Zygomatic Implant Rehabilitation of the Atrophic Maxilla: A Narrative Review

Rehabilitation of the atrophic maxilla is clinically demanding because of severe bone resorption and anatomical limitations, particularly in the posterior maxilla. Conventional grafting procedures, such as sinus augmentation and bone grafting, increase treatment time, morbidity, and cost. Zygomatic implants have emerged as a graftless alternative, offering stable anchorage in dense zygomatic bone and enabling immediate-loading protocols. This narrative review aims to evaluate the clinical outcomes, survival rates, indications, surgical challenges, and complication profiles associated with zygomatic implant rehabilitation of the atrophic maxilla. A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar. Peer-reviewed articles published in English from January 1990 to May 2025 were included. Eligible studies comprised clinical trials, cohort studies, case series, systematic reviews, and meta-analyses addressing zygomatic implant outcomes. Data regarding implant survival, prosthetic success, surgical protocols, complications, and patient satisfaction were narratively synthesized. A total of 31 studies met the inclusion criteria. Reported survival rates for zygomatic implants ranged from 95% to 100%. High success rates were observed in both immediate and delayed loading protocols, with cross-arch prostheses showing excellent long-term stability. Complications included sinusitis, peri-implant soft tissue inflammation, prosthetic failures, and rare cases of paresthesia. Despite these risks, outcomes consistently favored zygomatic implants as a predictable solution for severe maxillary resorption. Zygomatic implants provide a reliable graftless alternative for full-arch rehabilitation of the atrophic maxilla, reducing treatment time and patient morbidity compared to grafting procedures. Careful case selection, precise surgical planning, and clinician expertise remain critical for minimizing complications. Future multicenter randomized controlled trials are warranted to further validate long-term outcomes.