Iatrogenic Atrophic Mandible Fracture: Management Considerations and Digital Workflow

Atrophic jaws are frequently seen in edentulous patients due to early tooth loss, leading to progressive alveolar bone resorption, bone fragility, and increased susceptibility to fractures, even with low-energy trauma. Surgical management of these fractures presents additional challenges, such as reduced bone density, fragment instability, reduced blood flow, and lack of natural occlusal support. With advances in implant-supported rehabilitation, new perspectives have emerged, but risks remain, especially in areas with severe resorption. Iatrogenic fractures can occur during implant placement due to reduced bone thickness. Fracture reduction and adaptation of reconstruction plates are also limited by atrophic anatomy, compromising the stability of osteosynthesis. This paper reports the case of a 55-year-old patient with an iatrogenic fracture in the atrophic mandible after an attempt at dental implant placement. The treatment involved 3-dimensional virtual planning, biomodel printing, and prior adaptation of a reconstruction plate. The use of digital planning contributed to greater predictability, precision, and reduced surgical time. During the postoperative period, the patient developed an infection in the fistula region, which was successfully treated with antimicrobial photodynamic therapy (aPDT) with methylene blue, demonstrating efficacy in controlling the infection and accelerating healing. It is concluded that the management of atrophic mandibles remains challenging, requiring therapeutic individualization, and the use of digital technology through virtual surgical planning and 3-dimensional prototyping has proven to be an important tool in mandibular fracture surgery, although limitations persist regarding the accuracy of condylar positioning in edentulous patients.