An unusual, deceptive delayed of profuse haemorrhage after mandibular implant dentistry: Risk planning and medico-legal instruction

Mandibular implant placement (MIP) has been accepted and widely used for decades all over the world, and has reached a very high level of therapeutic reliability. MIP is used mostly in elderly edentulous patients who lost their teeth when dentistry was not oriented to fixed or removable prosthetic. Notwithstanding this, every year cases of severe complications during MIP due to haemorrhage causing life-threatening airway’s obstruction are reported. These severe complications of MIP need immediate therapy, usually with hospitalization, and may be potentially fatal. A 56-year-old man presented to the private practice requesting the placement of two dental implants at 41 and 31 previously lost for periodontal disease. Two implants of 3.3 mm of diameter, and 10 mm of length were inserted replacing teeth 31 and 41. Two hours after surgery and home delivery, the patient came to the emergency room complaining of dyspnoea and edema at the floor of the mouth. The maxillo-facial surgeon decided to perform tracheostomy and haemostasis under general anaesthesia. Two weeks after demission a complete healing was performed. This is important for dental practitioners to avoid severe bleeding complications during the MIP in the interforaminal region, especially on the midline. Moreover, when mandibles are severely atrophic, practitioners should be aware of this fact and the possible implications. The evaluation of these data is essential in the correct preoperative planning of implant procedures in the mandible, and with the increasing demand for MIP, the variations of the lingual foramen of the mandible should receive more attention.