$200,000 Of Robot, Or Twenty Minutes Of Planning

Every conversation about guided implant surgery eventually becomes a conversation about accuracy. Almost none of them become a conversation about price, which is strange, because the price range across the four levels of guidance is enormous.

Dr Jono Michael is an implant and reconstructive dentist in Sydney who has trained on the whole ladder, from freehand to robotic. On the full episode he put real numbers to it.

A static guide costs a few hundred dollars and about twenty minutes

Start at the accessible end. For a straightforward single unit implant, the cost of the guide itself is not high. Depending on the lab, a few hundred dollars.

The planning is the real input, and it is smaller than most people assume. Around fifteen to twenty minutes to import the implant into the software, position it where you want it, and send it to the lab. Labs are good at nudging the position towards where the tooth ideally should sit. Print times are short, and a practice printing in house drops the cost again.

Then it pays some of that back on the day.

If I'm confident in how things are feeling as I'm drilling, I'll trust in the system and place the implant through the guide sometimes in five minutes or less.

So for simple cases the arithmetic works. A few hundred dollars and twenty minutes at a desk, against saved chair time and a more predictable position.

A robot costs around two hundred thousand US dollars and most of a room

Now the other end. During his master's, a clinician from New York came to lecture on robotics. He had one in his practice.

I remember him telling us it was somewhere in the vicinity of 200,000 US dollars. And it occupied the good part of a room.

Two costs there, and the second one is the one people forget. A machine that takes up most of a room is not just a capital line. In a practice where rooms generate revenue, floor space has a running cost of its own.

That clinician was not buying accuracy alone, and Jono was straightforward about it. He wanted an edge his competitors did not have, a treatment very few people could say they offered. That is a legitimate reason to buy equipment. It is just a marketing reason wearing a clinical coat, and worth naming as such before you sign.

Dynamic navigation is the one he cannot make the numbers work for

This is where his answer gets uncomfortable for the middle of the market.

Dynamic navigation sits between static guides and robotics. He has not used it. Access is not the barrier any more, and the reps would happily let him trial it.

The barrier is that when you compare the literature on dynamic against static, the accuracy gap is not large. The cost gap is.

As cool of a toy as it might be, does it really justify the price tag associated with it, or should I stick to a static guide?

Add the setup and protocol time, which he calls prohibitive for the full arch work he does, and his conclusion is unusually direct for someone talking about a product category.

I think dynamic maybe doesn't have a true home in the future.

Useful as a stepping stone for engineers getting from static to robotic. Hard to justify as a purchase.

The cost nobody puts in the model

Here is the part of the conversation that should stop any practice mid business case.

Everything above assumes patients want this. Jono is not sure they do.

If they don't at heart feel comfortable, then we might have this really expensive piece of equipment that only a small percentage of people feel comfortable enough to allow us to use it on them.

Dentists can explain that a system is more accurate. Explaining is not the same as consenting. Some patients will actively prefer the human, and they will not be wrong to, because they may value judgement in a hard moment over accuracy on paper.

His own framing of the trap is the sharpest line in the episode.

It's a lot of money to put out front, only for it to sit in a room collecting dust if no one wants to be operated on with it.

Which produces an obvious, cheap, and almost never taken step: ask your patients first. Survey the list. Would you consent to a robot assisting your implant surgery? A short survey costs nothing next to a two hundred thousand dollar asset that turns into a liability because the demand was assumed rather than measured.

What the studies do and do not buy you

One more thing worth budgeting for, which is scepticism.

A 2026 network meta-analysis compared static, dynamic and robotic guidance against freehand and found robotic systems the most accurate on angulation and apex position. Jono had read it, and his response was not to accept or dismiss it.

The conditions in that paper were specific and operator dependent. Other studies have found robotics with a considerably larger margin of error. Most of this research runs in vitro, on models, without bleeding, without a patient moving, without bone that turns out softer than the scan suggested.

It could be really, really accurate in one case and wildly inaccurate in another case. And on average it will seem like it's not too bad.

So the honest position on cost is that you are not buying a guaranteed accuracy figure. You are buying a probability distribution whose shape depends heavily on the operator holding it.

How he would spend the money

Asked for the best piece of kit he has ever bought, he did not name any of this. He named photogrammetry units, because they made his digital workflow for implants genuinely more predictable and straightforward.

And asked whether he would let a robot place an implant in his own mouth, the answer was two words.

Not today.

Listen to the full conversation with Dr Jono Michael, and read why he still places most implants freehand. The $2 Dentist is about exactly this: spending on the things that change outcomes, and refusing the things that only look like progress.