therefore, manual blunt di-
ssection is required, if necessary.42 In addition, the robot is
also used to clean neck lymph nodes. Lee et al43 used the Da
Vinci robot to excise the neck lymph nodes above the muscu-
lus omohyoideus in 10 cases of N0-stage oral squamous cell
carcinoma. Compared with the control group (traditional arti-
ficial surgery), the robotic incision was small and could be
hidden in the hairline behind the patient’s ear. Therefore,
postoperative esthetic satisfaction was significantly higher
than with traditional surgery, although the average surgical
time was twice that of traditional surgery. There were no sig-
nificant differences between drainage tube retention time,
length of hospital stay, number of removed lymph nodes,
and complications.
Oral implantology
In order to further improve the safety and accuracy of oral
implant surgery and to quantitatively research the mechanics
theory of implant denture restoration, in recent years robots
have also been used in the field of oral implantology, and
some initial successes have been achieved.
In 2001, Boesecke et al44 constructed a robotic system for
assisting practitioners to drill holes during oral implant sur-
gery. The guiding device at the end of the robot arm can
International Journal of Computerized Dentistry 2019;22(3):251–260

Navigation device
Robot arm
Markers of
Implant navigation
machine
Endoscope Teeth model
Fig 10 Autonomic dental implant robotic system.
guide the practitioner to quickly and accurately prepare the
implant holes in the patient’s jawbone according to the pre-
operative plan, including the position, angle, and depth of
the implants. A collision monitoring and alarm unit were
integrated into this system to improve the safety of the sur-
gery.
In 2008, Wilmes et al45,46 built an oral implant robot based
on a six-degree-of-freedom RX60 robot (Stäubli Tec-Systems,
Bayreuth, Germany) to study the effect of certain factors such
as diameter, angle, depth and hole size of an implant on
torque and initial stability during implantation. This implant
robot system, which consists of a mechanical arm, an angle
sensor, and a force/torque sensor, measures and analyzes the
mechanical changes during the implantation process. The
results of the study were that, firstly, the implant torque is
largest when the implant angle is in the range of 60 to
70 degrees; secondly, if the implant torque is too large, the
probability of denture implant failure increases; thirdly, the
deeper the implant is implanted, the greater the torque; and
finally, the implant diameter is too large to reduce the implant
torque and implant stability.
In 2011, Sun et al47 constructed an image-guided dental
implant robot system based on the MELFA RV-3S robot. The
system includes preoperative planning software, robotic
arms, and a coordinate measuring machine. The surgical plan
is designed on the patient’s 3D image before the operation.
During the operation, the space coordinate mapping conver-
sion is achieved by a two-step coordinate registration meth-
od through the coordinate measuring machine. Finally, the
implant hole is prepared automatically by the robot accord-
International Journal of Computerized Dentistry 2019;22(3):251–260
Wu et al
Guidance arm
Design virtual
plan
Monitor-intraoperative
navigation
Handpiece
Patient
tracker
Fig 11 Yomi dental implant robotic system.
ing to the plan. The in vitro experiments showed that the
operative error of the whole system was 1.42 ± 0.70 mm.
In 2014, a dental implant robotic system based on force
feedback technology was built by Syed et al.48 The system
includes surgical planning software, an Omega6 force feed-
back device, surgical robots, and infrared optical navigators.
After the preoperative preparation and the establishment of
space mapping between the force feedback device and the
robot, the former can be used to remotely operate the robot
during surgery.
In 2016, for the purpose of clinical application, a highly
automated dental implant robot system (Fig 10) was devel-
oped by Professor Zhao’s team.49,50 The system consists of a
surgical planning system, a mechanical arm, a stress sensor, a
terminal operative actuator, and a visible light navigation sys-
tem. At present, the prototype has been completed, and in
vitro experiments have been carried out. The results show
that the shoulder deviation of the implant hole is ± 0.6 mm,
the top deviation is ± 1 mm, and the angular deviation
is ± 2 degrees. These parameters meet clinical requirements.
In 2017, the dental implant navigation robot system
manufactured by Neocis Inc, called Yomi (Fig 11), received
FDA approval and became the world’s first commercially
available oral implant robot.51,52 The system is operated by
haptic robot technology to provide physical guidance on the
position, orientation, and depth of the drill bit (eg, it con-
strains the direction and depth of the drill bit). Yomi allows
practitioners to visualize the surgical site and enables them to
change the plan in real time according to the specific circum-
stances during surgery.
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Treating temporomandibular
dysfunction (TMD)
TMD is often characterized by pain in the temporomandibular
joint (TMJ) area, limited mouth opening, and TMJ bounce with
sound. At present, conservative treatment is often used to alle-
viate its clinical symptoms.53 Massage, as a kind of physical
conservative therapy, is widely used in the treatment of TMD in
the clinic and has achieved good results. Compared with trad-
itional massage, robot massage saves human endeavor, and its
programmed and standardized massage process can give
patients a good treatment experience. Ariji et al54 used their
oral rehabilitation robot, called WOA-1, to massage 26 TMD
patients with different conditions three times (10 min per time).
They found that 75% of the patients with clinical symptoms of
myofascial pain were effectively alleviated, and 40% of the
patients had a 5 mm or more increase in mouth opening.
Open mouth training is an effective method to treat
mouth opening limitation caused by TMD. Takanobu et al55
set up a 6-DOF robot for lateral motion training and treated a
TMD patient. The results showed that the opening distance
increased from 28 to 45 mm, and the distance of lateral
motion was increased from 9 to 15 mm in the right TMJ, and
7 to 12 mm in the left TMJ. In 2015, Sun et al56 constructed a
soft oral rehabilitation robot (SORR) that was driven by a new
type of soft pneumatic actuator to train patients with mouth
opening limitation. The mechanical properties of the robot
were studied by a special model, which showed that it was
feasible to use the robot for mouth-opening training.
Conclusion
The advantages of medical robotics are surgical accuracy,
high stability, intellectualization, and standardization. Medi-
cal robotics will lead to the development of more precise,
quantified, and efficient oral diagnosis and treatment in the
future. Dental robots have become a much-discussed topic in
the field of medical robotics. The literature reports on analy-
ses of dental robots in chewing exercises,57 oral teaching,58
simulated mandibular motion,59 and dental light robotic sys-
tems.60 Although current research on robotics in the field of
stomatology has made great progress, robots are not yet per-
fect. The main disadvantages of these robots are, firstly, that
their level of intelligence is generally not high, and the diag-
nosis and treatment robots cannot completely liberate the
clinician from the heavy clinical work; secondly, their function
is singular, so they can only carry out operations involving a
258
certain aspect or a certain step but cannot cope with com-
plex and variable oral diseases; thirdly, their structure is com-
plex – they are large in size and the human–computer inter-
action is awkward. However, with the continuous
development and improvement of artificial intelligence
technology, nanorobot technology,61,62 and robot control
theory, the above problems will be solved in the future. This
means that robots will be more widely used in the field of
stomatology, and will add vitality to the oral medicine
technology revolution.
Disclaimer
The authors declare no conflicts of interest.
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Einsatz der Robotertechnik in der Zahn-, Mund- und Kieferheilkunde

Schlüsselwörter: Robotertechnik, Stomatologie, digitale Medizin

Der Einsatz der Robotertechnik bei oralen Behandlungsverfahren reduziert nicht nur die Arbeitsbelastung des Zahnarz-
tes, sondern verbessert auch die Präzision der Behandlung. Der vorliegende Artikel liefert einen Review des Applikations-
status und des aktuellen wissenschaftlichen Status der Robotertechnik in der Stomatologie.

Qin Wu, Master Shi-Zhu Bai, Dr.

Department of Stomatology, Shangqiu Medical
College, Shangqiu, Henan, China
Yi-Min Zhao, Dr.
State Key Laboratory of Military Stomatology,
Dept. of Prosthodontics, School of Stomatology,
Fourth Military Medical University, Shaanxi, Key
Laboratory of Stomatology, Xi’an, Shaanxi, China
State Key Laboratory of Military Stomatology,
Dept. of Prosthodontics, School of Stomatology,
Fourth Military Medical University, Shaanxi, Key
Laboratory of Stomatology, Xi’an, Shaanxi, China
Xiang Li, Master
Department of Stomatology, Shangqiu Medical
College, Shangqiu, Henan, China

Qin Wu

Address Dr. Qin Wu, Department of Stomatology, Shangqiu Medical College, 666 Ying Bin Road, Shangqiu, Henan, China 476000;
Tel: 0086 0370 3251884; E-mail: wuqin1987114@126.com

260 International Journal of Computerized Dentistry 2019;22(3):251–260