Article

Feature Article
Aug 12, 2026 // 17 min read
Computer-Assisted Implant Surgery: Definitions and Overview
Nikos Mattheos
DOI: 10.63580/ITI.FI.45787
computer-assisted implant dentistry CAIS
Abstract

Computer-Assisted Implant Surgery (CAIS) marks a profound paradigm shift in oral implantology towards a comprehensive, design-oriented, patient-centered digital workflow, empowering unprecedented clinical outcomes. The digital implant treatment plan is the cornerstone of the workflow and an essential prerequisite for any further procedures. Once this digital blueprint is locked, the clinician can conduct the surgical and restorative procedures, selecting from an array of protocols, as best indicated for the patient. 

Non-guided CAIS (digitally planned, executed freehand), although still feasible in straightforward cases of low complexity, is no longer considered the most efficient way to work with more complex clinical protocols. In contrast, guided CAIS allows the placement of the implants with minimum deviation from the planned position, thus simplifying complex protocols such as immediate loading with prefabricated prostheses and empowering minimally invasive surgeries and flapless placement.

Static CAIS (s-CAIS) relies on rigid CAD/CAM surgical guides to mechanically guide surgical drills. Although a low cost, mature and predictable technology with extensive documentation, s-CAIS presents with significant limitations. At the same time, it relies on technologies that offer little, if any, potential to further evolve.

Dynamic CAIS (d-CAIS) represents a different paradigm in guided surgery and relies on spatial tracking cameras to offer the surgeon real-time guidance. This allows maximum access to the surgical site and intraoperative flexibility, but requires expensive devices and demands significant training to master.

Finally, robotic CAIS (r-CAIS) is a promising new direction, pairing real-time navigation with automated execution. Collaborative or task-autonomous CAIS robots have advanced beyond proof of principle, placing thousands of implants worldwide with unprecedented trueness. Despite impressive claims with regards to accuracy, robotic CAIS relies on expensive, bulky and complex devices, is labor-intensive and involves high operational costs, and little is known about the patient and operator experience. Cost-effectiveness might represent the most important barrier to overcome before wider clinical adoption.

Ultimately, CAIS might be a transitory stage toward a highly automated digital ecosystem in implant dentistry, in which treatment planning will be supported by cloud-based artificial intelligence, while surgical and restorative procedures will be executed within immersive environments with unprecedented levels of real-time information and guidance. The use of CAIS may permanently transform implant surgery into a hyper-precise science.

CAIS: A new technology or a paradigm shift?

"To name it is to know it," wrote the Swedish botanist Carl Linnaeus, who is known as the father of modern taxonomy. He famously popularized the idea that scientific discovery and the understanding of the natural world begin with giving things a proper name. On the contrary, the famous physicist Richard Feynman argued for the exact opposite: that merely knowing the name of something is fundamentally different from understanding how it works.

Whichever view you happen to subscribe to, the fact remains that in dentistry we love classifications and taxonomies. This might reflect our effort to create a structure from abstract concepts and different procedures, so that we can teach, learn and improve clinical care. Taxonomies could be also essential to streamline research and synthesize individual studies efficiently towards the bigger picture. Bringing order to what we know might be the best way to identify what we don’t – and act effectively to discover what is needed to push the frontiers of science further. Organizing knowledge in this manner might have worked for centuries, but in the age of rapidly advancing technologies, it might prove a daunting task.

Thus, the name “Computer-assisted Implant Surgery” might be already misleading, as it is neither focused on computers nor limited to surgery. On the contrary, it entails a far wider workflow reflecting the new patient-centric paradigm of implant therapy (Fig. 1).

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Fig. 1: Computer-assisted implant surgery (A) entails a comprehensive workflow which necessitates a prosthetically driven digital treatment plan (B), continues with the surgical execution, which can be either non-guided or guided. The guided option follows three distinct pathways: static (C), dynamic (D) or robotic (E). Graph reproduced from Jorba-Garcia et al. 2025

At its inception, implant dentistry followed a "bottom-up" approach, where patients were assessed through two-dimensional radiographs and implants were placed where the bone offered best conditions for osseointegration. The subsequent challenge of fabricating an esthetic, biologically and functionally optimized prosthesis fell squarely onto the shoulders of the restorative dentist (Brånemark et al. 1983).

As the discipline matured, the paradigm shifted dramatically toward "prosthetically driven" implant placement. Clinicians realized that long-term biological stability and esthetic success depend on a “top-down” approach: the ideal position of the prosthesis dictates the surgical positioning of the dental implant. For many years, achieving prosthetically driven placement required advanced mental integration. Practitioners utilized vacuum-formed analog templates or radiographic stents with radio-opaque markers to visually bridge the gap between a physical diagnostic wax-up and the patient’s actual bone anatomy exposed during surgery (Buser et al. 2017).

The advent of the new paradigm did not come overnight and was not related to any single technological breakthrough. Instead, the new paradigm gradually emerged, catalysed by both digital technologies and new understanding of the impact of the microdesign of implant prostheses on the clinical outcomes and long-term success (Jorba-Garcia et al. 2025). The rapid spread of 3D optical and radiographic data acquisition, computer-aided design (CAD), and computer-aided manufacturing (CAM) technologies, along with guided surgery and spatial positioning systems, has transformed what used to be a mental exercise into a highly accurate and reliable workflow with unprecedented efficiency and clinical outcomes. 

Today, CAIS represents a workflow, starting with data acquisition, centered around the digital treatment plan and extending to different paths of guided implant placement, aiming to serve the patient with faster, safer, less invasive and more successful implant treatments (Jorba-Garcia et al. 2025). As a workflow, CAIS entails a massive technological ecosystem which spans from advanced artificial intelligence-driven diagnostics to real-time navigation surgery and task autonomous robotics.

The aim of this overview paper is to provide a comprehensive look at the entire field of CAIS, clarifying its baseline definitions, deconstructing core technical concepts, and helping clinicians to navigate a rapidly evolving field with a major impact on the way implant dentistry is being practiced.