Chrcanovic Bruno Ramos, Custódio Antônio Luís Neto
Oral Maxillofac Surg. 2009 Dec;13(4):231-8. doi: 10.1007/s10006-009-0171-7.
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.
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 techniques. 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 immobilization of the fractured site for restoration of form and function.
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 millimeters 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.
本研究旨在报告4例与骨内种植体相关的下颌骨骨折病例，并探讨此类骨折的预防和治疗方法。
为评估患者的解剖结构是否允许植入种植体，需要进行能显示高度及唇舌宽度的影像学检查。为减少潜在的骨折问题，可采用骨移植技术增强下颌骨。由于中央血供减少、骨活力降低以及对骨膜血供的依赖，治疗萎缩性下颌骨骨折始终是一项挑战。骨折治疗的基本原则是复位和固定骨折部位，以恢复外形和功能。
如果在严重萎缩的下颌骨中植入种植体，在种植手术期间或之后可能会发生医源性下颌骨骨折，因为种植体植入会削弱本已受损的下颌骨。在钻出种植体植入孔后，唇侧和舌侧均应保留几毫米的皮质骨。至少对于严重萎缩的下颌骨，应推荐进行三维手术规划，以防止骨组织严重减少。
