Dr. Shaqayeq Ramezanzade - "Zygomatic implants placed in atrophic maxilla: an overview of current systematic reviews and meta-analysis"
Episode summary
In this ZAGA Centers Podcast episode, Dr. Shaqayeq Ramezanzade, a dentist and University of Copenhagen PhD candidate, presents her 2021 umbrella review, 'Zygomatic implants placed in atrophic maxilla: an overview of current systematic reviews and meta-analysis,' published in Maxillofacial Plastic and Reconstructive Surgery. Because data was insufficient for a network meta-analysis, she and her co-authors pooled seven systematic reviews and two meta-analyses, screening 175 studies and grading methodological quality with the AMSTAR tool, which rated most included reviews as medium quality. The evidence shows zygomatic implant survival of 95-100% in severely atrophic maxillae, falling to about 78% in resected (maxillectomy) cases. Hybrid and zygoma quad approaches show similar survival, so hybrid is preferred when feasible, and delayed loading tends to reduce complications. She concludes zygomatic implants are a safe option for severe maxillary atrophy but require excellent training, anatomical knowledge, planning for complications, and more high-quality multicentre trials.
Key takeaways
- The study is an umbrella review (a review of reviews) that synthesised seven systematic reviews and two meta-analyses after screening approximately 175 studies across PubMed, Google Scholar, the Cochrane database and LILACS.
- Methodological quality of the included reviews was assessed with the AMSTAR tool (an 11-point scale) and most reviews were rated medium quality, indicating room for improvement in how the reviews were conducted rather than in the clinical findings.
- Reported zygomatic implant survival in atrophic maxilla was 95-100%, even at longer follow-ups.
- In resected maxillae (maxillectomy / cancer cases), failures rose to around 20%, corresponding to survival of about 78%.
- Hybrid rehabilitation (a zygomatic implant combined with standard implants) and the zygoma quad (two zygomatic implants per side) showed no significant difference in survival, so hybrid is preferred whenever possible and quad is reserved for severe anterior bone deficiency.
- Delayed loading was associated with fewer complications because it allows sufficient bonding between implant and bone before loading.
- The most frequently reported complication was sinusitis, with more serious complications including orbital cavity penetration, orbital nerve paresthesia, peri-implantitis, fractured implants and oro-antral communication.
- A network meta-analysis was not possible at the time because there was insufficient quantitative data and too few high-quality multicentre randomised controlled trials.
What you'll learn
- Why an umbrella review (review of reviews) was the right design when data was too sparse for a network meta-analysis
- Survival rates of 95-100% in atrophic maxilla but around 78% in resected/maxillectomy cases
- Hybrid (zygomatic + standard implants) versus zygoma quad show similar survival, so hybrid is preferred when feasible
- Delayed loading tends to lower complications by allowing sufficient implant-bone bonding
- The complication spectrum: sinusitis, orbital penetration, paresthesia, peri-implantitis, oro-antral communication
- Using the AMSTAR tool to grade systematic-review methodology (most included studies were medium quality)
About the guest
Dr. Shaqayeq Ramezanzade
Dr. Shaqayeq Ramezanzade is a dentist (DDS) and, at the time of recording, a PhD candidate at the Department of Odontology, University of Copenhagen, Denmark. Her main research field is artificial intelligence in dentistry with a focus on cariology and endodontics, and she has also published on implantology and zygomatic implants. She is the first author of the umbrella review discussed in this episode.
