Fratura de implante dentário: relato de caso / Dental implant fracture: case report / Fractura de implante dental: informe de un caso

Com o aumento da população brasileira e consequentemente o número de edêntulos realizando tratamentos reabilitadores com implantes dentários, se tornou frequente aparições de complicações como, por exemplo, sua fratura. O presente trabalho tem por objetivo apresentar as causas prováveis relacionadas a fratura de implante dentário, através de um relato de caso clínico onde pode-se avaliar a condição da fratura apresentada e como foi solucionada. Após a analise do caso clínico, foi constatado que o principal fator que levou a sua fratura foram as sobrecargas oclusais associadas ao mal posicionamento e a qualidade do implante antigo. A partir disso, conclui-se que é de extrema importância o cirurgião dentista estar ciente de todas as possíveis complicações acerca do implante dentário, afim de realizar um bom planejamento cirúrgico diminuindo a taxa de insucesso levando a um bom prognóstico.

With the increase of the Brazilian population and, consequently, the number of edentulous individuals undergoing rehabilitation treatmentes with dental implants, the appearance of complications such as, for example, their fracture has become frequent. The present work aims to presente the probable causes related to dental implant fracture, trough a clinical case report where the condition of the fracture presented and how it was resolved can be evaluated. After analyzing the clinical case, it was found that de main factor that led to its fracture were the occlusal overloads associated with poor positioning and the quality of the old implant. From this , it is concluded that it is extremely important for the dental surgeon to be aware of all possible complications regarding the dental implant, in order to carry out a good surgical planning, reducing the failure rate, leading to a good prognosis.

Con el aumento de la población brasileña y, en consecuencia, del número de personas edéntulas que se someten a tratamientos de rehabilitación con implantes dentales, las complicaciones, como las fracturas, se han vuelto comunes. El presente trabajo tiene como objetivo presentar las probables causas relacionadas con la fractura de implantes dentales, a través del reporte de un caso clínico, donde se puede evaluar la condición de la fractura presentada y la forma en que fue resuelta. Tras analizar el caso clínico, se comprobó que el principal factor que condujo a la fractura fue la sobrecarga oclusal asociada a una mala colocación y a la calidad del implante antiguo. Esto lleva a la conclusión de que es muy importante que el cirujano dental conozca todas las posibles complicaciones de los implantes dentales, para realizar una buena planificación quirúrgica, reduciendo así la tasa de fracasos y consiguiendo un buen pronóstico.

Clinical classification and treatment decision of implant fracture / 北京大学学报(医学版)

OBJECTIVE@#To propose a set of two-dimensional clinical classification of fractured implants based on the follow-up of fracturing pattern of implant body and peri-implant bone defect morphology of 32 fractrued implants, and summarize the treatment decisions of fractured implants according to this new set of classification, so as to provide guidance for clinical practice.@*METHODS@#During 25 years of clinical practice, clinical records of 27 patients of 32 fractured implants in 5 481 patients with 10 642 implants were made. The fracturing pattern of implant body, implant design, peri-implant bone defect morphology and treatment options were analyzed. A set of two-dimensional clinical classification based on the morphology and bone absorption of implant fracture was proposed. The treatment decision-making scheme based on the new classification of implant fracture was discussed.@*RESULTS@#In the new classification system, vertical fracture of implant neck (Type 1 of implant fracture morphology, F1) and horizontal fracture of implant neck (Type 2 of implant fracture morphology, F2) were common, accounting for 50% and 40.6% respectively, while deep horizontal fracture of implant body (Type 3 of implant fracture morphology, F3) (9.4%) were rare, while the three types of bone defects (D1, no bone defect or narrow infrabony defects; D2, wide 4-wall bone defects or cup-like defects, D3, wide 3-wall or 2-wall defects) around implants were evenly distributed. In the two-dimensional classification system of implant fracture, F1D1 (31.3%) and F2D2 (25%) were the most frequent. There was a significant positive correlation between F1 and D1 (r=0.592, P < 0.001), a significant positive correlation between F2 and D2 (r=0.352, P=0.048), and a significant negative correlation between F1 and D2 (r=-0.465, P=0.007). The most common treatment for implant fracture was implant removal + guided bone regeneration(GBR) + delayed implant (65.6%), followed by implant removal + simultaneous implant (18.8%). F1D1 type was significantly related to the treatment strategy of implant removal + simultaneous implantation (r=0.367, P=0.039). On this basis, the decision tree of implant fracture treatment was summarized.@*CONCLUSION@#The new two-dimensional classification of implant fracture is suitable for clinical application, and can provide guidance and reference for clinical treatment of implant fracture.

Comparison of implant component fractures in external and internal type: A 12-year retrospective study

PURPOSE: The aim of this study was to compare the fracture of implant component behavior of external and internal type of implants to suggest directions for successful implant treatment. MATERIALS AND METHODS: Data were collected from the clinical records of all patients who received WARANTEC implants at Seoul National University Dental Hospital from February 2002 to January 2014 for 12 years. Total number of implants was 1,289 and an average of 3.2 implants was installed per patient. Information about abutment connection type, implant locations, platform sizes was collected with presence of implant component fractures and their managements. SPSS statistics software (version 24.0, IBM) was used for the statistical analysis. RESULTS: Overall fracture was significantly more frequent in internal type. The most frequently fractured component was abutment in internal type implants, and screw fracture occurred most frequently in external type. Analyzing by fractured components, screw fracture was the most frequent in the maxillary anterior region and the most abutment fracture occurred in the maxillary posterior region and screw fractures occurred more frequently in NP (narrow platform) and abutment fractures occurred more frequently in RP (regular platform). CONCLUSION: In external type, screw fracture occurred most frequently, especially in the maxillary anterior region, and in internal type, abutment fracture occurred frequently in the posterior region. placement of an external type implant rather than an internal type is recommended for the posterior region where abutment fractures frequently occur.

Analysis of risk factors of 19 fractured implants / 中华口腔医学杂志

Objective@#To analyze the incidence and possible risk factors of 19 fractured implants out of 8 468 implants in 3 184 cases.@*Methods@#During the 22-year clinical practice, clinical records of 18 patients with 19 fractured implants in 3 184 cases with 8 468 implants were analyzed to determine the following factors: location of the fractured implants, prosthodontics option, date of implant fracture, dimensions of fractured implants, complications prior to implant fracture and parafunctional habit. An evaluation of fractured implants was performed to identify possible factors that may predispose an implant to a higher risk of fracture.@*Results@#Overall, the average duration of service of the implants was (7.0±4.5) years. Implant fracture occurred in 7 Camlog implants, 7 Nobel replace implants, 3 Ankylos implants and 2 Brånemark implants. No Thommen implant fractures were recorded. Amongst the 19 fractured implants, 8 occurred at the thinnest wall portion of the implant neck, 8 at the end of screw and 3 at the self-tapping thread region. All fractures were observed after functional loading. Furthermore, 9/19 (47.4%) of fractures occurred in the maxilla, indicating similar incidence rates in both arches (P=0.065). Most of fractures (16/19) occurred in the molar region and 18/19 in single implant-supported restorations. Totally 17 cases had received metal occlusal restorations. In 6 cases (35.5%), previous bone destruction apically extending to the level of implant fracture was documented before any clinical signs of fracture. Three fractured implants were removed and simultaneously re-implanted with larger-diameter implants, while the rest of the cases were left to heal, followed by a second-stage surgery.@*Conclusions@#Within the limitation of this analysis, the study demonstrated that appropriate implant-abutment connection design, implant diameter, prosthetic strategy and bone resorption are crucial to the long-term performance of implants. There is no significant difference of fractures rates in both archs.

Clinical and scanning electron microscopic analysis of fractured dental implants: a retrospective clinical analysis

Many longitudinal studies have reported the successful osseointegration of dental implants, with survival rates approaching 90-95%. However, implants regarded as a "success" may have also failed to undergo osseointegration. A variety of complications and failures have been observed, including implant fracture - a rare and delayed biomechanical complication with serious clinical outcomes. Given the increasing popularity of dental implants, an increase in the number of failures due to late fractures is expected. This study sought to determine the rate of implant fractures and factors associated with its development. This retrospective evaluation analyzed implants placed at Wonkwang Dental Hospital (from 1996 to the present). In our study we found that the frequency of dental implant fractures was very low (0.23%, 8 implant fractures out of 3,500 implants placed). All observed fractures were associated with hybrid-surface threaded implants (with diameter of 4.0 or 3.75 mm). Prosthetic or abutment screw loosening preceded implant fracture in a majority of these cases.

Application of finite element analysis to evaluate implant fractures / 대한치과보철학회지

Statement of problem. Higher fracture rates were reported for Branemark implants placed in the maxilla and for 3.75 mm diameter implants installed in the posterior region. Purpose. The purpose of this study was to investigate the fracture of a fixture by finite element analysis and to compare different diameter of fixtures according to the level of alveolar bone resorption. Material and Methods. The single implant and prosthesis was modeled in accordance with the geometric designs for the 3i implant systems. Models were processed by the software programs HyperMesh and ANSA. Three-dimensional finite element models were developed for; (1) a regular titanium implant 3.75 mm in diameter and 13 mm in length (2) a regular titanium implant 4.0 mm in diameter and 13 mm in length (3) a wide titanium implant 5.0 mm in diameter and 13 mm in length each with a cementation type abutment and titanium alloy screw. The abutment screws were subjected to a tightening torque of 30 Ncm. The amount of preload was hypothesized as 650 N, and round and flat type prostheses were 12 mm in diameter, 9 mm in height were loaded to 600 N. Four loading offset points (0, 2, 4, and 6 mm from the center of the implants) were evaluated. To evaluate fixture fracture by alveolar bone resorption, we investigated the stress distribution of the fixtures according to different alveolar bone loss levels (0, 1.5, 3.5, and 5.0 mm of alveolar bone loss). Using these 12 models (four degrees of bone loss and three implant diameters), the effects of loading offset, the effect of alveolar bone resorption and the size of fixtures were evaluated. The PAM-CRASH 2G simulation software was used for analysis of stress. The PAM-VIEW and HyperView programs were used for post processing. Results. The results from our experiment are as follows: 1. Preload maintains implant-abutment joint stability within a limited offset point against occlusal force. 2. Von Mises stress of the implant, abutment screw, abutment, and bone was decreased with increasing of the implant diameter. 3. With severe advancing of alveolar bone resorption, fracture of the 3.75 and the 4.0 mm diameter implant was possible. 4. With increasing of bending stress by loading offset, fracture of the abutment screw was possible.