Insight 96 — Multiple Implant Fixture Fractures: What Could Be the Cause?

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Question: In a patient whose anterior implant fixtures fractured shortly after treatment, what could have caused these multiple fractures?

Answer:

When several implant fixtures have fractured, the first thing I think of is excessive forces. A standard, intact fixture does not fracture easily under appropriate loading conditions. Therefore, we need to investigate what caused forces beyond the fixtures’ load-bearing capacity to act on them.

What caught my attention in this patient’s images was the presence of a removable partial denture in the mandible. I think this deserves closer investigation.

Two possibilities arise:

First, the partial denture may have failed to establish stable occlusion. Particularly in distal-extension partial dentures, differences in displacement between soft tissues and natural teeth make adjustment of occlusal contacts especially important. If the partial denture does not provide adequate posterior occlusal support, greater forces may be transferred to the anterior implants.

The second possibility is that the partial denture had no design or occlusal adjustment problem, but the patient did not wear it regularly. In that situation, posterior occlusal support is effectively absent, and a large proportion of the forces may be transferred to the anterior region.

Therefore, before making any treatment decision, we should assess the patient’s occlusion both statically and during excursive movements, and ensure that the partial denture establishes effective, stable occlusal contacts.

In addition, we should educate the patient that wearing the partial denture is essential.

Ultimately, fractures of this many fixtures indicate that we should look for the source of excessive loading. In this patient, assessing occlusion and how the partial denture is used is one of the first things I would do.

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