Adopting Navigation and Robotics: Robert Emery, BDS, DDS

Over a long career, Dr. Robert W. Emery has seen new technologies come and go — but only some have meaningfully changed the way he operates. As an early developer of computer-guided implant navigation, he’s been closely involved in one of those shifts. In this conversation, he talks through how navigation and robotics are actually playing out in practice — where they’re making a difference, where they’re still evolving, and what it takes for surgeons to use them well.

ACOMS Review (AR): You’ve been deeply involved in advancing surgical technologies, including cocreating a computer-guided dental implant surgery navigation system. How do you see robotics and dynamic navigation transforming oral and maxillofacial surgery?

Robert Emery, BDS, DDS (RE): When I look at any new technology, I always ask why I should use it. What problems does this technology solve? Cocreating the computer-guided dental implant surgery navigation system was about improving efficiency and outcomes for both the patient and the surgeon. Over the course of my career, we have gone from freehand (non-guided surgery), to static guides to navigated surgery. We all know that any form of computer-assisted surgery (CAS) is more accurate and precise. What many surgeons don't appreciate is that it is also faster and safer — for their patients and for themselves.

For patients, CAS enables minimally invasive techniques with fewer complications. For surgeons, the ergonomics of freehand surgery contribute to long-term chronic injuries in up to 25% of dentists. With navigation and robotics, those injuries should decrease dramatically. Once the techniques are mastered, surgery becomes faster and more efficient because fewer physical objects need to be fabricated to complete the procedure. While drilling, the surgeon no longer needs to look in the mouth to place an implant or to cut the inferior border during a bilateral sagittal split osteotomy (BSSRO).

Robotics is the next logical step. A surgical navigation system is, in effect, a robotic vision system — the ‘eyes of the robot.’ It also allows complex procedures to be executed more precisely and efficiently. High-risk osteotomies such as BSSRO, and high-risk implants such as zygomatic and pterygoid implants, become easier to place. The feeling once a surgeon learns to ‘trust’ the robot is astounding.

AR: With more than three decades in practice, what has been the most significant transformation in how surgeons interact with technology, particularly robotics, compared to earlier in your career?

RE: The move from analog to digital workflows has been the most profound technological change in our field. That said, AI is now accelerating that change. We can evaluate the patient in three dimensions, capture every aspect of the patient digitally, and plan our surgical approach without producing a single physical object. It is pure information.

CAS lets us translate that information into active surgical treatment, again without any physical objects — though the surgeon still has to hold the instruments. Robotics moves this one step further by controlling the motion itself, guided by the same information. The superiority of robotics is most evident in highly complex motions or at remote sites such as osteotomies and the zygoma. Robots are simply better at cutting complex curves. The pace of development over the last few years has been alarmingly fast.

AR: How do you navigate that relationship between surgeon expertise and robotic guidance for optimal patient outcomes?

RE: The first ‘autonomous’ dental robot was introduced in China in 2017. That optical robot requires a surgeon to teach it how to enter and leave the mouth. The workflow is cumbersome and inefficient, it is not truly autonomous, and it must be continuously monitored. The newer generation of robots has significantly improved workflow, but no real push toward autonomy is underway — the focus instead is on workflow efficiency. Even with the advent of AI, these systems still require a great deal of human interaction. At this point they have no capacity to adapt or problem-solve. As AI matures, that will certainly change.

The pace of these changes is unknown, but there is no doubt the change is coming. Surgeons who do not adapt to the new technology will be left behind. Embracing each development as it arrives is what will keep surgeons relevant.

AR: From a patient perspective, how has the introduction of advanced technologies like robotics and navigation changed the surgical experience in terms of outcomes, recovery, and trust in care?

RE: Most patients equate robotic surgery with the highest level and quality of care. Whether that trust is warranted or not, the perception is real. We know from the literature that any form of CAS improves precision and accuracy. In dental implant surgery, CAS statistically standardizes surgeons' outcomes — when properly executed, an experienced surgeon and a novice surgeon become statistically equivalent after only 10 to 20 implants. A recent 2025 review paper on CAS in orthognathic surgery concluded that operating room time decreased significantly and outcomes improved when navigation or static guides were used, compared with freehand. Trust is built over time, shaped by both patients' and surgeons' outcomes and experiences — and the literature suggests that, in this case, the trust may well be founded. Time will tell as the body of literature on robotics continues to grow.

AR: Adoption of robotics in oral and maxillofacial surgery still faces barriers such as cost, training, and workflow integration. What practical steps or mindset shifts are needed for wider adoption across the specialty?

RE: For any form of CAS to work, the patient must be registered to the system — the digital and the analog patient must occupy the same reference frame. The majority of surgical robots available worldwide are optically driven, and for good reason. The advantage of optical systems is a more efficient workflow: the same system that placed the implant can be used to capture its final position through navigated photogrammetry. Optically driven robots can also see when something is off and correct it. Mechanical robots cannot.

If a surgeon wants to use a robot, they must first learn the underlying principle of registration. They need a deep understanding of the process in order to adapt to unexpected situations in the clinical environment and to troubleshoot when things go wrong. Having mastered navigation, the transition to a robot becomes much easier.

The efficiencies gained from a navigation system pay for themselves quickly. In full-arch implant surgery, chair time is reduced by 50%. The cost of robotics will continue to decrease as the market and competition grow. The pace of recent adoption curves makes this evident — worldwide, navigation has been adopted faster than cone beam computed tomography (CBCT). The only real question is how quickly robotic technology will follow.

AR: Looking ahead, what does the next phase of transformation in oral and maxillofacial surgery look like?

RE: Anything a navigation system can do, a robot will eventually do more accurately and with less human intervention. AI has already reshaped navigation systems by automating the diagnostic workflow. CBCTs are segmented, IOS scans are superimposed, and the initial implant position is generated — all without human input. Full-arch final impressions can be captured and automatically superimposed on the prosthetic design, again without human input. In the EU, navigation systems have been approved for osteotomies using virtually created piezo instruments. Work is underway to allow ‘jaw in a day’ cases to be performed with no physical guides at all. Automated cold-ablation laser robots have been used for Le Fort osteotomies, and prototype robots have performed veneer and crown preparations.

AI is accelerating software and hardware development at a pace we have never seen. Software automation is now driven by the software itself, with a human in the loop. Robotics, by contrast, is still limited by the hardware and by its interaction with humans — and AI is steadily reducing that human-robot interaction, removing one of the largest remaining sources of error.

Robert Emery, BDS, DDS

Dr. Robert W. Emery is an innovator in the field of oral and maxillofacial surgery. An expert in dental implantology, he is one of the creators of the most advanced surgical tracking system in the world. His medical and technological contributions have revolutionized the way doctors perform surgical procedures that require extreme accuracy.

With over 35 years of experience as an oral surgeon and oral and maxillofacial specialist, Dr. Emery brings comprehensive knowledge and skill to dental implant procedures, wisdom teeth removal and extractions, bone grafting, treatment for facial trauma, and jaw surgery. In addition to supporting his patients, he also teaches and publishes extensively, and he is one of the founding partners of X-NAV, a cutting-edge medical device company.