CASE REPORT Mandibular fractures associated with endosteal implants Bruno Ramos Chrcanovic & Antônio Luís Neto Custódio Published online: 1 October 2009 # Springer-Verlag 2009 Abstract Purpose The purpose of this study is to report four cases of mandibular fractures associated with endosteal implants and to discuss prevention and treatment of these types of fractures. Discussion To evaluate whether the patient's anatomy allows insertion of implants, radiological exams that demonstrate the height and the labial–lingual width are needed. To reduce the potential fracture problem, the mandible can be restrengthened with bone grafting techni- ques. The treatment of a fracture in an atrophic mandible is always a challenge because of the diminished central blood supply, the depressed vitality of the bone, and the dependence on the periosteal blood supply. The basic principles in fracture treatment are reduction and immobi- lization of the fractured site for restoration of form and function. Conclusions If implants are placed in severe atrophic mandible, iatrogenic fracture of the mandible may occur during or after implant surgery because implant placement weakens the already-compromised mandible. A few milli- meters of cortical bone should remain on both the labial and the lingual sites after the hole for insertion of an implant has been drilled. A 3-D surgical planning should be recommended at least in severe atrophic mandibles in order to prevent a severe reduction of bone tissue. Keywords Edentulous patient . Dental implant . Mandibular fracture Introduction Endosseous cylinder implant rehabilitation of edentulous and partially edentulous jaws is currently an accepted and widespread treatment modality. The high success rate experienced in current clinical practice with endosseous cylinder implants is largely the result of the work of Brånemark [1], whose research led to the concept of osseointegration. One of the most severe complications related to endosteal implants is fracture of the edentulous mandible. Such fractures have been sparsely reported in the medical literature [2–12]. This complication is most likely to occur in the very atrophic mandible and may represent 0.2% of the patients with inserted implants in an edentulous mandible [2, 9, 13]. The objective of this report is to describe four cases and to discuss treatment philosophy. B. R. Chrcanovic (*) Av. Raja Gabaglia, 1000/1209-Gutierrez, Belo Horizonte, MG-CEP 30441-070, Brazil e-mail: brunochrcanovic@hotmail.com A. L. N. Custódio Departamento de Odontologia, Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500 Prédio 45–Coração Eucarístico, 30535-610 Belo Horizonte, Minas Gerais, Brazil e-mail: antonio.custodio@gmail.com A. L. N. Custódio Oral and Maxillofacial Surgery Department, School of Dentistry, Pontifícia Universidade Católica De Minas Gerais, Belo Horizonte, Brazil A. L. N. Custódio Department of Morphology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Oral Maxillofac Surg (2009) 13:231–238 DOI 10.1007/s10006-009-0171-7