Osteotomy preparation: safety of vascular channels?

Every time I plan for implants, I see blood vessels crossing the lingual cortical plate in the mandible. I am always worried about perforating these vessels and causing a lingual/sublingual hematoma. If I do not perforate the lingual cortical plate, how safe would it be to place implants near these vessels? When I encountered this situation, I have noticed a minute hemorrhage under the tongue measuring about 2- 4 mm.  Can you make some recommendations how to avoid hemorrhage from these vessels?

6 thoughts on “Osteotomy preparation: safety of vascular channels?

  1. Mark Bourcier says:

    The only way to avoid them is to identify them on CBCT and use guided surgery to guide your osteotomy away from them.

  2. Alejandro Berg says:

    If you are worried about perforating, fully guided surgery is for you. I would recomend Paltop.
    The vascular channels are of no major concern, except in blood disorder carrying patients and even then…

    • Peter Fairbairn says:

      Hah Alejandro , how are you ? , using Paltop myself now as well simple easy system done well ….. regards Peter

    • Mohammad Sabir says:

      How paltop will make a difference in avoiding vascular channels. I am already planning with CBCT therefore I am able to see blood channels and vessels. My concern is that if these blood channels and vessels are minor in diameter less than 0.5 mm and if they are in the path of osteotomy and they cannot be avoided , if there are chances of lingual and sublingual hemorrhage or is it safe .

  3. JLWperio says:

    Vascular channels from the lingual plate of the mandible (especially the anterior) are of considerable concern in any patient . Avoid them with CBCT; plan proper placement ahead of time or penetration of such a vessel can create a rapidly expanding sublingual hematoma which can compromise the patient’s airway.

    • Mohammad Sabir says:

      I am placing implants everyday in at least 3 different patients. I am always planning each and every case with CBCT and that is the my biggest concern as I always see vessels crossing lingual cortex at every level some minute and some big. What is the risk of cutting them within the bone and not perforating the cortex.
      Thanks for suggestion.

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