Complications after the operation of implantation of the lower jaw
Last reviewed: 23.04.2024
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Although any operation has a long list of complications, the incidence of problems after chin enlargement is usually low, and they are almost always temporary. When complications arise, they are usually easy to treat and, for a more correct selection of the implant or at the request of the patient, the operation can always be repeated and the implant replaced, so that it more closely matches the expectations of the patient and the surgeon.
The literature data show that infection after alloimplantation develops in 4-5% of cases. However, the frequency of infectious complications is reduced by intraoperative use of a solution of gentamicin for soaking the implant and washing the created pocket. Hematomas are very rare. Elongated mandibular implants do not cause asymmetry, unless the pocket is over the chin holes.
Sensitivity disorders, usually temporary, are observed in 20-30% of patients with implants in the chin. Hypesesia is expected, and patients should be warned about it before the operation. Extended implants are more likely to impair sensitivity than central chin implants, but this should not be the reason for not using extended implants. They do not migrate and are not ejected. Necrosis of the skin with external access is rare.
The bone resorption under the chin implants has been reported since the 60s of the last century, but no significant clinical consequences of this process have been identified. Implants, set too high above the chinion, contribute to the erosion of the thinner bone in this area. The resorption of the thicker compact bone of the chin protrusion and the chamomile is less important, including clinically. The extended mandibular implants, due to their placement under the chin holes, are not shifted to the top, and the muscular attachments do not allow them to move downwards, providing an ideal stability at the desired level. The softer cast implants of Silac-tic less promote bone resorption than dense implants. Implants of a larger size can cause more resorption due to greater tension between the periosteum, muscle and cortical bone. Absorption occurs during the first 6-12 months and stops on its own, if the implant is installed correctly. It is possible that some resorption even stabilizes the implant over the next few years. The soft-tissue profile of the chin remains stable, despite this process. It is not accompanied by pain or tooth decay. If the implant is removed, the bone resorption area can regenerate.
Sometimes there is a visible or palpable protrusion of the most lateral part of the elongated implants, probably as a result of an increase in volume due to the formation of a capsule that contracts the free ends of the implant. This applies primarily to the thinnest, very flexible edges of elongated anatomical chin implants. Often, massage of these edges promotes stretching of the capsule and eliminates the palpable protrusion, making it clinically insignificant. It is rare to remove the implant, expand the pocket and move the implant. The protrusion due to capsule contraction often occurs after 6 weeks.
As a result of damage to the muscle or swelling of the lower lip, changes can occur that are noticeable with a smile, but not noticeable at rest. Part of the lower lip may look weaker, as it is not pulled down as far as the lateral parts, due to temporary damage to the lowering muscles. This occurs more often after intraoral access.
Although asymmetry does not develop after proper implant placement, it can manifest itself in the postoperative period because of incorrect preoperative planning in the presence of initially asymmetric lower jaw. Any asymmetry should be discussed with patients before surgery so that they understand that asymmetry after surgery is a result of a preoperative condition, rather than caused by an implant or a technique for setting it. A very small number of patients experience temporary speech disorders, usually in the form of lisps, associated with swelling or dissection of the muscles that lower the lip. Such an effect on the lowering muscles and the chin muscle, in combination with hypoesthesia, can sometimes lead to temporary salivation and light vagueness of speech. Damage to the branches of the motor nerve of the edge of the lower jaw is rare, and its effects are temporary. Natural postoperative clefts or pits on the chin can change somewhat after the operation. Although the above list of potential problems is long, real experience is limited to hypodesia and bone resorption, while other complications are rare and temporary.
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