Zygomatic Implants for Rehabilitation of the Atrophic Maxilla: Clinical Indications, Outcomes, Complications, and Evidence Gaps—A Comprehensive Review

Background and Objectives: Zygomatic implants have progressively become a widely adopted graft-free treatment option for the rehabilitation of severe maxillary atrophy. However, the expansion of their clinical indications has generated debate regarding patient selection, treatment hierarchy, and potential overtreatment. This review aimed to critically analyze current evidence regarding the use of zygomatic implants in the rehabilitation of the atrophic maxilla. Methods: A comprehensive narrative review of the literature was conducted through searches of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Relevant clinical studies, systematic and narrative reviews, and consensus statements published in English up to 27 March 2026 were critically analyzed to provide a comprehensive narrative synthesis focusing on treatment indications, surgical protocols, complications, patient-reported outcomes, and evidence gaps. Results: The reviewed literature consistently reported high implant survival rates and highlighted the role of zygomatic implants in reducing the need for extensive grafting procedures in selected patients with severe maxillary atrophy. The most frequently reported complications included sinus-related disorders, soft-tissue complications, prosthetic problems, and challenges associated with the management of implant failure. Different surgical approaches, including intra-sinus, sinus-slot, and extra-sinus techniques, were described. However, substantial heterogeneity emerged regarding treatment algorithms, complication reporting, success criteria, and patient-reported outcome assessment. Conclusions: Zygomatic implants represent an established treatment option associated with high reported implant survival in selected patients with severe maxillary atrophy, particularly when conventional implant placement would require extensive reconstructive procedures. However, in borderline clinical situations characterized by partial residual bone availability, treatment planning should also consider less invasive alternatives, including short implants, tilted implants, regenerative procedures, or customized subperiosteal implants, according to individual anatomical, prosthetic, and patient-related factors. Greater standardization of indications, complication reporting, and patient-reported outcome assessment is needed to better define the role of zygomatic implants within evidence-based treatment planning for the atrophic maxilla.