PMC6942755_01
Intraoperative view. Implant site preparation after upper left lateral incisor extraction. No excessive bleeding was presented during the surgery.
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The implant placement and GBR procedures went without any complications (Figure 1); primary stability of the implant was 35 N cm (Dentium Implantium 3.5 mm*10 mm).
Intraoperative view. Immediate implant placement in the upper left lateral incisor region after GBR and soft tissue grafting. The healing abutment was placed and flaps were sutured.
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No excessive bleeding, as in the case of vessel damage, was noted during the surgery (Figure 2).
Preoperative CBCT scan. (a) Sagittal view. Accessory branches of CS (red arrows) have palatal and buccal directions close to the maxillary left lateral incisor. (b) Axial view. CS (red arrow) near the maxillary left canine and nasopalatine canal (yellow arrow).
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One of them was found close to the palatal side with the diameter 1.9 mm in size; the other was found close to the buccal side in the maxillary left lateral incisor/implant region (Figures 3 and 4) with the diameter 0.7 mm in size in the most coronal point (both were referred to the lateral incisor region according to the de Oliveira-Santos et al. classification).
Postoperative CBCT scan, sagittal view in the left maxillary incisor region. The dental implant in situ. The diagnosis is difficult due to artefacts caused by the titanium implant; however, the major palatal branch of the CS could be seen (red arrow). Also, the bony contours of the left greater palatal artery and nerve are visualized (green arrow).
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One of them was found close to the palatal side with the diameter 1.9 mm in size; the other was found close to the buccal side in the maxillary left lateral incisor/implant region (Figures 3 and 4) with the diameter 0.7 mm in size in the most coronal point (both were referred to the lateral incisor region according to the de Oliveira-Santos et al. classification).
Palatal mucosa necrosis after dental implant extraction.
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However, an area of necrosis was found by the end of the third week on the palatal mucosa (Figure 5) even though the palatal flap was not reflected and no palatal and nasopalatine anesthesia was provided, so palatal blood supply was not compromised. Also, bony contours of the left greater palatal artery and nerve were visualized on the CBCT scans in the anterior maxilla 10.1 mm from the implant (Figure 5); thus, the damage of the greater palatal artery was excluded.