Survival Rate and Prosthetic and Sinus Complications of Zygomatic Dental Implants for the Rehabilitation of the Atrophic Edentulous Maxilla: A Systematic Review and Meta-Analysis

Simple Summary Zygomatic dental implants have been proposed as an alternative to atrophic total edentulous maxillae rehabilitation with the necessity of bone grafting procedures. However, surgical, prosthetic, and maxillary sinus complications have been associated with this surgical procedure. Therefore, it is necessary to produce a systematic review and meta-analysis that provides evidence associated with the prognosis when using zygomatic dental implants as an alternative to atrophic total edentulous maxillae rehabilitation. The aim of this systematic review and meta-analysis was to analyze and compare the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Materials and methods: We conducted a systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Four databases were consulted during the literature search: Pubmed-Medline, Scopus, Embase, and Web of Science. After eliminating duplicate articles and applying the inclusion criteria, 46 articles were selected for the qualitative analysis and 32 for the quantitative analysis. Results: Four randomized controlled trials, 19 prospective clinical studies, 20 retrospective studies, and 3 case series were included in the meta-analysis. Conventional dental implants failure (n = 3549) were seen in 2.89% (IC-95% 1.83-3.96%), while zygomatic dental implants failure (n = 1895) were seen in 0.69% (IC-95% 0.21-1.16%). The measure of the effect size used was the Odds Ratio, which was estimated at 2.05 with a confidence interval of 95% between 1.22 and 3.44 (z test = 2.73; p-value = 0.006). The failure risk of conventional dental implants is 2.1 times higher than that of zygomatic dental implants. Slight heterogeneity was determined in the meta-analysis between 23 combined studies (Q test = 32.4; p-value = 0.070; I-2 = 32.1%). Prosthetic complications were recorded in 4.9% (IC-95% 2.7-7.3%) and mild heterogeneity was observed in a meta-analysis of 28 combined studies (Q test = 88.2; p-value = 0.001; I-2 = 69.4%). Sinus complications were seen in 4.7% (IC-95% 2.8-6.5%) and mild heterogeneity was observed in a meta-analysis of 32 combined studies (Q test = 75.3; p-value = 0.001; I-2 = 58.8%). Conclusions: The high survival rate and low prosthetic and sinus complications related to zygomatic dental implants suggest the use of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla.