Evaluating Implant Timing in Orthognathic Surgery for Edentulous Patients: A Systematic Review of Clinical Protocols and Outcomes

Background: Edentulous patients undergoing orthognathic surgery present significant challenges due to the absence of occlusal landmarks and reduced bone support, complicating surgical planning and postoperative stability. Determining the optimal timing of dental implant placement—before, during, or after jaw surgery—is clinically important but remains unclear. Purpose: This systematic review and meta-analysis evaluated how implant timing influences implant survival, complications, and clinical outcomes in edentulous patients undergoing orthognathic surgery. The review focused on adult and pediatric edentulous populations undergoing maxillary or mandibular osteotomies, with outcomes including implant survival rates, postoperative complications, and stability measures. Study Selection: Following PRISMA guidelines, PubMed and Embase were searched (November 15, 2024). Studies were included if they reported edentulous patients receiving dental implants in association with orthognathic surgery. Exclusion criteria were oncologic resections, free flap reconstructions, nonsurgical management, and insufficient outcome data. Two independent reviewers screened all studies, and 34 of 396 identified articles (8.6%) met eligibility criteria. Results: A total of 396 patients were included. Implants were placed after surgery in 82.4% of cases, during surgery in 16.0%, and before surgery in 1.5%. Pooled implant survival rates were 99.1% for presurgical placement, 94.4% for intraoperative placement, and 92.8% for postoperative placement, with no significant differences between groups ( P =0.68). Smoking status and posterior implant site were associated with lower survival, whereas graft type and surgical technique were not significant predictors. Conclusions and Relevance: Implant timing relative to orthognathic surgery does not significantly influence implant survival, which remains high across all protocols. Patient-specific factors—particularly smoking and implant location—play a larger role in implant success. These findings support individualized surgical planning and highlight the need for prospective studies with standardized reporting.