Fractures of severely atrophic (height < 10 mm) edentulous mandibles are infrequent and challenging to manage. Factors such as sclerotic bone and decreased vascularity combined with systemic diseases complicate the management of such fractures. Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders of type I collagen metabolism. Patients with OI characteristically present with histories of long bone fractures, deformities, blue sclerae, and opalescent dentin. However, fractures of the facial skeleton are rare. Bisphosphonate therapy has been proven to effectively reduce the fracture risk in patients with OI. The purpose of this clinical report is to present an unusual case of spontaneous fracture of the atrophic mandible in a patient with OI. Despite open reduction and internal fixation (ORIF) with miniplate osteosynthesis, the patient developed a second fracture at a screw placement site distal to the first fracture. The patient was successfully treated with ORIF using locking reconstruction plates fixed in the symphyseal and angle regions. Bone healing following ORIF was normal, and no clinical sign of osteonecrosis as a result of bisphosphonate therapy was observed. Patients with OI can present with spontaneous fractures of already weakened mandibles. Although such fractures can be managed with care using established protocols, further research is required to examine the effects of concomitant medication, such as bisphosphonates.

While conventional CT scan has historically been used for maxillofacial bone imaging. The introduction of cone beam CT (CBCT) in the new millennium has revolutionized the use of CT for dental and maxillofacial diagnoses. This paper presents two clinical examples of delayed diagnoses associated with maxillofacial imaging, describes the reasons for the delays and offers potential preventive measures. The first case involves a delay in the diagnosis of non-Hodgkin's lymphoma in a 49-year-old female who was being treated for an odontogenic problem. In the second case, a 9-year-old female who presented with a limited ability to open her mouth was mistakenly diagnosed with muscles spasm. Subsequently, she was found to have an elongation of the right lateral pterygoid plate that interfered with her right mandibular body, which restricted the degree to which she could open her mouth. A thorough clinical examination and accurate radiographic interpretation combined with a complete medical history can minimize these types of diagnostic delays. If the dentist is unable to conclusively reach a diagnosis, the patient should be referred immediately to a specialist who can better manage the specific medical problem.