Dental Implant Fracture: Evidence-based Study And Clinical Case Report

Purpose:The increased utilization of dental implants for restoration of completely and partiallyedentulous patients will inevitably lead to an increase in number of failure which requiresintervention. Implant fracture is one of the late biomechanical complications with a lowprevalence yet it possess severe clinical outcome for the patient and the clinician. However,careful treatment planning can contribute to reduce the incidence of fracture. The objective ofthis study was to investigate the literature and to determine the factors that may predispose animplant to fracture and the management for implant fracture.Materials and Methods:Electronic search was conducted of available literature published in English or with Englishabstract that presented studies regarding dental implant fracture. The portal used was Pubmedand Medch augmented by keywords. In addition, this paper describes a case demonstrating themanagement of implant fracture in a72year old patient and the possible causative factors thatcould contribute to this complication. In another clinical report, a case of screw loosening of ananterior implant is discussed.Results:The study suggested that fracture of the fixture component of the dental implant in the firstclinical case occurred possibly because of three factors: one is excessive forces in the form ofbruxism exhibited by the patient. The other is inadequate implant diameter in relation to the siteneeding rehabilitation which caused increased stress ultimately leading to fracture. The third cause could be attributed to the large occlusal table of the prosthetic crown which producedbending moment load on the implant. Management required removal of the fractured implantsurgically using explantation trephine and replacement with a new wider diameter implant. In thesecond clinical report the screw loosening could be due to excessive bone resorption thatproduced undue stress on the implant.Conclusions:It is important to avoid mechanical problems and excessive bone resorption in order to preventimplant fracture. Special attention should focus on the number, diameter and distribution of theimplant in relation to the edentulous space size as well as on the design of the prosthesissupported by them (reduction of cantilever, cusp inclination and prosthetic crown dimension).Another logical approach is to use the slightly wider4mm or5mm diameter implant wheneveranatomy permits. It is important to know and apply the measures required to prevent implantfracture, and to seek the best individualized solution for each patient because when fractureoccurs, complete implant removal is usually the best management option. The new implantreplacing the fractured implant should be as wide as possible, with adjustment of the occlusalforces in order to avoid overload.