Background Function and aesthetics have a significant impact on the quality of life in patients undergoing mandibular reconstructive surgery, but achieving satisfactory results remain challenging. The aim of the study is to investigate the feasibility and accuracy of robot-assisted mandibular reconstruction with fibula flap in comparison to that with a computer-assisted navigation system and the freehand technique. Methods Experimental procedures (15 phantom studies and 6 animal experiments) were performed with a custom three-arm robotic system automatically, under the guidance of a computer-assisted navigation system, and by the freehand technique, respectively. The accuracy of the reconstruction was assessed by comparison between the preoperative and postoperative three-dimensional surface virtual models. Results All procedures were successfully performed. In the phantom study, the mean deviation of the fibula implant was 1.221, 1.581, and 2.313 mm, respectively, with the robotic system, the navigation system, and the freehand technique; in the animal experiment the corresponding figures were 1.7697, 1.7847, and 2.0815 mm, respectively. The mean deviation of the proximal mandibular ramus was 1.0420, 1.0532, 1.8800 mm with the robotic system, computer-assisted navigation system, and freehand technique, respectively, and the mean deviation of the distal mandibular segment was 1.1645, 2.7198, and 2.8445 mm, respectively. Conclusions The robotic system is feasible, efficient, and reliable for mandibular reconstruction. The accuracy of the fibula implant orientation with the robotic system was comparable to that with navigation system and superior to that with the freehand technique.
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