Major considerations and findings of clinical studies on zygomatic implant placement in older patients with severe maxillary atrophy: a systematic review

Abstract

Introduction: Zygomatic implant (ZI) rehabilitation of edentulous patients with maxillary atrophy is an approach that has been used with well-standardized procedures and considerable survival. Objective: The aim was to address and describe the main considerations and findings of clinical studies on the placement of zygomatic implants in elderly patients with severe maxillary atrophy. Methods: The present study followed a concise systematic review model (PRISMA rules). The search was carried out in the PubMed, Embase, Ovid, Cochrane Library, Web of Science, and Scopus databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 116 articles were found. In total, 41 articles were fully evaluated and 25 were included and evaluated in this study. Of the initial total of articles, 28 articles were excluded because they did not meet the GRADE and AMSTAR-2 classification, and 12 were excluded because they presented a risk of bias that could compromise the credibility of the studies. The symmetric funnel plot does not suggest a risk of bias. According to the GRADE instrument, most studies presented homogeneity in their results, with X2=92.1%>50%. It was concluded that the use of zygomatic implants is an alternative procedure, making implant rehabilitation of extensively atrophic maxillas possible when conventional procedures are not possible. Several anatomical and procedural factors, such as sinus conformation and sinus mucosa thickness, may influence the overall success of zygomatic implant rehabilitation and predispose to a higher occurrence of complications. Furthermore, dynamic navigation technology had better predictability in terms of precision and accuracy