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Year : 2019  |  Volume : 9  |  Issue : 2  |  Page : 87-90

Hemolacria and epistaxis as a complication of basal bone implant

1 Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
2 Dhanashri Maxillofacial Center, Dhanashri Hospital, Mumbai, Maharashtra, India

Date of Web Publication13-Jan-2020

Correspondence Address:
Dr. Sruthi Janardhan Rao
Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Rungta Knowledge City, Bhilai, Chhattisgarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdi.jdi_11_19

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Although perceived as comparatively risk free, every treatment has its own share of risks and complications. This case report illustrates an incident of epistaxis and hemolacria after basal bone implant placement in an edentulous atrophic maxilla. Most standard complications such as sinusitis, soft-tissue infection, paresthesia, and oroantral fistula are well known. Few very rare complications such as cutaneous fistula in the left zygomatico-orbital area caused by aseptic necrosis at the apical part of the implant, infection, and peri-implantitis have also been reported in literature. This article presents an unusual complication of basal implant placement along with a review of literature.

Keywords: Basal implant, complication, epistaxis, hemolacria

How to cite this article:
Sabnis R, Lokare S, Rao SJ, Thakur D, Patel M. Hemolacria and epistaxis as a complication of basal bone implant. J Dent Implant 2019;9:87-90

How to cite this URL:
Sabnis R, Lokare S, Rao SJ, Thakur D, Patel M. Hemolacria and epistaxis as a complication of basal bone implant. J Dent Implant [serial online] 2019 [cited 2020 Aug 10];9:87-90. Available from:

   Introduction Top

Basal bone implants are mainly indicated in bone-deficient situations such as edentulous arches, failed conventional implant placement, atrophic ridges, and failed bone augmentation procedures.

This case report highlights an unusual complication of nasal bleeding (epistaxis) and eye bleed (hemolacria) after the placement of basal bone implant for atrophied bone. A written informed consent was taken from the patient for publication, and ethical clearance for the same was obtained from the Institutional Ethics Committee.

   Case Report Top

A 50-year-old female patient reported to the department of oral and maxillofacial surgery with a complaint of edentulous maxillary and mandibular arches for 4 years and wish for replacement of missing teeth. The patient was coherent, cooperative, and comfortable with no significant medical history. According to the patient's preference for fixed full-mouth rehabilitation, implant-supported fixed prosthesis was suggested. Orthopantomogram and Cone-Beam Computed Tomography were advised. They revealed severe atrophy of bone with very less bone height in both maxillary and mandibular arches. In order to improve the volume of bone for the placement of conventional implants, a staged procedure involving bone grafting and sinus lift were explained to the patient. In view of increased duration of rehabilitation. The patient was reluctant to undergo a prolonged treatment, so basal bone implant with prosthesis within 72 h was planned. Under all aseptic conditions, the basal implant was placed in usual manner.

After successful placement of the basal implants, the patient was shifted to the ward, and 4 h later, the patient developed bleeding from the nose and eyes [Figure 1]. Immediately, the patient was taken to minor operating room and was examined for the cause of epistaxis and hemolacria. Caldwell-luc approach from the canine fossa was used, and hemostasis was achieved using bipolar cautery. The epistaxis ceased immediately. Hemolacria which was possibly due to capillary action from the nasolacrimal duct stopped within 15 min. The patient was given postoperative antibiotics, and daily follow-up was done for a week. Nasal packing was removed after 48 h. Stability of the implants were confirmed by taking scan postoperatively [Figure 2]. Dentures were successfully delivered postoperatively on 2nd day [Figure 3].
Figure 1: Extraoral image showing hemolacria and epistaxis

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Figure 2: Postoperative cone-beam computed tomography

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Figure 3: Postoperative prosthetic rehabilitation

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   Discussion Top

Osseous tissue underlying the alveolar processes of the maxilla and mandible is known as basal bone. It is fixed and unchangeable framework of the mandible and maxilla.[1]

The teeth are situated in less dense bone portions of the jaw bones called the alveolar bone. This is also known as the crestal bone of the jaw. Once the teeth start shedding, this less dense alveolar or crestal bone gradually gets resorbed and recedes. The bone which ultimately remains after regression of the alveolar bone following loss of teeth is the basal bone which lies below the alveolar bone. The basal bone is less prone to bone resorption and infections. It is highly dense and corticalized and offers excellent support to implants.

Basal implantology also known as bicortical implantology or just cortical implantology is a system which is specially designed to facilitate retention and to accommodate dental implants by utilizing basal cortical portion of the maxilla and mandible because it provides high-quality cortical bone for retention of these uniquely specially designed basal implants. Basal implantology includes the application of the rules of orthopedic surgery, and the basal implants are also called as “orthopedic implant.”[2] Considering the time and cost, in contrast to conventional implants which utilize grafting and ridge augmentation procedure which will take 6 months–1 year, the prosthesis can be delivered within 3–4 days after implant surgery with these basal bone implants.[3]

Many complications of dental implant have been reported in literature, and we have reviewed the same. These complications include those associated with the implant, those related to the surgical procedure, delayed complications, and patient factor-associated complications [Table 1]. In this case, epistaxis and hemolacria were seen 3–4 h after placing the implant. Epistaxis is defined as bleeding from the nostril, nasal cavity, or nasopharynx, which may have been caused due to injury to the anterior superior alveolar artery which was collected in the maxillary sinus and drained through the antral opening. Hemolacria is defined as a condition that causes a person to produce tears of blood, which could have been caused due to capillary action through the nasolacrimal duct.
Table 1: Complications of implant

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Variety of implant-associated complications such as fracture of dental implant may occur secondary to biomechanical overloading, and implant fracture may be contributed by bone resorption around an implant decreasing the amount of supporting bone surrounding the implant and thus placing undue stress on the implant itself.[7],[8] Good dental hygiene is important for preservation of the implant. Failure to do so can lead to microbial buildup and an infection around the implant, presenting with redness, induration, and painful inflammation of the gingiva surrounding the implant causing peri-implant disease[4],[5] which can be prevented by implant maintenance or by coating the implant surface with antimicrobials[22],[23] or silver coating;[24] implant removal can lead to fracture of the mandible and increased bone temperature;[6] immediate implant placement can cause resorption of buccal bone which can be prevented by socket-shield technique.[9] Rhinosinusitis may occur with sinus lift dental implantation.[25] Exploring surgical complications associated with maxillary implants, Krauthammer M reported extraocular muscle damage from dental implant penetration to the orbit.[10] Wolff J reported perforation of nasal floor and altered nasal airflow following implant surgery in the anterior maxilla.[11] Dental implant displaced into the maxillary sinus can be extracted as described by Lim D using Trans-nasal endoscopy, using lateral window technique or bone repositioning technique described by Zhou Q.[13],[26] Sinus lift procedure can cause Schneiderian membrane perforation. Beck-Broichsitter BE described that immediate surgical management in cases of intraoperative membrane perforation during a sinus lift procedure, can improve the long term survival.[12] one can prevent the sinus perforation by PRP technique as described by Abdalla RI,[27] by using Short implants as described by Gastaldi G.[28] Yamamoto S noticed Surgical ciliated cyst following maxillary sinus floor augmentation.[19] In association with mandibular implants, Law C noticed hematoma of floor of the mouth following implant placement, whereas Kirtay M narrated a case of displacement of implant in submental and sublingual space.[15],[16] Eskow CC Kasat V showed the effect of patient related factors like diabetes mellitus and smoking on the success of the implant respectively.[17],[18] Semel G reported Mandibular osteomyelitis associated with dental implants.[20] Vázquez-Delgado E reported trigeminal neuropathy (TN), TN without pain, painful posttraumatic TN after dental implant placement.[21] Different authors have reported different complications we have found hemolacria and epistaxis. Jain A. reported accidental ingestion of implant screwdriver during implant placement.[14] Hemolacria and epistaxis described in our case is an addition to this variety of surgical complications

   Conclusion Top

Various dental implant-related complications have been described in literature. Owing to the anchoring of basal implants into cortical bone, one must be cautious of the nasolacrimal apparatus during placement of maxillary implants to avoid hemolacria or epistaxis as described in this article.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

The glossary of prosthodontic terms. J Prosthet Dent 2005;94:10-92.  Back to cited text no. 1
Ihde S. Comparison of basal and crestal implants and their modus of application. Smile Dent J 2009;4:36-46.  Back to cited text no. 2
Garg R, Mishra N, Alexander M, Gupta SK. Implant survival between endo-osseous dental implants in immediate loading, delayed loading, and basal immediate loading dental implants a 3-year follow-up. Ann Maxillofac Surg 2017;7:237-44.  Back to cited text no. 3
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Gaudio RM, Ottria L, Lauritano D, Palmieri A, Cura F, Tagliabue A. Peri-implant test is a proposal of a new procedure to prevent peri-implantitis and forensic claims. J Biol Regul Homeost Agents 2018;32:43-50.  Back to cited text no. 4
Rosen PS, Froum SJ. Emerging issues associated with peri-implant disease. Compend Contin Educ Dent 2016;37:440-7.  Back to cited text no. 5
Meisberger EW, Bakker SJ, Cune MS. Temperature rise during removal of fractured components out of the implant body: An in vitro study comparing two ultrasonic devices and five implant types. Int J Implant Dent 2015;1:7.  Back to cited text no. 6
Stoichkov B, Kirov D. Analysis of the causes of dental implant fracture: A retrospective clinical study. Quintessence Int 2018;49:279-86.  Back to cited text no. 7
Tabrizi R, Behnia H, Taherian S, Hesami N. What are the incidence and factors associated with implant fracture? J Oral Maxillofac Surg 2017;75:1866-72.  Back to cited text no. 8
Han CH, Park KB, Mangano FG. The modified socket shield technique. J Craniofac Surg 2018;29:2247-54.  Back to cited text no. 9
Krauthammer M, Shuster A, Mezad-Koursh D, Shlomi B, Stolovitch C, Leibovitch I. Extraocular muscle damage from dental implant penetration to the orbit. Am J Ophthalmol Case Rep 2017;5:94-6.  Back to cited text no. 10
Wolff J, Karagozoglu KH, Bretschneider JH, Forouzanfar T, Schulten EA. Altered nasal airflow: An unusual complication following implant surgery in the anterior maxilla. Int J Implant Dent 2016;2:6.  Back to cited text no. 11
Beck-Broichsitter BE, Westhoff D, Behrens E, Wiltfang J, Becker ST. Impact of surgical management in cases of intraoperative membrane perforation during a sinus lift procedure: A follow-up on bone graft stability and implant success. Int J Implant Dent 2018;4:6.  Back to cited text no. 12
Lim D, Parumo R, Chai MB, Shanmuganathan J. Transnasal endoscopy removal of dislodged dental implant: A case report. J Oral Implantol 2017;43:228-31.  Back to cited text no. 13
Jain A, Baliga SD. Accidental implant screwdriver ingestion: A rare complication during implant placement. J Dent (Tehran) 2014;11:711-4.  Back to cited text no. 14
Law C, Alam P, Borumandi F. Floor-of-mouth hematoma following dental implant placement: Literature review and case presentation. J Oral Maxillofac Surg 2017;75:2340-6.  Back to cited text no. 15
Kirtay M, Yolcu U, Dundar S. Displacement of dental implant into the submental space after surgical integration. J Craniofac Surg 2017;28:e403-e405.  Back to cited text no. 16
Eskow CC, Oates TW. Dental implant survival and complication rate over 2 years for individuals with poorly controlled type 2 diabetes mellitus. Clin Implant Dent Relat Res 2017;19:423-31.  Back to cited text no. 17
Kasat V, Ladda R. Smoking and dental implants. J Int Soc Prev Community Dent 2012;2:38-41.  Back to cited text no. 18
Yamamoto S, Maeda K, Kouchi I, Hirai Y, Taniike N, Imai Y, et al. Surgical ciliated cyst following maxillary sinus floor augmentation: A case report. J Oral Implantol 2017;43:360-4.  Back to cited text no. 19
Semel G, Wolff A, Shilo D, Akrish S, Emodi O, Rachmiel A. Mandibular osteomyelitis associated with dental implants. A case series. Eur J Oral Implantol 2016;9:435-42.  Back to cited text no. 20
Vázquez-Delgado E, Viaplana-Gutiérrez M, Figueiredo R, Renton T, Gay-Escoda C, Valmaseda-Castellón E. Prevalence of neuropathic pain and sensory alterations after dental implant placement in a university-based oral surgery department: A retrospective cohort study. Gerodontology 2018;35:117-22.  Back to cited text no. 21
Hickok NJ, Shapiro IM, Chen AF. The impact of incorporating antimicrobials into implant surfaces. J Dent Res 2018;97:14-22.  Back to cited text no. 22
Verardi G, Cenci MS, Maske TT, Webber B, Santos LR. Antiseptics and microcosm biofilm formation on titanium surfaces. Braz Oral Res 2016;30. pii: S1806-83242016000100225.  Back to cited text no. 23
Kuehl R, Brunetto PS, Woischnig AK, Varisco M, Rajacic Z, Vosbeck J, et al. Preventing implant-associated infections by silver coating. Antimicrob Agents Chemother 2016;60:2467-75.  Back to cited text no. 24
Kayabasoglu G, Nacar A, Altundag A, Cayonu M, Muhtarogullari M, Cingi C. A retrospective analysis of the relationship between rhinosinusitis and sinus lift dental implantation. Head Face Med 2014;10:53.  Back to cited text no. 25
Zhou Q, Zhu ZK, Sun RN, Ma Y. Removal of the displaced implant from the maxillary sinus: Report of one case. Shanghai Kou Qiang Yi Xue 2016;25:125-8.   Back to cited text no. 26
Abdalla RI, Alqutaibi AY, Kaddah A. Does the adjunctive use of platelet-rich plasma to bone graft during sinus augmentation reduce implant failure and complication? Systematic review and meta-analysis. Quintessence Int 2018;49:139-46.  Back to cited text no. 27
Gastaldi G, Felice P, Pistilli R, Barausse C, Trullenque-Eriksson A, Esposito M. Short implants as an alternative to crestal sinus lift: A 3-year multicentre randomised controlled trial. Eur J Oral Implantol 2017;10:391-400.  Back to cited text no. 28


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]


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