Implants in atrophic mandible: potential fracture complication?

I am a general dentist just beginning to place implants.  My patient was planned for a mandibular implant retained overdenture. Recently, I placed 4 regular implants (3.6mm X 10mm) on the atrophic mandible and realized the implants looked rather deep. I have read that mandibular fractures are a potential complication in such cases.  However, if this does not occur during the surgery, will it occur in the future? Do you recommend any treatment? When should I load these implants? Would deeply appreciate if I can get some comments on this case please. Thank you

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10 thoughts on “Implants in atrophic mandible: potential fracture complication?

  1. If mandibular fracture is going to occur it will be in the premolar area since this is the thinnest portion of the resorbed mandible. Since this patient lower will oppose a full denture I would not worry about fracture related to normal function where it could happen is in trauma to the mandible with a fall or such. But even without the implants that can happen.

    I would wait 3 months from placement to restore. Will this be fixed or a bar overdenture?

  2. I have placed implants in lower jaws a lot more fragile than what you are showing….. with no fractures over many years….what concerns me in this case is the radiolucency that appears around the most central of the implants…perhaps a Cone Beat CT scan can give more information.
    In any case, I would advice the patient to give up boxing or mixed martial arts…not a good idea for this patient.

    1. The pre op radiograph does not have the radiolucency as noted. I am guessing it might be an artefact.. Patient is too old for martial arts! 😉

  3. I would not consider this a resorbed mandible. This is a normal edentulous ridge. I agree with the above comment about the radiolucency. Also, what’s your over denture plan? Why do 4 for an over denture? Making a bar and clip? Only need two implants for locators. If you’re only planning locators then the patient overspent on the surgery. Make sure you have a firm restorative plan before ever placing the implants.

    1. I am planning for a mini ball attachment over denture. I have read up online and most surgeons recommend placing 4 implants for better retention AND stability. Many liken the number of implants to the legs of a chair, ie 4 legs will be more stable than 2. Also, having 4 implants will allow patient to have enough “backup” if any fails. As I am only a novice in this field, I have made concessions in the cost so patient is paying only slightly more than cost price for the implants… Please correct me if i am wrong.. Thank you for your comments!

  4. I agree with previous comments. More, the bone in lateral mandible will increase in quality, and quantity, thanks to function. Your mandible will soon be stronger than before treatment.

  5. Should work well. In the early years of implants placement to the inferior cortical bone in the anterior mandible was common and was even suggested.

    Have you taken a course for mini implants? The one piece “O” ring implants sized 2mm – 3mm diameter would have worked very well in this case and most likely could have been loaded into immediate function with soft liner or “O” rings.

    If you decide to use a mini implant take a course first. The surgical protocol is not the same as for the larger implants.

  6. Did you hear about transmandibular implant? where the lower cortical bone engage as well to get support. your case is perfect for the overdenture or Bar supported denture. Don’t worry about fracture until you have harmed to the buccal or lingual plate.

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