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Clinical case reports displacement of dental implant into pterygoid fossa

By Dental Tribune International
December 17, 2019

MINNEAPOLIS, U.S.: Pterygomaxillary implants improve implant biomechanics and have reported mean implant survival rates comparable with traditional implant sites. To date, only minor surgical complications have been reported in the literature. Now, researchers from the Division of Prosthodontics in the Department of Restorative Sciences at the University of Minnesota School of Dentistry in Minneapolis have reported the first major complication related to implant surgery in the pterygomaxillary region.

A patient presented with an implant-assisted removable partial denture but complained that she could no longer tolerate the maxillary partial denture. The maxillary teeth and existing implant were removed by an oral and maxillofacial surgeon. During the surgery, two implants were placed bilaterally in the pterygomaxillary region.

On placement of the left implant, the insertion torque was inadequate and the surgeon elected to remove the implant and increase the implant diameter. On insertion with the hand driver, the implant was displaced into the left pterygoid fossa. Efforts to retrieve the implant were unsuccessful.

When the patient was seen two weeks later for follow-up, she reported pain on her left side and limited mandibular opening. She was referred to a radiology team who determined that the dental implant was in close proximity to vital anatomical structures, including the carotid artery, and was at risk of migration into these structures. The patient underwent surgery by the interventional radiology team and the implant was removed.

The clinical report provides a guideline for the management of a patient with a major surgical complication associated with dental implants in the pterygomaxillary region and highlights the importance of an appropriate referral to medical colleagues for implant removal.

The study, titled “Displacement of a dental implant into the pterygoid fossa: A clinical report,” was published in the December issue of the Journal of Prosthodontics.

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