Zygomatic implants for rehabilitation of head and neck cancer patients: a systematic review and meta-analysis

• Zygomatic implants show 97% survival in oncologic maxillary rehabilitation • No significant difference in failure between primary and secondary placement • Radiotherapy increases risk, but without statistical significance • ZIs ensure reliable rehabilitation in complex post-oncologic defects • Timing and loading remain key factors for clinical optimization Rehabilitation of extensive maxillary defects after oncology resection is challenging due to anatomical complexity, functional impairment, and effects of radiotherapy (RT). Zygomatic implants (ZIs) offer a versatile solution, providing predictable functional and prosthetic outcomes. This systematic review and meta-analysis aimed to evaluate ZI survival, failure rates, timing of placement, complications, and patient-reported outcomes in oncology patients. A systematic review was conducted in accordance with the PRISMA guidelines and registered in PROSPERO (ID 1245372). PubMed/MEDLINE, Ovid MEDLINE, Cochrane Library, Scopus, EMBASE, and Google Scholar were searched from 1950 to 2025 for studies reporting outcomes of ZIs in oncology patients undergoing maxillary rehabilitation. Study quality was assessed using the Newcastle-Ottawa Scale. Single-arm meta-analyses assessed overall implant survival, failure according to surgical timing, and failure in patients undergoing radiotherapy. Heterogeneity was evaluated using Cochran’s Q and I², publication bias with funnel plots and Egger’s test, and robustness of results with a leave-one-out sensitivity analysis. Seventeen studies including 294 patients and 679 ZIs were analyzed. Pooled overall survival was 97% (95%CI: 94–99; I²=42.4%). Failure rates were 2% for implants placed at primary surgery and 9% at secondary surgery (p=0.4073). Radiotherapy was associated with higher, though not statistically significant, odds of failure (OR=3.42; 95%CI: 0.97–12.06; p=0.0546). Patient-reported outcome measures consistently showed satisfactory oral function, mastication, speech, and psychosocial well-being, even in irradiated patients. ZIs provide a reliable, predictable option for maxillary rehabilitation in oncology patients, achieving high survival, low failure, and improved quality of life. Placement at the time of primary resection may offer additional benefit, and rehabilitation remains feasible after radiotherapy. ZIs represent a predictable and minimally invasive solution for the functional rehabilitation of oncology patients with extensive maxillary defects, even in the presence of previous or planned radiotherapy. The high survival rates and favourable patient-reported outcomes observed in this review support their routine use in appropriately selected patients and emphasize the importance of multidisciplinary planning and optimal timing of placement.