Reabilitação protética com implantes zigomáticos em comparação à prótese sobre implantes instalados na maxila em pacientes com edentulismo maxilar severo: revisão sistemática e meta-análise

Abstract

Objective: To conduct a systematic review with meta-analysis to evaluate the effectiveness of oral rehabilitation with complete prostheses on zygomatic implants compared to fixed complete prostheses on conventional implants in edentulous patients with atrophic maxillae. Methods: The chosen study was a Systematic Review following the PRISMA flowchart, with registration in PROSPERO. The research question, based on the PICO framework, is: "Does rehabilitation with complete prostheses on zygomatic implants in patients with atrophic maxillae demonstrate greater effectiveness compared to prostheses on conventional implants?" Outcome (O): Implant loss and Quality of Life (Primary); Prosthetic complications and Peri-implantitis (Secondary). Six databases were electronically searched until July 2024: BVS (BBO-Dentistry and LILACS), MEDLINE (PubMed), Cochrane Library, EMBASE, Web of Science, and Scopus. Inclusion criteria encompassed randomized clinical trials (RCTs) and prospective and retrospective cohort studies, with no restrictions on time or language, including studies with patients aged 18 years or older, regardless of race or gender. The study eligibility process was conducted by two independent reviewers. The first stage consisted of screening studies by title and abstract, followed by full-text analysis, conducted via the Rayyan®️ platform. Risk of bias assessment was performed using the RoB 2.0 and ROBINS-I tools, and the quality of evidence was evaluated using GRADE. Results: Study selection identified 608 initial references, of which 285 were assessed after removing duplicates. Following title and abstract screening, six studies proceeded to full-text review, resulting in the inclusion of four reports and three studies (three randomized clinical trials and one retrospective cohort). In total, 194 patients (57.2% female and 42.7% male) aged 18–74 years were evaluated, with half treated with zygomatic implants and the other half with conventional implants, totaling 897 implants placed (353 zygomatic and 544 conventional). The analysis revealed differences in implant loss between the evaluated types, with higher incidence in conventional implants compared to zygomatic implants, which showed better maintenance rates in the long term. Additionally, patients rehabilitated with zygomatic implants reported superior quality of life. Conclusions: The findings of this systematic review indicate that zygomatic implants are a viable alternative for prosthetic rehabilitation in patients with atrophic maxillae, presenting lower incidence of failures and prosthetic complications compared to conventional implants. The lower frequency of peri-implantitis and the greater stability and durability observed reinforce the advantages of zygomatic implants, while superior quality-of-life scores highlight their positive impact on patients' well-being and masticatory functionality.