Survival and complications of zygomatic implants compared to conventional implants reported in longitudinal studies with a follow‐up period of at least 5 years: A systematic review and meta‐analysis

Abstract

Background Zygomatic implants (ZI) have been frequently indicated to rehabilitate patients with extensive atrophies in alternatives to major bone reconstructions. It can be installed inside the maxillary sinus, called instrasinus zygomatic implant (IZI) or outside the maxillary sinus (EZI), depending on the surgery technique. Objective To evaluate the survival and complication rates of ZI in longitudinal studies when compared with conventional implants (CI). Methods An electronic search was performed in five databases and in Gray literature for articles published until April, 2022. The eligibility criteria comprised observational cohort studies (prospective or retrospective) and randomized clinical trials (RCTs) with at least 5 years of follow‐up, reporting survival rate of ZI versus CI. A meta‐analysis was conduct with 18 studies. Results A total of 5434 implants (2972 ZI and 2462 CI) were analyzed in 1709 patients. The mean survival rate was 96.5% ± 5.02 and 95.8% ± 6.36 for ZI and CI, respectively (mean follow‐up time of 78 months). There were observed no statistically significant between ZI and CI in prospective studies (risk ratio [RR] of 1.21; 95% confidence intervals [CIs]: 0.28 to 5.28; chi‐squared [Chi2] = 11.37; I2 = 56%; degrees of freedom [df] = 5; z‐score = 0.25; P = 0.80), retrospective studies IZI (RR of 1.29; 95% CIs: 0.52 to 3.23; Chi2 = 4.07; I2 = 2%; df = 4; z‐score = 0.55; P = 0.58) and retrospective studies EZI (RR of 0.72; 95% CIs: 0.31 to 1.66; Chi2 = 1.99; I2 = 0%; df = 3; z‐score = 0.78; P = 0.44). The biological complications most related to ZI was sinusitis, followed by infection and oroantral communication. Conclusion ZI have a high long‐term survival rate (96.5% with a mean of 91.5 months of follow‐up), showing no significant difference when compared with CI. The most prevalent biological complication is sinusitis, being most commonly to the IZI technique. This systematic review (SR) was registered in INPLASY under number INPLASY202280025.

Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review

“…The incidence rate of OST could be caused by the intra-sinus path and lack of surrounding bone due to the palatal entrance. In recent systematic reviews, the frequency of this complication varies between 1.5 and 7.5% [ 17 , 20 ]. One study found fistula formation in 3 patients with no persisting fistula after a 3-year follow-up.…”

“…Although the OST was a rather generic description of zygomatic implant position, in recent publications defined zygomatic implant positions for different anatomical situations are suggested (“Anatomy-Guided” techniques. Current systematic reviews were primarily aimed at comparing the survival rates with ZI treatment in different levels of atrophy maxillae, such as the classic approach versus the quad approach or ZI rehabilitation versus regular implant restoration [ 17 , 18 ].…”

Round and flat zygomatic implants: effectiveness after a 3‑year follow‑up non‑interventional study

“…Since the 1990s, zygomatic implants (ZI) have been used to rehabilitate atrophic maxillae [ 1 ] and reconstruct maxillary defects [ 2 ]. They have demonstrated commendable survival rates [ 3 – 6 ] and emerged as an alternative to extensive bone grafting [ 7 ].…”

Longitudinal reactions of maxillary sinus in patients treated with multiple zygomatic implants: A modified radiographic evaluation with clinical follow‐up

“…The reported survival rate of zygomatic implants ranges between 89.9% and 96.5% 8,9 . Maxillary sinusitis is the most frequent late complication of zygomatic implants, with a reported incidence of 0%–26.6% 10,11 .…”

“…6,7 The reported survival rate of zygomatic implants ranges between 89.9% and 96.5%. 8,9 Maxillary sinusitis is the most frequent late complication of zygomatic implants, with a reported incidence of 0%-26.6%. 10,11 We previously showed that the Schneiderian membrane thickness (SMT) increases after zygomatic implant placement.…”