Zygomatic Implants for the Rehabilitation of Maxillary Defects Post-Mucormycosisy: A Systematic Review

Abstract

Introduction: Rhino-orbital-cerebral mucormycosis (ROCM) following COVID-19 frequently necessitates extensive, life-saving maxillectomies, resulting in massive anatomical defects that severely compromise masticatory function, speech, and health-related quality of life (HRQoL). Conventional obturator-based rehabilitation is often unpredictable in this cohort due to fungus-induced avascular necrosis of the residual tissue and inadequate basal bone volume. Zygomatic implants (ZIs), by anchoring into the dense, viable cortical bone of the zygomatic arch—anatomically distant from the necrotic maxillary zone—offer a promising graftless reconstructive solution. This systematic review aims to evaluate the survival rate, functional efficacy, and short-term clinical outcomes of ZIs in the rehabilitation of post-COVID-19 mucormycosis maxillary defects.

Materials and Methods: A comprehensive systematic search was conducted across PubMed, Scopus, Web of Science, and Embase, covering publications up to December 2024. Studies were selected based on predefined inclusion and exclusion criteria, focusing on zygomatic implant-based rehabilitation in post-COVID-19 mucormycosis patients. Study selection, data extraction, and qualitative synthesis were performed in accordance with PRISMA 2020 guidelines. Methodological quality of primary clinical studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools, while review articles were evaluated using a modified AMSTAR-2/SANRA framework.

Results: Twelve studies met the inclusion criteria, comprising 6 primary clinical studies, 4 review articles, and 2 finite element analysis (FEA) studies. The synthesized evidence indicated high primary stability and favorable short-term survival rates for ZIs placed in zygomatic bone anatomically distant from the necrotic maxillary zones. ZIs facilitated rapid functional restoration and demonstrably improved HRQoL in post-mucormycosis survivors. Reported complications included soft tissue dehiscence, oroantral fistulas, and recurrent sinusitis, underscoring the necessity of meticulous surgical planning and structured postoperative follow-up.

Conclusion: Zygomatic implants represent a viable and promising graftless modality for the prosthetic rehabilitation of extensive post-COVID-19 mucormycosis maxillary defects. While short-term functional and biomechanical outcomes are encouraging, the current evidence base is constrained by small sample sizes, predominantly retrospective study designs, and limited follow-up durations. Rigorous, long-term prospective cohort studies are warranted to establish standardized clinical protocols and definitively evaluate the long-term survival of ZIs in this specific patient population.