Submental abscess following peri-implantitis: case report and comprehensive literature review

Background: Dental implantology is the greatest popular choice for the treatment of partial or total edentulism. However, despite its apparent simplicity, it represents a technique that necessitates adequate surgical knowledge and significant technical skills. There are several potential complications related to dental implant surgery and some of these can be particularly dangerous. The aim of the present study is to make a comprehensive review of head and neck abscess as a complication of dental implant infections and the consequent medical and therapeutic approach. Case report: A case of submental abscess related to peri-implantitis is presented from the hospital access to the emergence surgical treatment and medical therapy. The patient presented with painful swelling in the right submental and submandibular region. The surgical procedure included both an extraoral and intraoral approach. Extraorally, a right paramedian submental incision was performed. Intraorally, after removal of the fixed prosthesis screwed to a single implant, a muco-periosteal flap was elevated in correspondence of the third and fourth quadrants to allow implant exposure. All implant sites of infection and possible complications were removed. Then, Penrose-type drains were positioned intraorally and extraorally. Results: The patient remained hospitalized for ten days for clinical conditions assessment, the wounds were treated, and the drains replaced. Laboratory tests showed that neutrophils and PCR returned to normal values, indicating an interruption of the inflammatory process. The patient was discharged in good general and local clinical conditions with dedicated therapy. Conclusions: At 5-month follow-up the swelling had vanished and tissues appeared normotrophic and healthy. However, a computed tomography (CT) scan of the lower arch showed significant generalized bone loss at the mandibular level compatible with a state of advanced bone atrophy. The early diagnosis and treatment of these complications is fundamental for the patient prognosis.