Failure of Osseointegrated Dental Implant After Alveolar Nerve Transposition: A Report of an Unusual Complication and Surgical Management.

PURPOSE: To describe an unusual case of mandibular fracture after osseointegrated dental implant removal placed after inferior alveolar nerve transposition. REPORT OF CASE: The patient underwent inferior nerve transposition for implant placement due to lack of interarch space. Two months after metal-ceramic crowns installation, the patient began to complain of pain in the region of the implant. In an attempt to remove the implant, there was a fracture of the implant, and only two third of it was removed, leaving only the apical portion of the implant in the mandible. The patient opted for the total removal of implant. At 15 days of follow-up, the patient returned with mandibular fracture, which was treated through an internal fixation with a titanium reconstruction plate of 2.0-mm thickness with locking screws. CONCLUSION: The inferior alveolar nerve transposition may represent the only rehabilitation option, especially in cases where there is insufficient bone remaining for installation of short implants with reduced interarch space.

Bisphosphonate-related osteonecrosis of the jaw: a review of the literature.

Bisphosphonates (BPs) are a class of drugs used to treat osteoporosis and malignant bone metastasis. BPs show high binding capacity to the bone matrix, especially in sites of active bone metabolism. The American Society for Bone and Mineral Research defines BRONJ as "an area of exposed bone in the maxillofacial region that has not healed within 8 weeks after identification by a healthcare provider in a patient who is receiving or has been exposed to a bisphosphonate and has not had radiation therapy to the craniofacial region." Bisphosphonate-related osteonecrosis of the jaw (BRONJ) can adversely affect quality of life, as it may produce significant morbidity. The American Association of Oral and Maxillofacial Surgeons (AAOMS) considers as vitally important that information on BRONJ be disseminated to other dental and medical specialties. The purpose of this work is to offer a perspective on how dentists should manage patients on BPs, to show the benefits of accurately diagnosing BRONJ, and to present diagnostic aids and treatments strategies for the condition.