<b>Accuracy and Clinical Pitfalls of Cone-Beam CT for Planning Zygomatic Implant Placement: A Systematic Review</b>

Background: Zygomatic implants have become an important treatment option for the rehabilitation of patients with severely atrophic maxillae, offering an alternative to extensive bone grafting procedures. Accurate preoperative planning is essential due to the complex anatomical trajectory and proximity to critical structures such as the maxillary sinus and orbit. Cone-beam computed tomography (CBCT) has gained widespread use in implant dentistry because of its ability to provide three-dimensional visualization of craniofacial structures. However, concerns remain regarding the diagnostic accuracy and potential clinical limitations of CBCT imaging in planning zygomatic implant placement. Objective This systematic review aimed to evaluate the accuracy and clinical pitfalls associated with CBCT imaging in the surgical planning of zygomatic implants and to assess its reliability in guiding complex implant procedures. Methods A systematic review was conducted following PRISMA guidelines. Electronic databases including PubMed, Scopus, Web of Science, and the Cochrane Library were searched to identify relevant studies. Eligible studies included clinical and observational research evaluating the use of CBCT in preoperative planning for zygomatic implants. Non-clinical studies, case reports, and non-English publications were excluded. Study selection was performed through a structured screening process, and data were extracted using standardized forms. Methodological quality and risk of bias were assessed using established evaluation tools. A qualitative synthesis of findings was performed due to methodological variability among studies. Results Eight studies met the inclusion criteria and were included in the final analysis. The findings consistently indicated that CBCT imaging provides accurate three-dimensional assessment of anatomical structures relevant to zygomatic implant placement. Measurement deviations between planned and intraoperative findings were generally minimal, often within clinically acceptable ranges. CBCT was shown to improve visualization of implant trajectory and anatomical landmarks; however, certain limitations such as imaging artifacts, variability in voxel resolution, and interpretive challenges were reported in some studies. Conclusion CBCT imaging appears to be a reliable and valuable tool for planning zygomatic implant placement, offering improved visualization and enhanced surgical planning capabilities. Nevertheless, awareness of potential imaging limitations and careful interpretation remain essential. Further large-scale clinical studies are recommended to strengthen the current evidence and refine imaging protocols for complex implant rehabilitation.