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Evaluate long-term survival rates of zygomatic and conventional implants in full-arch rehabilitation and identify influencing factors.

July 5, 2026International Journal of Implant Dentistry0 citationsOpen Access

Investigation of the long-term prognosis (3–13 Years) of full mouth implant prosthetics combining zygomatic implants based on the all-on-four concept

TUTakashi UesugiShowa University YSYoshiaki ShimooTokyo Medical and Dental University MMMotohiro MunakataShowa University

Key Points

Evaluate long-term survival rates of zygomatic and conventional implants in full-arch rehabilitation and identify influencing factors.
Retrospective analysis of 923 implants in 203 patients from 2010 to 2021.
Cumulative survival rates estimated using Kaplan-Meier, with intergroup comparisons via log-rank test.
Cox proportional hazards regression calculated hazard ratios for factors affecting survival.
Cumulative survival rates at 3-13 years: 94.5% for zygomatic implants, 97.9% for conventional implants (p=0.0178).
Palatal positioning of zygomatic implant platform associated with significantly reduced survival (HR=18.177, p=0.026).
Systemic disease linked to reduced zygomatic implant survival (HR=14.872, p=0.012).

Abstract

PURPOSE: Zygomatic implants (ZIs) are indicated for severely atrophic maxillae where conventional implant (CI) placement is difficult. Although ZIs show favourable outcomes, factors influencing their survival remain unclear. This retrospective study evaluated implant- and patient-related factors associated with ZI survival in full-arch immediate-loading rehabilitation using the all-on-four concept combining ZIs and CIs. METHODS: A total of 923 implants (323 ZIs and 600 CIs) placed in 203 patients between 2010 and 2021 were analysed. Cumulative survival rates were estimated using the Kaplan-Meier method, and intergroup comparisons were performed using the log-rank test. Cox proportional hazards regression analyses were performed to calculate hazard ratios (HRs). Statistical significance was set at p < 0.05. RESULTS: Cumulative survival rates at 3-13 years were 94.5% and 95.9% at the patient and implant levels, respectively, for ZIs, and 97.9% and 98.7%, respectively, for CIs. ZIs showed significantly lower implant-level survival than CIs (p = 0.0178). Palatal positioning of the ZI platform was significantly associated with reduced implant-level survival (HR = 18.177, 95% CI: 1.418-233.053, p = 0.026). Systemic disease was significantly associated with reduced patient-level ZI survival after adjustment for sex and smoking status (HR = 14.872, 95% CI: 1.812-122.077, p = 0.012). CONCLUSIONS: Immediate full-arch rehabilitation combining ZIs and CIs achieved high long-term survival; however, palatal platform positioning and systemic disease were associated with ZI failure.

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