Retention and Quality of Life Outcomes of Zygomatic Implants vs. Conventional Removable Obturators in Post-Maxillectomy Defect Rehabilitation: A Systematic Review and MetaAnalysis

Abstract

Background: Rehabilitation after maxillectomy requires closure of the defect and restoration of oral function. Zygomatic implants can provide anchorage for an obturator, but the comparative effects on retention and quality of life remain uncertain.

Objective: To compare retention and quality-of-life outcomes of zygomatic implant-retained obturators with those of conventional removable obturators in patients with maxillectomy defects.

Methods: Comparative clinical studies in patients after maxillectomy were eligible. Direct evidence compared zygomatic implant retained or supported obturators with conventional removable obturators; broader midfacial implant comparisons were retained as indirect evidence. Web and publisher searches were recorded through 3 October 2026. One reviewer selected studies, extracted data and assessed nonrandomized comparisons with ROBINS-I. Findings were synthesized narratively using SWiM reporting principles, and certainty was assessed with GRADE. Structured bibliographic database searches and duplicate review were not performed.

Results: Seventeen reports were assessed; 13 were excluded, two remained awaiting classification in the recorded extraction, and two comparative studies involving 27 unique patients were included. One study directly evaluated zygomatic implants in eight patients; the other compared broader implant supported obturators in nine patients with conventional obturators in ten. Neither directly measured retention. The eight patient study reported an OHRQoL impact score of 0.173 ± 0.187 with the zygomatic obturator versus 0.519 ± 0.168 with the conventional obturator (lower is better; reported p < 0.01). Masseter and temporalis electromyographic amplitudes increased by 53.4 and 81.85 µV, respectively; all eight implants survived at 12 months of loading. The cross-sectional comparison reported better selected oral function and chewing outcomes with implant support. Both studies had serious risk of bias. Certainty was very low for outcomes with available evidence, and no meta-analysis was performed.

Conclusion: Zygomatic implant retained obturators may improve oral health related quality of life and aspects of masticatory function, but direct comparative evidence is limited to one small nonrandomized study. Broader implant evidence is indirect. Retention superiority and comparative safety have not been demonstrated. The findings require cautious interpretation because searches were restricted, some reports remained unclassified and certainty was very low.