This systematic review and meta-analysis was performed to assess the 20-year survival rate and marginal bone loss (MBL) of titanium endosseous dental implants with cylindrical or conical screw-shaped designs. Only prospective studies were included. Ten studies met the inclusion criteria. These reported 1857 implants (baseline) of which 1028 were followed up for ≥20 years, during which 115 implant failures were recorded. Implant survival was estimated using a descriptive Kaplan-Meier approach accounting for censored observations. The 20-year implant survival rate was 93.0% (95% confidence interval 91.6-94.1%). The specific cause of failure was explicitly reported for 44 of the 115 implants and was almost equally distributed between biological and mechanical causes. MBL was quantitatively synthesized using a random-effects meta-analysis. The pooled mean MBL was 1.11 mm (95% confidence interval 0.55-1.68 mm). There was substantial variability in long-term marginal bone changes across studies, ranging from slight bone gain to moderate bone loss. Exploratory subgroup analyses suggested differences in MBL according to implant surface characteristics. However, this analysis was based on a limited number of implants and was characterized by high heterogeneity; therefore, the results should be interpreted with caution. The certainty of the evidence (GRADE framework) was rated as moderate for both implant survival and MBL; however, this rating was limited by substantial heterogeneity. Overall, the long-term performance of the dental implants in these prospective studies with follow-up of ≥20 years was favourable. Further well-designed long-term studies are required to elucidate the factors influencing implant survival and marginal bone stability.
Keywords: Dental implants; Epidemiologic measurements; Follow-up studies; Meta-analysis; Survival rate; Systematic review.
Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.