Robotics and navigation systems in periodontal and implant surgery (Review)

Robotics and computer‑assisted navigation are increasingly being integrated into digital dentistry, particularly implant surgery, through the combination of three‑dimensional imaging, virtual treatment planning, real‑time tracking and robotic assistance. However, their clinical role, comparative effectiveness and applicability to periodontal procedures remain incompletely defined. The present narrative review synthesizes current literature on the development, principles, clinical applications, accuracy, limitations and future directions of freehand surgery, static‑guided surgery, dynamic navigation, robotic‑assisted surgery, artificial intelligence and augmented reality in periodontal and implant surgery. Particular emphasis is placed on distinguishing technical feasibility from clinically validated benefit and differentiating implant‑focused evidence from periodontal applications. Static guides facilitate the reproducible transfer of a predefined surgical plan; however, they provide limited intraoperative flexibility. Although dynamic navigation enables the real‑time visualization and adjustment of instrument positioning, it remains dependent on registration accuracy, tracking, calibration and operator experience. Robotic‑assisted systems demonstrate promising positional accuracy in selected implant workflows; however, available evidence is predominantly implant‑focused and characterized by heterogeneous study designs, small clinical cohorts and variable risk of bias. Artificial intelligence and augmented reality may support image interpretation, treatment planning, anatomical visualization and workflow integration, although their clinical effectiveness requires further external validation. Periodontal applications, including flap surgery, root‑surface instrumentation, regenerative procedures, connective tissue grafting and microsuturing, remain largely investigational. Current evidence is limited by methodological heterogeneity, inconsistent accuracy definitions, limited long‑term clinical outcomes, operator‑related variability, technological costs, learning‑curve effects, and inadequate assessment of biological and patient‑centered endpoints. Robotics and navigation systems represent promising adjuncts to periodontal and implant surgery, with the strongest evidence currently supporting selected implant applications. Broader periodontal translation will require clinician‑supervised development, standardized comparative studies, independent validation, and assessment of biological, functional, economic, and patient‑reported outcomes. At present, evidence is stronger for technical accuracy than for long‑term clinical and patient‑centered benefits.