Postimplantation fracture in atrophic mandibles: A literature review completed with a case report

Mandibular fracture is a seldom encountered but nevertheless serious postimplantation complication. Mostly elderly patients with atrophic mandibles are affected. Fractures often occur in the anterior mandibular segment. Therapy in such instances is challenging because of the limited bone mass and difficulty of fixating the osteosynthesis material. Based on a search of the literature over the past 10 years (MEDLINE), information regarding the frequency, localization, and predisposing factors of postimplantaton mandibular fractures was analyzed. In addition, a case report is presented to illustrate the typical course of this complication. Although numerous publications refer to the insertion of dental implants in the atrophic mandible, there is little published knowledge about the complication of a mandibular fracture. A detailed preimplantation strategy-including a three-dimensional scan-certainly helps to reduce risks. Furthermore, the use of an exact and reproducible grading of fracture risk would contribute to standardizing procedures for implant placement in the atrophic mandible. Dimension and design of dental implants highly influence bone stability and the risk of fracture. Continuous follow-up investigations are also relevant to success.