Implant-Supported Auricular Prostheses: Current Evidence and a Six-Year Clinical Case Report with Navigated Flapless Placement

Background: Auricular defects resulting from congenital anomalies, trauma or oncologic resection pose significant functional and psychosocial challenges. When autologous reconstruction is not feasible or not desired, implant-retained auricular prostheses represent a reliable alternative with high patient satisfaction. This study aimed to systematically evaluate the clinical performance of craniofacial implants used for auricular prosthetic rehabilitation, focusing on implant survival, prosthetic outcomes, workflow typologies and complications. A secondary objective was to illustrate the long-term validity of a minimally invasive navigation technique through a clinical case with 6-year follow-up. Methods: A systematic review was conducted according to PRISMA guidelines. Clinical studies published between 2005 and 2025 reporting outcomes of implant-retained auricular prostheses were searched in PubMed and Scopus databases. Data were extracted on implant type, survival rates, prosthetic performance, workflow and complications. Risk of bias was assessed using appropriate tools based on each study design. Results: 32 studies were included comprising 15 case reports, 15 case series, 1 cohort study and 1 prospective observational study. Implant survival was consistently high across all workflow categories, with failures predominantly associated with irradiated or anatomically compromised bone. Prosthetic outcomes were favorable, showing excellent esthetics, stable retention and high patient satisfaction irrespective of manufacturing method, although digital and navigation-assisted workflows improved reproducibility, symmetry and planning precision. Complication rates were low and generally limited to mild peri-abutment inflammation manageable with conservative care. The clinical case confirmed these findings, showing stable osseointegration, healthy soft tissues and uncompromised prosthetic function at 6-year follow-up. Conclusions: Implant-retained auricular prostheses show predictable long-term success, independent of whether traditional, hybrid or fully digital workflows are employed. Digital technologies enhance surgical accuracy, minimize morbidity and streamline prosthetic fabrication, although high-quality comparative studies remain limited.