Treatment of Resorbed Mandibles with Titanium Plate and Immediate Implant-Supported Prosthesis - Case Series

Abstract Severely resorbed mandibles with only cortical bone remaining can fracture during or after implant placement. This case series presents a technique to reduce the risk or the consequences of mandibular fracture. Seven patients with only cortical mandibular bone remaining were treated with the fixation of a titanium plate in the frontal surface previously to implant placement, during the same surgical procedure. Immediate complete-arch implant supported prosthesis were installed. Patient’s systemic and local conditions that could influence implant survival were registered previously to surgery and during the follow up period. Biological and biomechanical complications were recorded. The condition of peri-implant tissues was evaluated. The follow-ups ranged from 12 to 84 months. Twenty-nine implants were placed and no implant failure or other biological complication was observed. The peri-implant tissue evaluation demonstrated most implants was surrounded by keratinized tissue (89.5%). No marginal recession (implant platform cervical to gingival margin) was observed. Probing depth was normal, ranging from 0 to 3 mm. Low scores of plaque index or bleeding on probing were recorded. Biomechanical complications evolved loosening of 4 prosthetic screws and 1 fractured. The use of a titanium plate for the fixation of severely resorbed mandibles with only cortical bone remaining was a safe treatment procedure, avoiding biological and major biomechanical complications in the treatment with immediate complete-arch implant-supported prosthesis. Resumo Mandíbulas severamente reabsorvidas com apenas osso cortical remanescente podem fraturar durante ou após a colocação de implantes. O presente relato de casos apresenta uma técnica para reduzir o risco ou as consequências da fratura mandibular. Pacientes com apenas osso cortical remanescente foram tratados com a fixação de placa de titânio na superfície frontal, previamente a colocação dos implantes, no mesmo procedimento cirúrgico. Próteses totais implanto-suportadas foram instaladas com carga imediata. Condições locais e sistêmicas dos pacientes que poderiam influenciar a sobrevivência dos implantes foram registradas previamente a cirurgia e durante o período de acompanhamento. Complicações biológicas e biomecânicas foram registradas. A condição dos tecidos peri-implante foi avaliada. Sete pacientes completaram o período de acompanhamento, variando entre 12 e 84 meses. Vinte e nove implantes foram colocados e ne