Factors associated with hematoma of the floor of the mouth after placement of dental implants

Hemorrhagic Complications in Implant Surgery: A Scoping Review on Etiology, Prevention, and Management

This article seeks to provide the most relevant aspects of the etiology, prevention, and management of bleeding in routine implant surgery. A comprehensive and systematic electronic search was conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews databases until June 2021. Further references of interest were retrieved from bibliographic lists of the selected articles and the "Related Articles" feature of PubMed. Eligibility criteria were papers about bleeding, hemorrhage, or hematoma associated with routine implant surgery on human subjects. Twenty reviews and 41 case reports fulfilled eligibility criteria and were included in the scoping review. Involved implants were mandibular in 37 and maxillary in 4 cases. The major number of bleeding complications was in the mandibular canine region. The most injured vessels were sublingual and submental arteries, due mainly to perforation of the lingual cortical plate. Time to bleeding occurred intraoperatively, at suturing, or postoperatively. The most reported clinical manifestations were swelling and elevation of the mouth floor and the tongue with partial or complete airway obstructions. First aid to manage airway obstruction was intubation and tracheostomy. For active bleeding control, gauze tamponade, manual or digital compression, hemostatic agents, and cauterization were applied. When conservative procedures failed, hemorrhage was controlled by intra- or extraoral surgical approaches to ligate injured vessels or by angiographic embolization. The present scoping review provides knowledge and evidence on the most relevant aspects of the etiology, prevention, and management of implant surgery bleeding complications.

Three-dimensional assessment of the mandibular lingual foramina with implications for surgical and implant therapy: A multicentre cross-sectional study

Treatment planning for dental implants in the anterior mandible is often complicated by the presence of vascular structures. The aim of our study was to investigate the prevalence, location and morphology of the mandibular lingual foramen (LF) through cone beam computed tomography (CBCT) scans and contribute to its anatomical knowledge in an Indian population. A total of 400 mandibular anterior CBCT scans from 4 centers were included in this retrospective analysis. The vertical distance from alveolar crest (Hcre) and inferior border of mandible (Hinf) to the LF, horizontal distance from lingual canal to labial cortical plate (LC-CP), length of the lingual canal (LLC) and diameter of the LF were measured. Data was analysed using Wilcoxon signed rank test and compared between median and lateral LF. 14 (3.5%) scans were excluded due to non-visualization of LF. A lateral LF was detected in 149 scans (38.6%), predominantly in the canine region (61.7%). Hcre was significantly higher for median LF (16.35 ± 4.59 mm) than lateral LF (12.94 ± 3.92 mm) (p < 0.001), while Hinf did not show significant difference between median (11.38 ± 3.62 mm) and lateral (12.94 ± 3.92 mm) LF (p = 0.0032). The LC-CP, LLC and diameter of LF averaged at 5.05 ± 1.76 mm, 6.26 ± 1.82 mm and 0.88 ± 0.72 mm respectively. The LF can be visualized in CBCT scans with a prevalence of 96.5%. This study stresses on the need for a CBCT, prior to surgeries in anterior mandible to avoid excessive bleeding episodes.

How to Avoid Life-Threatening Complications Associated with Implant Surgery

Life-threatening complications of dental implant surgery are rare, but include hematoma/hemorrhage of the floor of the mouth, aspiration, and ingestion. Prevention of lethal hemorrhagic complications stem from knowledge of anatomic structures and precise surgical planning. Prevention of aspiration and ingestion can be improved by simple techniques while understanding clinical settings and factors that put patients at higher risk. In the event of these potential lethal situations, early recognition of signs and symptoms along with immediate action followed by transfer to an emergency department is often necessary.

Anterior Mandibular Lingual Defect As a Possible Cause of Near-Fatal Bleeding During Routine Dental Implant Surgery: A Retrospective Computed Tomography Study

INTRODUCTION

The anterior mandible is generally regarded as a safe anatomical region for implant placement. However, anatomical variations may lead to severe intraoperative complications with potential fatal outcome. The objective of this study was to evaluate the anterior mandibular lingual defect (AMLD) in patients undergoing implant surgery.

MATERIALS AND METHODS

The CT data of 338 consecutive dental implant patients were reformatted with appropriate software. The AMLDs were first identified using 3-D reconstruction and further evaluated in the relevant 2-D slices.

RESULTS

The AMLD was present in 10.95% of patients; of these, 83.8% were present bilaterally. No significant differences were found between sex, age, or race within the investigated population with regards to the presence of the AMLD.

CONCLUSIONS

The presence of an AMLD might be a possible cause of near-fatal bleeding during routine dental implant surgery. This study found the presence of the AMLD in a small (10.95%), but not negligible number of patients. To avoid possible complications, meticulous planning and the use of 3-D imaging are advisable before performing implant surgery in this anatomical region.

Massive Lingual and Sublingual Haematoma following Postextractive Flapless Implant Placement in the Anterior Mandible

Dental implants placement in the anterior mandible with flap or flapless technique is a routine procedure and is considered to be safe. However, serious life-threatening complications may occur. We report the first case of massive lingual and sublingual haematoma following postextractive implant placement in the anterior mandible with flapless technique. A 45-year-old female patient underwent placement of four immediately postextractive implants in the anterior mandible using flapless technique. During the procedure, the patient referred intense acute pain and worsening sign of airway obstruction, dysphagia, dyspnea, and speech difficulties. Bimanual compression of the mouth floor, lingual surface of the mandible, and submental skin was maintained for approximately 25 minutes in order to stop the bleeding. Computerized tomography highlighted the massive lingual and sublingual haematoma. The symptoms and signs had almost completely resolved in the next 48 hours. The prevention of these complications is mandatory with clinical and CT analyses, in order to highlight mandibular atrophy and to select carefully the correct length and angulation of bone drilling and to keep more attention to the flapless technique considering the elevation of a lingual mucoperiosteal flap to access the mandibular contour intraoperatively and to protect the sublingual soft tissues and vasculature in high risk cases.

Surgical complications after implant placement

Placement of dental implants in the maxillofacial region is routine and considered safe. However, as with any surgical procedure, complications occur. Many issues that arise at surgery can be traced to the preoperative evaluation of the patient and assessment of the underlying anatomy. In this article, the authors review some common and uncommon complications that can occur during and shortly after implant placement. The emphasis of each section is on the management and prevention of complications that may occur during implant placement.