Biomechanical performance of zygomatic and pterygoid implants in the rehabilitation of the severely atrophic maxilla: a systematic review

Zygomatic and pterygoid implants are reliable graft less options for severely atrophic maxilla rehabilitation. These implant configurations have been explored in many finite element and experimental biomechanical investigations; however, the evidence is scattered, and a systematic review has not been done to analyze their biomechanical performance to thoroughly assess the biomechanical performance of zygomatic and pterygoid implants for severely atrophic maxillae. The systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251130553). We searched PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar since database establishment to June 2026. Stress distribution, strain, implant displacement, micromotion, load transfer, prosthetic framework stress, and peri-implant bone stress were assessed using finite element models and experimental biomechanical tests. Methodological quality was assessed using the ROBFEAD and QUIN tool of risk assessment Thirteen studies were included. Most were finite element analyses, with 2 biomechanics experiments. While isolated zygomatic implants had lower peri-implant stress than pterygoid implants, coupled zygomatic-pterygoid implants improved posterior load transfer, cantilever effects, biomechanical stability, and implant micromotion. The available biomechanical evidence suggests that implant distribution and posterior support may substantially influence mechanical behavior under simulated loading conditions. Combined zygomatic-pterygoid configurations generally demonstrated more favorable load sharing, reduced cantilever-related stress and lower micromotion in the investigated models. However, these findings represent relative biomechanical trends derived predominantly from computational simulations and should not be interpreted as evidence of superior clinical survival or treatment success. Standardized biomechanical studies and prospective clinical investigations are required to determine their clinical relevance.