Factors Influencing Dental Implant Osseointegration in Post-Orthognathic Surgery Patients: A Systematic Review with Focus on the Saudi Arabian Context

Combining orthognathic surgery with dental implant therapy represents a complex clinical challengein patients with dentofacial deformities. While both procedures individually demonstrate highsuccess rates, their sequential application requires careful consideration of biological, biomechanical,and technical factors influencing osseointegration, particularly in regions such as Saudi Arabiawhere distinctive demographic patterns, cultural practices, and environmental factors—including ahigh prevalence of vitamin D deficiency—may modify treatment outcomes. This systematic reviewsynthesizes current evidence on factors affecting dental implant osseointegration followingorthognathic surgery, with particular emphasis on data from Saudi Arabian and Middle Easternpopulations, while evaluating implant survival rates, osseointegration parameters, andpatient-reported quality of life. Following PRISMA 2020 guidelines, a comprehensive literaturesearch was performed in PubMed, Scopus, Web of Science, Saudi Digital Library, and GoogleScholar from database inception to November 2024. Eligible studies included adult patients (≥18years) who received endosseous dental implants after orthognathic surgery and reported quantifiableoutcomes such as implant survival, bone-to-implant contact (BIC), implant stability quotient (ISQ),marginal bone loss, complications, or validated quality-of-life measures (Orthognathic Quality ofLife Questionnaire [OQLQ] or Oral Health Impact Profile-14 [OHIP-14]). Observational studies andrandomized controlled trials with ≥5 participants and ≥6 months follow-up were included. Risk ofbias was assessed using the Newcastle-Ottawa Scale for observational designs and Cochrane RoB 2for RCTs. Due to substantial methodological heterogeneity (I² > 50%), a narrative synthesis wasprioritized, supplemented by pooled descriptive statistics and subgroup analyses where feasible. Of1,247 initial records, 28 studies involving 1,847 patients and 3,256 implants met inclusion criteria.The pooled implant survival rate was 94.3% (95% CI: 91.8–96.2%) across follow-up periods of 6months to 10 years. Key influencing factors included timing of implant placement (delayed >12months: 96.2%; early 6–12 months: 93.8%; immediate: 89.4%; p600: 96.8%; p=0.003), patient age (≤25 years: 95.8%; >35 years: 91.7%; p=0.021),computer-guided surgery (96.4% vs. conventional 92.8%; p=0.012), bioactive implant surfaces(95.8% survival; p=0.007), smoking (88.4% in current smokers; p=0.008), and vitamin D deficiency(