Mandibular Endosseous Gonial Implants (MEGI): Exploring the mandibular angle as an alternative anchorage site in the severely atrophic mandibles

Severe mandibular atrophy remains a major challenge in oral and maxillofacial surgery because progressive alveolar bone loss frequently limits the placement of conventional endosseous implants. Although treatment options such as bone augmentation, short implants, inferior alveolar nerve lateralisation, basal implants, and subperiosteal implants have expanded rehabilitation possibilities, they are often associated with increased surgical complexity, morbidity, treatment duration, and financial cost. This hypothesis proposes the Mandibular Endosseous Gonial Implant (MEGI) as a novel cortical anchorage concept for selected patients with severely resorbed mandibles in whom conventional implant therapy is not feasible. The mandibular angle possesses favourable cortical bone characteristics and biomechanical properties that may permit stable implant fixation when supported by meticulous three-dimensional planning and careful preservation of adjacent neurovascular structures. The proposed concept is based on anatomical and biomechanical principles and is intended to stimulate scientific investigation rather than immediate clinical application. Its feasibility should be evaluated through cone-beam computed tomography morphometric studies, finite element analysis, cadaveric validation, and prospective clinical trials. If validated, MEGI may broaden the therapeutic options available for implant rehabilitation in patients with advanced mandibular atrophy.