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       Dental Implant Aspiration

      Aspiration of a dental implant or implant components is one of the possible complications during implant placement. Coughing, choking, wheezing, and hoarseness, chest pain, and shortness of breath are the signs and symptoms of respiratory distress secondary to aspiration, and this represents a medical emergency. In such cases, basic life support should begin immediately, and patient monitors should be applied including noninvasive blood pressure monitoring, pulse oximetry, three‐lead electrocardiogram, end‐tidal carbon dioxide monitoring, and supplemental oxygen; endotracheal intubation could be considered to secure the airway in extreme circumstances. Some authors have described the use of simple finger sweep technique to remove the aspirated material, but only if the implant or foreign body is visible in the oral cavity, or else further displacement into the airway may result. If accidental ingestion is suspected, the Heimlich maneuver should be performed and the patient should be placed on supplemental oxygen, if necessary. If an aspirated implant or implant component can be visualized, an attempt at removal can be made with the use of Magill forceps and laryngoscope. If there is a decline in oxygen saturation, endotracheal intubation or emergent surgical cricothyroidotomy may be indicated [29]. In most cases of aspiration, the foreign body (dental implant) becomes lodged in the right mainstem bronchus due to the more vertical course from the trachea, as well as its greater diameter compared to the left mainstem bronchus. A chest X‐ray must be obtained to confirm the location of an aspirated object, and this will likely include a visit to the Emergency Department. Once confirmed that the implant has been aspirated, appropriate consultations should occur with respiratory therapy or pulmonology and bronchoscopy should be carried out urgently to retrieve the implant.

       Dental Implant Ingestion

      Ingestion of a dental implant or implant component can pose several concerns. Due to their small size, implants and components are smaller than coins, and usually do not become lodged in the esophagus; most often, they are found in the stomach on radiographs and then move on through the digestive tract without incident; most of the time (90%), the ingested foreign object passes through the gastrointestinal (GI) tract without complications, and they also rarely become lodged at the ileocecal valve. About 10% of the time, an endoscopic retrieval may be required if the implant does not move completely through the GI tract spontaneously. Although most data show that small and blunt objects pass through the GI tract uneventfully, it is estimated that in 1% of cases a GI surgical procedure is required to retrieve an ingested object [29]. A conservative approach to this complication should include a clinical abdominal examination, obtaining abdominal X‐rays, and timely stool inspection for documentation that the implant has passed. Perforation within the GI tract is rare, but more likely to occur with sharp foreign objects, and this warrants a referral to a gastroenterologist for an early open or endoscopic assessment of the GI tract and removal of the object. Surgical intervention is recommended if the object has not passed spontaneously, has been present for >2 weeks, or if the patient becomes symptomatic with abdominal pain or rebound tenderness, guarding, nausea, or vomiting [29]. Such cases require a prompt referral to a gastroenterologist for diagnosis and management.

       Bleeding

Major bleeding during dental implant placement is a rare complication, but can occur and may be life‐threatening. Failure to acknowledge the anatomical vascular variations in the maxilla and mandible can lead to iatrogenic vascular injury and major hemorrhage during implant placement. Many publications have reported that life‐threatening hemorrhage occurred most commonly when implants were placed in the anterior region of the mandible. Most patients experienced some degree of airway compromise necessitating intubation or the creation of a surgical airway (Figure 3.10). The bleeding is believed to be caused by lingual plate violation with the drill or implant with vascular injury to the terminal branches of the sublingual or submental artery (Figures 3.11 and 3.12) [30]. There may be tributaries of the terminal branches of the sublingual or submental arteries that enter the lingual aspect of the mandible through accessory lingual foramina in the lingual cortical bone (Figure

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