Dentale Implantate und Unterkieferfrakturen – Ursachen, Therapie, Vorbeugung

Widmung

Zu Ehren des 65. Geburtstages von Herrn Prof. Dr. Dr. Christopher Mohr.

Eine der weniger häufig auftretenden, dafür aber unter Umständen schwerwiegende Komplikation beim Setzen von dentalen Implantaten ist die implantatassoziierte pathologische Fraktur des Unterkiefers. Sie kann, wenn nicht rechtzeitig erkannt und korrekt behandelt, zu Implantatverlusten, Pseudarthrosen, Sensibilitätsverlust im Versorgungsgebiet des N. alveolaris inferior, zu Osteomyelitis bis hin zum Verlust von ausgedehnten Teilen des Unterkiefers führen.

Kernaussagen

• Pathologische Unterkieferfrakturen als Folge des Einsatzes dentaler Implantate sind eine seltene, aber erhebliche Komplikation in der Implantologie.

• Ätiologisch sind mechanische von entzündlichen Mechanismen zu unterscheiden.

• Spezielle Kenntnisse der Anatomie, Physiologie und Mechanik sind erforderlich, um das Auftreten dieser Komplikation möglichst zu minimieren.

• Insbesondere gefährdet sind Patienten mit einer fortgeschrittenen Atrophie des Unterkiefers. Weitere Risikofaktoren sind eine Osteoporose, Einnahme von Antiresorptiva, Zustand nach Bestrahlung im Kopf-Hals-Bereich oder ein schlecht eingestellter Diabetes mellitus.

• Eine mechanische Instabilität des Unterkiefers nach Implantatsetzung, anhaltende Schmerzen beim Kauen oder Zeichen einer Infektion im Implantatbereich sollten eine radiologische Diagnostik veranlassen, am besten mittels einer CT- oder DVT-Untersuchung.

• Therapeutisch ist in den meisten Fällen die chirurgische Versorgung der Fraktur anzustreben. Die Reposition und Verplattung der Fraktur über einen extraoralen Zugang mit einer winkelstabilen Platte stellt häufig den sichersten Weg zur Frakturheilung dar.

Publication History

Article published online:
01 October 2024

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