Mandibular fractures through endosseous cylinder implants: report of cases and review.

These case reports and review focus on three mandibular fractures that occurred through endosseous cylinder implant sites. The first patient, and most likely the second, had osteoporotic changes that affected their already atrophic mandibles. The third patient probably had an area of deficient mineralization or poorly consolidated bone in the region where the fracture developed. These bony conditions increased the potential for fracture. Although the exact mechanism by which such fractures occur is not known, an examination of past research suggests that stress concentration at the mandibular defect prepared for implant placement is a probable explanation. The site of an implant that has not yet osseointegrated acts as a site of tensile stress concentration and ultimately an area of weakness. Consequently, this area of weakness in a mandible with decreased bone density or mineralization is more prone to applied functional forces. Repeated submaximal functional forces in an area of bony weakness, such as an endosseous implant site, may lead to a spontaneous fracture with no associated trauma. With these factors in mind, several extra precautions should be taken when implants are placed in thin or weak mandibles.