COMPLICATIONS Medical Assignment Help

COMPLICATIONS

Potential- complications include improper angulation or position of the implants; perforation of the inferior border, the maxillary sinus, or the inferior alveolar canal; dehiscence of the buccocortical ‘or iinguocortical plate; mandibular fracture; and soft tissue wound dehiscence. Variation in the position or angulation of the implant results when the anatomy found at surgery requires implant placement different from that planned preoperatively. This should be avoided by grafting to allow  implant placement in the desired location and angle. In the event that ideal angulation has not been achieved, a variety of prosthodontic attachments are available to salvage implants that have nonideal angulation. Sinus perforation occurring during drilling for implant placement is unlikely to cause serious sequelae. Shorter implant length than ‘planned may be necessary to prevent  the implant from extending too far into the sinus.
Usually the resistance provided by the cortical bone of the mailIary sinus-floor is encountered before a perforation results and can serve as an indicator that maximum depth has been reached. If perforation does occur and the implant is placed only a short distance into the maxillary .. sinus, a problem is not likely (Fig. 14-55). Similar guidelines exist for perforation of the inferior border of the.  mandible. The apical portion of the implant should be  within the cor.tical bone of the inferior border. Perforation’ of the interior alveolar canal is a serious problem. Local infiltration over the. bone crest rather than inferior alveolar nerve block may facilitate identification of this at surgery because the patient-will be adequately
anesthetized f or implant placement but feel sharp pain if the canal is perforated. Perforation  may also be accompanied by sudden increased·
bleeding. If this occurs an implant shorter than planned should be used. If the implant appears to extend into the inferior alveolar canal on the postoperative radio graphs (Fig. 14-56), the implant should be immediately removedand a shorter implant placed. If no indication of perforation
exists and no radiographic evidence of violation of the canal is noted, patients maystill have postoperative00  neurosensory alteration. This may be from trac.tion on the mental nerve, from direct in jury during implant
placement, or from etraosseous hematoma or s.oft tissue swelling. These patients should be followe-d closely. Deficits of this nature will generally resolve wit.h time but may require surgical intervention if they persist and are bothersome to the patient. . _ Perforation of the buccocortical or linguocorticalplates may occur when resorption has re sulted in a thin
ridge along the planried implant site. A simple solution is to countersink the implant until tt re depth of the implant recipient site is adequate for t’ he length of the implant. This may leave excess bone h eight on the lin-·
gual, mesialnd distal surfaces. At the time ofuncovering there may be bone growth over the implant that requires removal. If the sharp crest i s generalized and several implants are to be placed, the entire crest can be
reduced down to a suitable width. If a dehiscence does occur, it should be evaluated and a de cision made regarding treatment. A small, 1- to 2″mm loony dehiscence on the buccal aspect of an implant will generally require no additional treatment. Larger defect .s, particularly if the implant is short, may cornprom.lse stability.’ If this results, the defect can be grafted (‘fig. 14-57). This technique is more fully discussed in’ th.e section on advanced
surgical techniques. An unusual complication of implant placement in the
. mandible is mandibular fracture (Fig. 14-58). This is most likely when the mandible is very atrophic, when preexistingmetabolic disease (e.g., osteoporosis) Is seen, orwhen the patient has a history of postoperative trauma.Failure to tap threaded implants in very dense mandibularbone may also be associated with fracture, Managementmay require bone graftlng to. increase the bonemass of the mandible.Soft tissue wound dehiscence may occur, which illlowspart of the imptant to become exposed, If this occurs noattempt should be made to resuture the wound, because
the only result will be increased wound dehiscence

FIG. 14-56 A, Radi09ra'ph taken: imm~iately after place~ent of, two implants in right posterior mandible.Jrnptants appear tQ. violate s·uperior border of inferior !llveolar carial (dotted line). 8, Implants were replaced and are above canal (dott~ ;ine): Patient had no permanent deficit.

FIG. 14-56 A, Radi09ra’ph taken: imm~iately after place~ent of, two implants in right posterior
mandible.Jrnptants appear tQ. violate s·uperior border of inferior !llveolar carial (dotted line). 8, Implants
were replaced and are above canal (dott~ ;ine): Patient had no permanent deficit.

FIG. 14-~7 In an ideal situation (A), adequate bone on buccolinguc11areas for implant placement e~ists. This may not occur when there has been resorption of buccal bone (B). Acceptable ways to handl~ this include removal of sharp crest to level of adequate width for implant or placement of bone graft over buccal dehiscence that results.

FIG. 14-~7 In an ideal situation (A), adequate bone on buccolinguc11areas for implant placement
e~ists. This may not occur when there has been resorption of buccal bone (B). Acceptable ways to handl~
this include removal of sharp crest to level of adequate width for implant or placement of bone
graft over buccal dehiscence that results.

fiG. 14-58 Implants may weaken mandible and lead to fracture. This is most common in severely atrophic mandible and after traus:na.

fiG. 14-58 Implants may weaken mandible and lead to fracture. This is most common in
severely atrophic mandible and after traus:na.

Chlorhexidine rinses should be used until soft tissue healing has occurred. If the tissue is healthy but the implant  remains exposed, a soft toothbrush dipped in chlorhexidineshould be used to keep the implant clean  hroughout the Iategration period. This should result in no increase implant failure, because single-stage implants are purposely left exposed throughout osseointe gration and have comparable success as two-stage systems

 

 

 

 

 

 

 

 

 

Posted by: brianna

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