Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 2026 2 2026 08 25 141 150 Sahar Chokami Rafiei Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran. Mehdi Fakhri Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran. 2025 11 23 2026 04 11 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.  Keywords: Zygomatic implant; Mucormycosis; Post-COVID mucormycosis. https://jcr.tums.ac.ir/index.php/jcr/article/view/587 https://jcr.tums.ac.ir/index.php/jcr/article/download/587/492