Clinical management and microscopic characterisation of fatique-induced failure of a dental implant. Case report

The difficult management of this rare complication of implant dentistry together with the following rehabilitation is described. Additionally, the authors performed an accurate analysis of the removed fractured implant both by the stereomicroscope and by the confocal laser scanning microscope.The fractured impant showed the typical signs of a fatigue-induced fracture in the coronal portion of the implant together with numerous micro-fractures in the apical one. Three dimensional imaging performed by confocal laser scanning microscope led easily to a diagnosis of "fatigue fracture" of the implant. The biomechanical mechanism of implant fractures when overstress of the implant components due to bending overload is discussed.When a fatigue-induced fracture of an dental implant occurs in presence of bending overload, the whole implant suffers a deformation that is confirmed by the alterations (micro-fractures) of the implant observable also in the osseointegrated portion that is easily appraisable by the use of stereomicroscope and confocal laser scanning microscope without preparation of the sample.Osseointegrated endosseous implants are widely used for the rehabilitation of completely and partially edentulous patients, being the final prosthodontic treatment more predictable and the failures extremely infrequent [1-3]. Nevertheless, in the iter of realization of an implant retained prosthesis a series of possible complications have to be considered by the implant/prosthetic team: these are usually distinguished in surgical (disturbance, parae/anaesthesia, haematoma, mandibular fractures, haemorrhage, tooth necrosis) [4,5] that are the most frequent ones, and mechanical (screw loosening, screw fractures, framework fractures, veneering resin or ceramic fractures, problems of mechanical retention) [6,7]. Instead, implant fracture is very infrequent but, when it occurs, its management is very challenging because of its surgical, rehabilitative and emotional implications,