Interforaminal hemorrhage during anterior mandibular implant placement: An overview

Abstract

Implant surgery in mandibular anterior region may turn from an easy minor surgery into a complicated one for the surgeon, due to inadequate knowledge of the anatomy of the surgical area and/or ignorance toward the required surgical protocol. Hence, the purpose of this article is to present an overview on the: (a) Incidence of massive bleeding and its consequences after implant placement in mandibular anterior region. (b) Its etiology, the precautionary measures to be taken to avoid such an incidence in clinical practice and management of such a hemorrhage if at all happens. An inclusion criterion for selection of article was defined, and an electronic Medline search through different database using different keywords and manual search in journals and books was executed. Relevant articles were selected based upon inclusion criteria to form the valid protocols for implant surgery in the anterior mandible. Further, from the selected articles, 21 articles describing case reports were summarized separately in a table to alert the dental surgeons about the morbidity they could come across while operating in this region. If all the required adequate measures for diagnosis and treatment planning are taken and appropriate surgical protocol is followed, mandibular anterior region is no doubt a preferable area for implant placement.

Cone beam imaging – an imperative arm in implant planning

“…According to a study by Romanos GE et al 2012, panoramic radiograph can detect only 2.7% of lingual foramen. 16 However, incidence reported on CBCT ranges from approximately 85-100% according to studies by Makris N et al, Kusum CK et al, Denny CE et al [17][18][19] In the present study a low incidence of 45% was observed. One possible interpretation for this disagreement could be the imaging technique used.…”

Topographical distribution of neurovascular canals and foramens in the mandible: avoiding complications resulting from their injury during oral surgical procedures

“…Intraoral bleeding is a very serious situation when it obstructs the airway [6] . Previous reports [19] suggest that small blood vessels with a diameter <1 mm are rarely problematic when resecting these blood vessels.…”

“…Damage to neurovascular canals and foramens in the mandible during oral surgical procedures causes many complications, the most serious of which are sensory disturbances and bleeding [ 1 , 2 , 3 , 4 , 5 , 6 ].…”

Morphometric study of lingual foramina in macerated mandibles to assist in implant placement in the anterior mandibular region

“…Due to the proximity of the blood vessels to the lingual cortical plate of the mandibular midline, there is a risk of surgical trauma in implant placement in this region since even a very small perforation of the mandibular cortical plate may cause bleeding [23]. The most likely reason for a haemorrhage is bleeding from a sublingual artery or its branches, secondary to lingual cortex perforation during osteotomy preparation for implant placement [11]. Woo et al [24] report a case of haemorrhage resulting from an incision made too far lingual from the alveolar crest; the dissection was carried out supraperiosteally, resulting in laceration of the sublingual artery and hypoglossal nerve.…”

“…These arteries may lie superficially in atrophic cases and can be an important source of haemorrhage if traumatised during implant placement. Haemorrhages in the anterior mandibular region (immediate or delayed) caused by implant placement may lead to serious respiratory complications even including death of the patient [11].…”