The Importance of Bone Quality Diagnostics in Preventing Displacement of Dental Implants within the Mandibular Body: A Case Report.

Abstract

Among the immediate complications that can occur after dental implant placement, accidental displacement within the medullary spaces of the mandibular body is a rare clinical situation. This case report describes implant displacements in the posterior mandibular region and emphasizes the importance of assessing bone density and mandibular medullary patterns prior to implant placement according to a new classification by Lekholm and Zarb modified by Rosas et al. The case reports reported three implant displacements in type II bone of the mandibular body, as classified by Lekholm and Zarb. Following the complication, the bone was reclassified as II-B according to the modification by Rosas et al. The implants were extracted from three female patients aged from 37 to 75 years, with only one having a medical history. All complications were treated and resolved without any alteration after implant removal. To reduce the risk of intraoperative complications that affect the primary stability of dental implants, such as implant migration in the mandibular body, it is important to consider factors that may affect the mechanical locking of the implant at the time of placement, such as the pattern and thickness of the bony trabeculae and the size of the medullary spaces in areas of anatomical risk. For this purpose, we recommend using the modified Lekholm and Zarb classification by Rosas et al. This classification considers the trabecular bone biotype, which helps in planning the surgical approach procedure and establishing a regenerative protocol to minimize the risk of complications with the inferior dental nerve.