Penetration of the mandibular cortex during dental implant surgery may damage 3 important arteries and could lead to life-threatening circumstances. To lessen the likelihood of lateral angulations and cortical perforations, dental implants of less than 14 mm may be considered for the mandible. The courses of the inferior alveolar, facial, and lingual arteries and their branches are reviewed. Management of hemorrhage from a branch of the lingual or facial arteries may require an extraoral approach for ligation, because the mylohyoid, sublingual, and submental arteries can anastomose and be anatomically variable as well. A violation of 1 of these may be difficult to manage and lead to a compromise of the airway. A cortical perforation may be avoided by studying the anatomy of the ridge being treated. This article discusses what procedures to perform to obtund bleeding from 1 of these arteries and the technique of performing an emergency tracheotomy.

Dental implant treatment can restore oral function to edentulous patients. Recently, mini implants have been shown to be successful in minimally invasive treatment. There are initial reports of mini implants retaining removable prostheses and supporting fixed partial and complete dentures. This article reviews the treatment of edentulous patients with prostheses and mini implants and offers guidelines for successful outcomes.

Very small diameter (1.8-3.3 mm) dental implants may be successfully used to support fixed partial dentures in edentulous sites of compromised bone width or length. Very small implants can be successfully used in highly selected sites where there is adequate bone density and bone volume for immediate implant stability. Adequate or augmentable attached gingiva may be a requirement. A small diameter implant presents less of an obstacle for angiogenesis and there is less percutaneous exposure and bone displacement as compared with standard sized implants. In posterior sites, rounded and narrow prosthetic teeth present small occlusal tables to minimize axial and off-axial directed forces. Multiple splinted implants may be necessary to minimize metal fatigue from cyclic loading. Anterior restorations supported by mini implants may need occlusal relief to minimize the effects of cyclic loading.