Large Hematoma around Implant Site: Proper Treatment?

Dear Doc.Cb. It's looks like you placed an implant on edentulous ridge with FLAPLEES if this is the issue, you need gently removed tissue conditioner and bring some HEALTHY TISSUE with good blood supply around the implant( ice-packed) and save an implant.Hematoma is most likely to change to infection.Your second vist was not hematoma any more,this problem is come from NECROTIC infected soft tissue(even if you used flap for osteotomy).Infected now is supra-bone and looks like hematoma , so with keep continue draining not only you changed it to infra-bone pocket but also you'II lost an implant. Good luck to you. Dr. Vaziri

Give us an idea where the implant was placed. You may have damaged the soft tissue at the apex of the implant ???

We need to know the tooth # in order to consider the surrounding anatomy to best answer your question. Otherwise we are only guessing. Obviously the hematoma formed from damage to a vascular area adjacent to the implant, but where exactly was the implant placed?

Unless hemetomas are peri-cardial or causeing damage due to pressure necrosis.etc. Do not drain!!!! bleeding stops by tompanade draining the hemetoma may cause additional bleeding if there is a significant vascular component. BYW was the any anticoagulants such as Plavix, Warfrin, ASA involved?

You don't state the area where you placed the implant, or where exactly the hematoma formed. If the region where you placed the implant is the mandibular area, you probably caused the hematoma during reflection of lingual the flap, or most probably the apex of the implant perforated the lingual cortical plate and damaged the periosteum or a vessel. If the hematoma is very big, and is subperiosteal, I think you should drain it in the first few hours to avoid a secondary infection. If some time has elapsed though, say 1 day or more, the hematoma will already be in the process of organizing itself (fibrin) and it is best to leave it alone, for the body will eventually resorb it. Do cover the patient with AB treatment.

Haematomas are notorius for becoming infected and I would remove it and assess for the underlying cause and thus try prevent a similar problem. One only needs to see severe complications once to learn avoidance.

Dear DR CB Haematomas are caused either by damageing a big vassel or because of blood discresie or if the patient is under anticoagulant therapy or by a sudden attack of hypertation.The patient had to be questioned before the operation about the systemic diseases or therapy. draınıng the haematoma next day is a good treatment but at the same time looking for the real cause should be done .(consulting with the patients internist as quıckly as possible )Haematomas of the floor of the mouth is very dangerous because they push tongue and the soft tıssues backwards causıng air way obstraction and if not large infection of the dıafragma oris.If the haematoma is at the floor of the mouth ıt means that you have been working on the mandible and the apex of the implant perforated the lıngual compact bone and perforated one of the perıpheral branches of the lıngual arterie.(this shows us the ımportance of CT).If the haematoma is under palatal soft tissues that means you have been working on the maxilla and you have damaged either perıpheral branches of major palatınal arterıa or if you have gone too far minor palatınal arterıa.İf the haematoma is at the incisors region of maxilla you have either damaged the content s of the incisiv canal or one of the small vessels thah comes down with N.İnfraorbitalis. So after the draining the haematoma the patient should be under antienflammatory and antibiotic therapy that will cover both anaerobic and aerobic spectrums at least for a week.Good luck.

The patient returned 2 weeks later and hematoma is absent...just time resolved this issue....

if i work in the mandible i tell the patient to cover his head and chin with a clean piece of clothe like the one we see in comics for patients that hurt and go to the dentist!!it prevents hematoma to follow gravity.this and ice externally helps to reduce the possibility of big hemetoma.and remember once it appears it can go down to mesothorax and suppurate there!! cover with adibiotics in every case