Hemorrhagic complication after dental implant placement in the mandible: A case report
DOI:
https://doi.org/10.33448/rsd-v15i3.50725Keywords:
Hemorrhage, Dental implants, Oral surgery.Abstract
The objective of this study is to report a clinical case of hemorrhage in the floor of the mouth following dental implant placement, as well as to highlight the management of such hemorrhagic events. Methodology: this is a retrospective, descriptive, observational study based on the analysis of medical records, imaging examinations, and photographic documentation, with patient authorization obtained through an informed consent form. Results: A hypertensive female patient was referred to the Hospital Universitário do Oeste do Paraná for emergency care after hemostatic control measures with tranexamic acid were unsuccessful due to active bleeding following dental implant placement in the left mandibular canine region. Computed tomography revealed a hypodense mass in the interforaminal region. During the surgical procedure under general anesthesia, due to involvement of an accessory lingual foramen, implant removal, vessel cauterization, and suturing were performed. Management of floor-of-the-mouth hemorrhage must be immediate in order to prevent airway compromise. Conclusion: Dental implant surgeries are safe and effective procedures for the rehabilitation of edentulous patients. However, intraoperative and postoperative complications may occur. A thorough medical history, individualized case assessment for systemically compromised patients, and complementary examinations prior to surgical intervention are essential. Hemorrhage is generally caused by vascular injury associated with perforation of the lingual cortical plate in the anterior mandibular region and damage to the sublingual and submental arteries, which are more susceptible due to possible local anatomical variations.
References
Barros, J. C. S. de, Melo, C. C. de, Isolan, C. P., & Dietrich, L. (2024). Taxa de sucesso e complicações dos implantes: Os fatores que causam o insucesso. Revista do CROMG, 22(Supl. 4).
Carreira-Nestares, B., Fornovi, I., Carreira-Delgado, M., Gutiérrez-Díaz, R., & Sánchez-Aniceto, G. (2024). Clinical case and literature review of a potentially life-threatening complication derived from mouth floor hematoma after implant surgery. European Dental Research and Biomaterials Journal, 04.
Chaar, M. S., et al. (2022). Vascular and neurosensory evaluation in relation to lingual canal anatomy after mandibular midline implant installation in
edentulous patients. Clinical Oral Investigations, 26(3).
Choi, B. K., Lee, S. S., Yun, I. S., & Yang, E. J. (2023). Vascular Anatomy for the Prevention of Sublingual Hematomas: Life-Threatening Complication of Genioplasty. The Journal of craniofacial surgery, 34(4), 1308–1311.
Dawoud, B. E. S., Kent, S., Tabbenor, O., George, P., & Dhanda, J. (2021). Dental implants and risk of bleeding in patients on oral anticoagulants: a systematic review and meta-analysis. International journal of implant dentistry, 7(1), 82.
Direk, F., et al. (2018). Mental foramen and lingual vascular canals of mandible on MDCT images: Anatomical study and review of the literature. Anatomical Science International, 93(2).
Freire, C. N. B. M., et al. (2017). Complicações decorrentes da reabilitação com implantes dentários. Revista Uningá, 51(3), 63–68.
Garcia, G., Oliveira, A., Oliveira, A., Borges, D., Dias, H., Pereira, L., Reis, L., Mendonça, M., Andrade, R., & Silva, I. (2024). Manejo de pacientes anticoagulados na prática clínica odontológica. Brazilian Journal of Implantology and Health Sciences, 6(10), 4455–4471.
Gomes, L. M. C., Machado, R. E. T., & Machado, D. R. (2022). Hemorragia exsanguinante: Uma introdução importante na avaliação primária do trauma. Revista Científica UNIFAGOC – Saúde, 6(2), 75–87.
La Monaca, G., Pranno, N., Polimeni, A., Annibali, S., Di Carlo, S., Pompa, G., & Cristalli, M. P. (2023). Hemorrhagic Complications in Implant Surgery: A Scoping Review on Etiology, Prevention, and Management. The Journal of oral implantology, 49(4), 414–427.
Matheus, E., et al. (2024). Dental conduct in patients using oral anticoagulants: Integrative literature review. Research, Society and Development, 13(3), e1713345133.
Muley, P., Kale, L., Choudhary, S., Aldhuwayhi, S., Thakare, A., & Mallineni, S. K. (2022). Assessment of accessory canals and foramina in the mandibular arch using cone-beam computed tomography and a new classification for mandibular accessory canals. BioMed Research International, 2022, 5542030.
Nathan, T., et al. (2019). What does the Cochrane Database of Systematic Reviews tell us about hemophilia? Expert Review of Hematology, 12(11), 919–922.
Peñarrocha-Diago, M., Balaguer-Martí, J., Peñarrocha-Oltra, D., Bagán, J., Peñarrocha-Diago, M., & Flanagan, D. (2019). Floor of the mouth hemorrhage subsequent to dental implant placement in the anterior mandible. Clinical, Cosmetic and Investigational Dentistry, 11, 235–242.
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria: Editora da UFSM.
Pereira, B. M., Bortoto, J. B., & Fraga, G. P. (2018). Agentes hemostáticos tópicos em cirurgia: Revisão e perspectivas. Revista do Colégio Brasileiro de Cirurgiões, 45(5), e1900.
Pereira, F. M., et al. (2022). Airway management of a patient with acute floor of the mouth hematoma after dental implant surgery. Journal of Oral and Maxillofacial Surgery, 80(5), 942–947.
Rasaratnam, L., et al. (2017). Risk-based management of dental procedures in patients with inherited bleeding disorders: Development of a Dental Bleeding Risk Assessment and Treatment Tool (DeBRATT). Haemophilia, 23(2), 247–254.
Risemberg, R. I. C., Wakin, M., & Shitsuka, R. (2026). A importância da metodologia científica no desenvolvimento de artigos científicos. E-Acadêmica. 7(1), e0171675.
Rodriguez, A., et al. (2021). Life-threatening sublingual hematoma after dental implant surgery: Case report and literature review. International Journal of Oral and Maxillofacial Surgery, 50(9), 1201–1206.
Safi, Y., et al. (2021). The occurrence of dental implant malpositioning and related factors: A cross-sectional cone-beam computed tomography survey. Imaging Science in Dentistry, 51, 251–260.
Sfondrini, D., et al. (2024). Floor of the mouth hemorrhage following dental implant placement or guided bone regeneration (GBR) in the atrophic interforaminal mandible. Case Reports in Dentistry, 2024, 8413875.
Vassallo, M., Zamberlin, J., Roig, M. D., Macchi, R., & Aguilar, J. E. (2023). Efficacy of Local Hemostatic Management in Implant Surgery in Anticoagulated Patients on Warfarin: A Randomized Clinical Study. The International journal of oral & maxillofacial implants, 38(3), 545–552.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Bruna Caroline Ruthes de Souza, Natalia Karolina da Silva, Luiza Wammes, Natasha Magro Érnica, Eleonor Álvaro Garbin Junior, Geraldo Luiz Griza, Ricardo Augusto Conci
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
