Zygomatic Implant Fixed Rehabilitation: A Systematic Review and Narrative Synthesis.
Abstract
Objective
To summarise outcomes of zygomatic implant (ZI) fixed rehabilitation in comparison to alternative fixed implant-supported approaches for the rehabilitation of the atrophic edentulous maxilla.
Methods
A comprehensive literature search was conducted in MEDLINE, Web of Science, EMBASE and other relevant databases. Eligibility included studies comparing fixed implant-supported techniques in adults with atrophic edentulous maxilla. The primary outcome was patient satisfaction. Secondary outcomes were oral health-related quality of life (OHRQoL) and disease-oriented outcomes. Risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool and ROBINS-I, and certainty of evidence, using GRADE. Findings were synthesized narratively.
Results
The search yielded 3,092 citations, of which five RCTs and one observational study were included in the review. Compared with All-on-4, greater satisfaction with ZI was reported in one study, while another found no statistically significant differences across most domains, except with surgery, which favoured All-on-4. Patients with ZI reported better OHRQoL than those with All-on-4 (SMD=3.02, 95% CI: 2.37,3.66). For implant failure, one RCT reported more failures with bone augmentation than ZI, whereas a retrospective study found no significant difference. For biological complications, one RCT favoured bone augmentation (OR=0.18, 95% CI:0.05,0.61), whereas the retrospective study found no difference. The certainty of evidence ranged from low to very low.
Conclusion
The findings suggest that ZI may improve OHRQoL compared to the All-on-4 technique. The evidence also suggests fewer implant failures with ZI, but higher biological complications compared with bone augmentation. However, the confidence in the summary results is currently limited for all outcomes. CLINICAL
Significance
Although zygomatic implants could improve the patients' quality of life compared with the All-on-4 technique, with lower implant failures as compared with the bone augmentation technique, the overall certainty of evidence was low to very low. These results, alongside the limitations in the collated evidence, may guide clinicians and patients in informed, shared decision-making for the rehabilitation of the edentulous atrophic maxilla.