Lingual Plate Perforation

When an implant was placed at #21 as a part of the 1st stage surgery of the lower jaw a month ago, the lingual plate perforated.  The latter was repaired as described below.  There was mild postop edema.

In the 2nd stage, three implants are placed at #20,25 and 30 (Fig.9). 

At the site of #30, the lingual plate perforates in the early stage of osteotomy (Fig.1 red arrow).  As indicated by the thick lingual plate, the osteotomy turns out to be difficult.  The trajectory is corrected immediately (Fig.2 red) and with control so that the Inferior Alveolar Canal (brown circle) will be not be violated.  The perforation is repaired with Osteogen plug (Fig.3 white) and nearby autogenous bone (red circles) before placement of a 3.8x8 mm implant (green).

At the site of #20, osteotomy for the same implant is finished without sign of nerve injury or lingual plate perforation.  To place the implant a little deeper, a 2 mm drill is used to deeper for another 2 mm.  The latter also turns out to be hard.  When it is done, perforation occurs, noticed first by the patient (Fig.4).  The perforation is fixed with Osteogen plug (Fig.5 white area), while the implant is placed at the crestal level as planned.

It appears that a longer implant (3.8x10 mm) can be placed at #25.  The effort to deepen the osteotomy beyond the planned level fails.  It feels that the drill is dull.  The patient does not like vibration associated with the further osteotomy.  The drill must be contacting the extremely dense lingual plate next to mental tubercles (Fig.6).  Finally a 3.8x8 mm implant (Fig.7) is placed deeper than planned (Fig.8).   There is no sublingual edema or hematoma postop.

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Xin Wei, DDS, PhD, MS 1st edition 07/13/2016, last revision 02/25/2017