Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 97

The occurrence of a mandible fracture is an uncommon complication due to dental implant reconstruction, and has been reported almost exclusively in the atrophic, completely edentulous mandible. Several factors need to be considered when treatment planning for these cases. The first consideration is that not every mandible is a candidate for implant reconstruction, and the benefits must outweigh the risks especially in the case of a severely atrophic mandible. Imaging needs to delineate clearly not only the height of the mandible, but also the width. A minimum height of 7–10 mm and a minimum width of 6–8 mm of bone are required for implant placement. In most reports, mandible fractures occurred after the restoration of the implants, and the prosthesis was in function for a period of months to years. Mandible fractures secondary to implant reconstruction immediately, or prior to prosthetic reconstruction, are rare, and again, typically occur in atrophic edentulous mandibles (Figure 3.14). The treatment should follow basic trauma principles regarding atrophic mandible fractures (Algorithm 3.5). Immobilization and fixation with a locking reconstruction plate is necessary for stability, and bone grafting may be necessary given the cortical, noncancellous, nature of the atrophic mandible rendering the healing capacity of the atrophic mandible less than optimal (Figure 3.15). Additional bone grafting for augmentation may also be considered before implant placement in the atrophic, edentulous mandible. Several techniques have been described to facilitate reconstruction of the atrophic mandible. Although the use of the transmandibular implant had been advocated as a solution for the severely atrophic mandible, more recent evidence suggests that long‐term outcomes may not be superior (or comparable) to traditional techniques of implant placement, and this form of mandibular reconstruction has fallen out of favor over the years.

Fig. 3.14. Right mandible fracture from implant placement.