Hemorrhagic complications in implant surgery: a scoping review of etiology, prevention, and management

Purpose: To provide the most relevant aspects of the etiology, prevention, and management of bleeding in routine implant surgery. Materials and methods: A comprehensive and systematic electronic search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until Jun 2021. Further references of interest were retrieved from bibliographic lists of the selected articles and the "Related Articles" feature of PubMed. Eligibility criteria were papers about bleeding, hemorrhage or hematoma associated with routine implant surgery on human subjects. Results: Twenty reviews and 41 case reports fulfilled eligibility criteria and were included in the scoping review. Involved implants were mandibular in 37 and maxillary in 4 cases. The major number of bleeding complications was in the mandibular canine region. The most injured vessels were sublingual and submental arteries, mainly due to perforation of the lingual cortical plate. Time to bleeding occurred intraoperatively, at suturing, or postoperatively. The most reported clinical manifestations were swelling and elevation of the mouth floor and the tongue with partial or complete airway obstructions. The first aid to manage airway obstruction was intubation and tracheostomy. For active bleeding control, gauze tamponade, manual or digital compression, hemostatic agents and cauterization were applied. When conservative procedures failed, hemorrhage was controlled by intra- or extraoral surgical approaches to ligate injured vessels or by angiographic embolization. Conclusions: The present scoping review provides knowledge and evidence on the most relevant aspects of the etiology, prevention, and management of implant surgery bleeding complications.