These may be either intraoperative or delayed (post-operative)
Intra-Operative
These include:
1. Hemorrhage - mild to moderate capillary ooze can readily be controlled by pressure packing. A more severe venous or, in rarer instances, an arterial bleed may require clamping, ligation and/or cauterization.
2. Pain - inadequate local anesthesia, especially infiltration, may need to be supplemented with a nerve block.
3. Flap tearing - poor preoperative surgical planning can result in flap of small size with inadequate exposure of the underlying bone. In an effort to increase the visibility, the surgeon may stretch and inadvertently tear the flap. Such a torn flap requires additional suturing.
4. Buccal Perforations - buccal concavities in the bone can result in some threads of the implant being exposed. Where these are very circumscribed and covered with thick and well-vascularized soft tissue flap, they may be left. Where not,then the situation can be managed by placing bone graft (bone chips collected at the time of site preparation or HA granular graft), or by guide tissue techniques.
5. Problems with Implant seating - usually caused by dense bone and can be managed by removing the implant and drilling to slightly larger size.
6. Sinus Perforations - the maxillary antrum can sometimes be inadvertently penetrated. Through careful pre-operative planning using radiographs,including axial scans, this complication can be avoided. However, when accidental perforation of the sinus dose occur it usually closes spontaneously provided the flap is carefully sutured and the patient assiduously follows post- operative instructions. In the rare instance when this antral communication fails to heal, and forms an oro-antral fistula, it may require extensive flap mobilization from both the buccal (Berger's Flap) and the palatal (Pedicled) soft tissues with or without bone grafting and guided tissue regeneration.
Delayed
1. Wound breakdown - with careful flap design and gentle tissue handling this is a rare complication. The healing which follows is by secondary intention and can be aided by chlorhexidine rinses.
2. Exposure of cover screws - this is now not considered a problem. Patients can be instructed to clean around the cover screws carefully.
3. Post-operative pain - there is some discomfort for about 24-48 hours. Persistent pain for a longer duration, with swelling, may indicate possible infection around the implant and failure of the integration process.
Intra-Operative
These include:
1. Hemorrhage - mild to moderate capillary ooze can readily be controlled by pressure packing. A more severe venous or, in rarer instances, an arterial bleed may require clamping, ligation and/or cauterization.
2. Pain - inadequate local anesthesia, especially infiltration, may need to be supplemented with a nerve block.
3. Flap tearing - poor preoperative surgical planning can result in flap of small size with inadequate exposure of the underlying bone. In an effort to increase the visibility, the surgeon may stretch and inadvertently tear the flap. Such a torn flap requires additional suturing.
4. Buccal Perforations - buccal concavities in the bone can result in some threads of the implant being exposed. Where these are very circumscribed and covered with thick and well-vascularized soft tissue flap, they may be left. Where not,then the situation can be managed by placing bone graft (bone chips collected at the time of site preparation or HA granular graft), or by guide tissue techniques.
5. Problems with Implant seating - usually caused by dense bone and can be managed by removing the implant and drilling to slightly larger size.
6. Sinus Perforations - the maxillary antrum can sometimes be inadvertently penetrated. Through careful pre-operative planning using radiographs,including axial scans, this complication can be avoided. However, when accidental perforation of the sinus dose occur it usually closes spontaneously provided the flap is carefully sutured and the patient assiduously follows post- operative instructions. In the rare instance when this antral communication fails to heal, and forms an oro-antral fistula, it may require extensive flap mobilization from both the buccal (Berger's Flap) and the palatal (Pedicled) soft tissues with or without bone grafting and guided tissue regeneration.
Delayed
1. Wound breakdown - with careful flap design and gentle tissue handling this is a rare complication. The healing which follows is by secondary intention and can be aided by chlorhexidine rinses.
2. Exposure of cover screws - this is now not considered a problem. Patients can be instructed to clean around the cover screws carefully.
3. Post-operative pain - there is some discomfort for about 24-48 hours. Persistent pain for a longer duration, with swelling, may indicate possible infection around the implant and failure of the integration process.
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