Purpose: The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. Methods: Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. Results: A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34–2.29) at the entry point and 2.95 mm (95% CI: 1.66–4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04–4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83–1.54) at the entry point and 1.80 mm (95% CI: 1.10–2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43–2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69–2.39) at the entry point and 3.23 mm (95% CI: 2.34–4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86–5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. Conclusion: Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches.

Introduction: There are few zygomatic implants (ZI) designs available. The objective of this non-interventional study was to report the effectiveness of two new site-specific ZI, selected and placed following the zygoma anatomy-guided approach (ZAGA). Materials and methods: Consecutive patients presenting indications for rehabilitation using ZI were treated according to ZAGA Concept recommendations. Implants were immediately loaded following the manufacturer’s instructions. Success criteria regarding prosthetic offset, rhino-sinus status, soft tissue condition, and implant stability were additionally used as outcome parameters. Results: Twenty patients were followed for a period of 12 to 28 months (average 18.8 months). Ten received 2 ZI plus regular anterior implants; One received 3 ZI plus regular implants and nine received 4 ZI. In total, 59 ZI were placed, 34 (58%) Straumann ZAGA-Flat design, and 25 (42%) ZAGA-Round. Forty-nine percent of the sites were classified as ZAGA-4 type and 27% as ZAGA-2. Four patients (20%) presented discontinuities of the sinus–nose floor before surgery and 15 patients (75%) presented previous sinus opacities. All implants bar one reached more than 45 N.cm of insertion torque. No surgical complications were observed. After 1 year, the modified Lund–Mackay score was negative in 17 patients. Seventeen sites in 11 patients exhibited decreased opacity when pre-surgical imaging was compared to 1-year post-surgical CBCT. All implants and prostheses remained stable and in function. Conclusions: The study concluded 100% implant/prosthesis survival rates and low complication levels. Within the limitations of the sample and observation period, results suggest that even in cases of extremely resorbed maxillae (as per cases in this study), ZAGA-Flat and ZAGA-Round ZI are viable treatment options when restoring atrophic maxillae following the ZAGA protocol.

Objectives: This retrospective study aimed to evaluate the clinical outcomes associated with zygomatic implant (ZI) rehabilitation in partially atrophic edentulous maxillae over a mean follow‐up period of more than 10.3 years.Methods: All consecutive patients underwent ZI rehabilitation between 1999 and 2020, with a minimum follow‐up period of 3 years. The primary outcome was the implant survaival rate. Secondary outcomes included the prosthesis success rate, complications, and Oral Health‐Related Quality of Life.Results: Of the 21 patients, treated with 27 ZIs and 48 conventional implants (CIs), 9 (42.9%) were females. The mean follow‐up was 10.3 ± 5.7 years (range 3.2–23.4). ZI and CI survival rates were 100% and 97.9%, respectively, with one CI that failed. Eleven patients received 12 CIs placed in the pterygoid and tuberosity region. Most of the implants (81.33%) were immediately loaded, with 17 patients (80.9%) receiving 21 acrylic bridges. Of the total of 26 definitive prosthesis, the success rate was 96.1%. Local inflammation (n = 2) and soft tissue recession (n = 1) were reported as complications, occurring at a mean follow‐up of 4.5 and 3.2 years, respectively. The mean score of the OHIP‐14 questionnaire was 1.19 ± 1.99.Conclusions: Unilateral ZI rehabilitation was a predictable option for patients with partially atrophic edentulous maxilla who have experienced previous graft or implant failures, or who require immediate loading. Splinting the ZI with CI for restoration appeared to be essential in unilateral ZI treatment. Complications were infrequent and could be managed effectively, with patient‐reported outcomes indicating normalization in quality of life.

Objectives: To evaluate the long‐term clinical outcomes of quad zygomatic implants (ZIs) as a rescue therapy for patients with failed full‐arch implant rehabilitation in the maxilla due to advanced peri‐implantitis. Material and Methods: This was a retrospective cohort study of all patients treated with the Quad Zygoma Protocol. Primary outcomes included the ZI survival and success rates, and secondary outcomes, the prosthetic success rate and complications. Results: The study population included 28 consecutive patients who received 112 ZIs between 2006 and 2024, with a mean follow‐up of 8.2 ± 4.1 years. In 23 patients, a total of 113 failed conventional implants were removed, and 48 ZIs were immediately placed into the explantation sites. The ZI survival rate was 98.2%, with two ZIs requiring removal due to late complications. The implant success rate was 93.5%, and prosthetic success was achieved in 96.4% of cases. Sinusitis was diagnosed in 8 patients (28.5%) at a mean of 5.92 years postoperatively; all cases were successfully managed medically without implant loss. Soft tissue recession occurred in 9.8% of cases, while oroantral fistula and facial fistula were each observed in 0.9% of implants. Conclusions: The Quad Zygoma Protocol may represent a reliable and predictable option for the rescue of failed maxillary full‐arch implant rehabilitations. Despite a relatively high prevalence of sinusitis, favorable long‐term clinical outcomes were achieved with appropriate management.