Survival Rate and Prevalence of Complications in Basal Implants: A Systematic Review and Meta Analysis

To evaluate the effectiveness of basal implants in patients with atrophic jaw or compromised alveolar bone and to assess survival rate and related complications.

This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines and was registered in PROSPERO (CRD42024615184; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024615184). Databases (PubMed, SCOPUS, EBSCOhost, Google Scholar) were searched through April 2025. Screening and data extraction were performed independently by two reviewers. Quality assessment was evaluated using the Cochrane Risk of Bias (RoB-2) tool, and evidence certainty was assessed using the GRADE approach. Standardized mean difference (SMD) and risk ratio (RR) were used as summary statistics with a random-effects model, with p < 0.05 considered statistically significant. Analysis was performed using Review Manager (RevMan) version 5.3.

Five studies (1,388 implants, 140 patients) were included for qualitative synthesis and four for meta-analysis. All studies were randomized controlled trials with low to moderate risk of bias. Basal implant effectiveness was assessed for pain reduction (3rd day to 3rd month), soft tissue health indices, and survival rates at 12 and 24 months comparing healed bone sites versus fresh extraction sites. Meta-analysis revealed significant pain reduction at 3 months (SMD = 3.94, 95% CI: 3.30-4.57, p < 0.001) and significant improvement in soft tissue indices (SMD = 1.26, 95% CI: 0.89-1.63, p < 0.001). A numerical trend favored healed sites without statistical significance at 12 months (RR = 1.56, 95% CI: 0.59-4.09, p = 0.37) and 24 months (RR = 1.84, 95% CI: 0.79-4.29, p = 0.16). Complications varied considerably, with one study reporting implant bending in 30.9% of cases (376/1,019 implants), while mobility was rare (0.5%). GRADE assessment indicated moderate certainty for pain and soft tissue outcomes, and low certainty for survival outcomes.

Basal implants demonstrate favourable healing trajectories for pain reduction and soft tissue maturation in atrophic jaws. However, significant complication rates-notably a 30.9% bending rate-and the lack of direct head-to-head comparisons with modern conventional implants necessitate a cautious clinical approach. Direct comparison with contemporary conventional implants was not possible due to a lack of eligible randomized clinical trials. Current evidence remains geographically concentrated and limited by short follow-up periods; therefore, high-impact international RCTs are required to establish definitive comparative effectiveness and long-term safety.

The online version contains supplementary material available at https://doi.org/10.1007/s12663-026-03060-2.