How to Manage Lingual Perforation?

This patient had a perforation on the lingual side of the mandible after implant placement. There was no pain and swelling 2 days after the operation. But, there was pain and left submandibular swelling occurred 3 days after the operation. Then pain was relieved on the 4th day after the operation. What should I do? Observe or extraction?

Hongkonger comments:

Observation only

AM comments:

Leave it and it should be fine. Observe.

Dennis Flanagan DDS MSc comments:

Best to remove it especially since there are symptoms. The submental artery is nearby. There may be late, more dire symptoms if it is left. Take it out now before it integrates. After integration it would be much more difficult to remove and the submental artery may be involved. Dennis Flanagan DDS MSc

rsdds comments:

just missed the facial artery and in my opinion implant is too long for a #18 . I would remove and attempt new placement in 3 months

Gerald Rudick comments:

Best to remove immediately, and please some kind of regenerative product to fill in the defect ......there are many types of products available these days to choose from. Gerald Rudick dds

Matt Helm DDS comments:

Remove immediately, before it causes more severe problems (which it will), and before it integrates. Graft the area and close the perf. Observe and re-attempt at minimum 4 months, the lingual plate needs time to rebuild. Concur with rdds that the implant is too long. And use a guide approach next time so you don't do this again on this patient.

kevin Wang comments:

better to take it out immediately. even it will be fine later, it will be a problem when you make the bridge.

Dr.Mahijeet Singh Puri comments:

Remove this implant,redo the osteotomy at the same time,place this same implant in the new osteotomy not raise the lingual flap.if required do the bone grafting also . This way you will also achieve parallel implants and abutments at the time of loading. See the angulation of your implant in CT?

Guest comments:

Wow and wow, you are providing substandard care and you are thinking of leaving an implant with all dangerous landmarks being there. This implant needs to be removed asap!!

Iurii Klyus comments:

What are the indications? Postoperative pain and swelling?

Greg Kammeyer, DDS, MS comments:

Since the pain and swelling peaked at day 3, as with all surgery, you were prudent to follow the patient closely. In my experience, this is no bigger problem than an implant in the sinus. I certainly respect those that would want it removed and yet haven't seen any "dire' problems with any of those patients. By the way, I presume all of us that use CT scanners, do post surgery CT's to evaluate our results. It is humbling at times to see the results.

Guest comments:

The implant is off center and poorly placed. That’s why the anatomy and lingual plate was violated. You were very lucky that the post op bleed stopped and did not cause an airway issue. There is plenty of bone to place a correctly aligned implant using I hope your restorative skills. This is substandard work and could have been avoided with a correctly made guided surgical guide. It’s pretty obvious on the CT. If this implant is removed it may bleed again refer it to someone experienced in managing this if you have a collaborative relationship with an OMS. Good Luck.

Dr Bülent ZEYTİNOĞLU comments:

please remove the implant becarefull with the lingual nerve and blood vessels during the operation keep a finger giving mild compression to the adjacent mucousa and keep the finger there untill you notice no bleeding I think grafing the socker may push the graft material to deep tissues you may do grafing later on after the formation of coagulum leave the socker for secondary healing Good LUCK

Mounir Iskandar comments:

Not ideal length selection but leave it alone don't touch it. trying to remove and replace will create much more damage !! Observe only and proceed.