Survival and Complications of Zygomatic Implants: An Updated Systematic Review

Abstract

To assess the survival rate of zygomatic implants (ZIs) and the prevalence of complications based on previously published studies. An electronic search of 3 databases was performed in December 2015 and was supplemented by manual searching. Clinical series of ZIs were included. Interval survival rate and cumulative survival rate (CSR) were calculated. The untransformed proportion of complications (sinusitis, soft tissue infection, paresthesia, oroantral fistulas) was calculated by considering the prevalence reported in the studies. Sixty-eight studies were included, comprising 4,556 ZIs in 2,161 patients with 103 failures. The 12-year CSR was 95.21%. Most failures were detected within the 6-month postsurgical period. Studies (n=26) that exclusively evaluated immediate loading showed a statistically lower ZI failure rate than studies (n= 34) evaluating delayed loading protocols (P= .003). Studies (n= 5) evaluating ZIs for the rehabilitation of patients after maxillary resections presented lower survival rates. The probability of presenting postoperative complications with ZIs was as follows: sinusitis, 2.4% (95% confidence interval [CI], 1.8-3.0); soft tissue infection, 2.0% (95% CI, 1.2-2.8); paresthesia, 1.0% (95% CI, 0.5-1.4); and oroantral fistulas, 0.4% (95% CI, 0.1-0.6). However, these numbers might be underestimated, because many studies failed to mention the prevalence of these complications. ZIs present a high 12-year CSR, with most failures occurring at the early stages postoperatively. The main observed complication related to ZIs was sinusitis, which can appear several years after ZI installation surgery.