Implant failure of facial prostheses: systematic review and meta-analysis

The aim of this systematic review was to evaluate craniofacial implant failure in the auricular, orbital, and nasal regions, including the impact of radiotherapy and evaluation of early (<1 year) and late (>1 year) implant failure. Five electronic databases were searched for articles reporting studies on implant failure in auricular, nasal, and/or orbital prostheses. The PRISMA guidelines were followed. Sixteen studies (3630 implants in 1127 patients) were included. The pooled implant failure rate was 3.5% in the auricular region, 18.7% in the orbital region, and 8.8% in the nasal region. Compared to the auricular region, implants inserted in the orbital (risk ratio (RR) 4.54) and nasal (RR 3.00) regions had a significantly higher risk of failure. Auricular (RR 2.17) and orbital (RR 2.07) implants had an increased risk of failure in irradiated bone. Regarding early failure (<1 year), 79.8% of nasal implants that failed were found to fail early, compared to 21.4% and 35.4% of failed auricular and orbital implants, respectively. This meta-analysis is novel in studying the timing of implant failure. Future studies should cover long observation periods and adequately report failure rates. There is a lack of high-quality studies and well-defined standardized outcome parameters. Results should be interpreted with caution due to low levels of evidence. DATA AVAILABILITY: This review has been registered with the Open Science Framework (doi:10.17605/OSF.IO/EBUC4). The study protocol and data files are publicly accessible.