Foreign Body Ingestion During Dental Implant Procedures:

Removal of dental implants displaced into the maxillary sinus: a retrospective single-center study

Background

The use of dental implants in the prosthetic rehabilitation of the posterior atrophic maxilla might be a challenge procedure because of low bone quantity and quality. This study aimed to report cases of implant displacement or migration into the maxillary sinus treated from 2008 to 2021.

Materials and methods

All patients with unintentional insertion and/or displacement of dental implants into the maxillary sinus cavity that underwent surgical removal were included. Variables assessed included the patients’ characteristics, past medical history, clinical and radiological findings at presentation, surgical approach (transoral, transnasal, combined), and outcome.

Results

A total of forty patients (23 male, 17 female) underwent surgical removal of dental implant displaced in the maxillary sinus. The mean age was 52,3 + 11,3 years. Seven patients presented with oro-antral fistula (OAF). In 15 cases, an ostium obstruction was diagnosed. Twenty-five patients underwent transoral surgery under local anesthesia. Eleven patients were treated solely via transnasal endoscopic approach, and four patients who had an associated OAF underwent surgery through a combined transnasal and transoral approach. All patients healed uneventfully without complications.

Conclusion

These results and recent literature validate that transoral and transnasal approach, or a combination of these procedures, can be used safely to treat complications following displacement/migration of dental implants in the maxillary sinus. Early surgical removal minimizes sinus inflammation and prevents more invasive procedures. Each procedure presents specific indications that must be carefully evaluated prior to treatment choice to optimize intervention outcomes.

Sonographic features of various dental materials and foreign bodies

OBJECTIVE

To reveal the sonographic characteristics of various foreign bodies and dental materials to aid diagnosis.

METHODS AND MATERIALS

24 objects consisting of various dental materials and foreign bodies were included in the study. Objects were embedded in bovine gelatin. Images of the objects were obtained by conventional radiography and ultrasonography (USG). Opacities were evaluated by conventional radiography. Their visibility and posterior acoustic behaviors were examined by USG. In addition, the actual sizes of the objects and their dimensions measured by USG were compared.

RESULTS

All objects included in the study, including non-opaque ones, could be visualized by USG. When the posterior acoustic behavior of objects was examined, 15 of the objects (62.5%) caused posterior acoustic shadowing on USG. While 6 of the objects (25%) did not have any USG artifacts, 2 of them (8,3%) had comet tail artifact and 1 of them (4,2%) had reverberation artifact. There was no statistically significant difference between the actual dimensions of the objects and their dimensions measured by USG (p > 0,05).

CONCLUSION

USG is a very useful technique for imaging foreign bodies and dental materials, it can even show objects that cannot be seen in X-rays on in-vitro environment.

Foreign body aspiration and ingestion in dental clinic: a seven-year retrospective study

Background

This retrospective study investigated the incidence rate of accidental foreign body aspiration and ingestion according to patient sex, age, and dental department. This study aimed to verify whether the incidence rate is higher in geriatric than in younger patients and whether it is different among dental departments.

Methods

Accidental foreign body aspiration and ingestion cases were collected from electronic health records and the safety report system of Yonsei University Dental Hospital from January 2011 to December 2017. The collected data included patients’ age, sex, medical conditions, treatment procedures, and foreign objects that were accidentally aspirated or ingested. The incidence rate was calculated as the number of accidental foreign body aspirations and ingestions relative to the total number of patient visits. Differences depending on the patients’ sex, age, and dental department were statistically identified.

Results

There were 2 aspiration and 37 ingestion cases during the 7-year analysis period. The male to female incidence ratio was 2.8:1. The incidence rate increased with age and increased rapidly among those aged 80 years or older. Seven of the 37 patients with accidental foreign body ingestion had intellectual disability, Lou Gehrig’s disease, dystonia, or oral and maxillofacial cancer. The incidence rate was highest in the Predoctoral Student Clinic and the Department of Prosthodontics. The most frequently swallowed objects were fixed dental prostheses and dental implant components.

Conclusion

The incidence rate of accidental foreign body aspiration and ingestion differed according to patient sex, age, and dental department. Dental practitioners must identify high-risk patients and apply various methods to prevent accidental foreign body aspiration and ingestion in dental clinics. Inexperienced practitioners should be particularly careful.

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.

Accidental Swallowing of Dental Implant: Complication of Transnasal Endoscopic Removal From Maxillary Sinus

Transnasal endoscopic removal of displaced dental implants in the maxillary sinus can be done easily under local anesthesia. However, very little is known regarding the precaution of this technique. In this report, we present the case of a 63-year-old man who visited the otolaryngologic department with a displaced dental implant in the maxillary sinus. Transnasal endoscopic removal of the displaced dental implant was planned and performed. However, the displaced dental implant was lost during removal. The implant was not seen in the other parts of the nasal cavity nor in the other parts of the oral cavity. Finally, radiographs revealed the presence of the dental implant at the level of the esophagus, although the patient did not notice anything because of local anesthesia. Thus, we conclude that operators should take into account the possibility of aspiration or swallowing of an implant through the posterior nasal aperture during the removal procedure. Precautions should be taken to avoid the possibility of implant aspiration or implant ingestion.

Thorough documentation of the accidental aspiration and ingestion of foreign objects during dental procedure is necessary: review and analysis of 617 cases

OBJECTIVES

To review the cases of accidental aspiration and ingestion of foreign objects during dental procedure, and to emphasize the importance of thorough documentation of the accidents.

METHODS

A comprehensive search on (dental procedure/treatment/practice), (aspiration/inhalation), and (ingestion/swallow) was performed for all years before 1st October 2014 available. The statistic analysis was made on the variables including journals and reported year, patients' age, gender, general conditions, dental procedure and location for procedure, foreign objects, site of involvement, possible causes, anesthesia during procedure and treatment, symptoms, treatment time and treatment modality, follow-up, and so on.

RESULTS

A total of 617 cases reported by 45 articles from 37 kinds of journals were included and analyzed. Most reports made detailed record. While some important variables were recorded incompletely, including patient's general conditions, location for procedure, clinical experience of the involving dentists, tooth position of procedure, possible causes, and anesthesia during procedure and treatment for the accident.

CONCLUSIONS

Aspiration and ingestion of foreign objects are rare and risky complication during dental procedure. Each accident should have thorough documentation so as to provide enough information for the treatment and prevention.