|Year : 2020 | Volume
| Issue : 2 | Page : 84-86
A case of accidental ingestion and medical retrieval of dental implant hex driver
Vidya Sankari, Ashna Soundararaj, Chalakuzhiyil Abraham Mathew, Senthil Kumar
Department of Prosthodontics, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
|Date of Submission||18-Mar-2020|
|Date of Acceptance||30-Mar-2020|
|Date of Web Publication||21-Aug-2020|
Dr. Vidya Sankari
Department of Prosthodontics, KSR Institute of Dental Science and Research, KSR Kalvi Nagar, Thokkavadi, Tiruchengode - 637 215, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Accidental aspiration and ingestion of the dental instrument and material is an infrequent occurrence in dental practice. The location of the foreign body should be confirmed with radiographs. Radiographic examination will allow the correct diagnosis and the treatment to be conducted according to the specific situation of the object in the lungs or gastrointestinal tract. This is a case report of an accidental ingestion and medical retrieval of dental implant hex driver.
Keywords: Accidental ingestion, aspiration, endoscopy, foreign body, retrieval
|How to cite this article:|
Sankari V, Soundararaj A, Mathew CA, Kumar S. A case of accidental ingestion and medical retrieval of dental implant hex driver. J Interdiscip Dentistry 2020;10:84-6
|How to cite this URL:|
Sankari V, Soundararaj A, Mathew CA, Kumar S. A case of accidental ingestion and medical retrieval of dental implant hex driver. J Interdiscip Dentistry [serial online] 2020 [cited 2020 Sep 20];10:84-6. Available from: http://www.jidonline.com/text.asp?2020/10/2/84/292916
| Clinical Relevance to Interdisciplinary Dentistry|| |
Accidental ingestion and aspiration of small instruments or materials can take place during any dental procedure. It is mandatory to take preventive steps, such as the placement of a gauze screen across the oropharynx and the use of dental floss or suture material to attach to small instruments.
| Introduction|| |
In dentistry, aspiration and ingestion of foreign bodies can occur during root canal treatment, surgical extraction, orthodontic procedures, and implant treatment. Saliva makes the dental instruments more slippery and leads to slippage of the instruments from the operator's hand. Endodontic instruments, implant components, dental burs, cast or fiber posts, orthodontic brackets, molar bands, provisional or fixed restorations, and irrigation needles are the frequently aspirated or ingested dental instruments.,,
The incidence of ingestion is more prevalent than aspiration. Accidental inhalation of the dental instruments and materials is more serious event than ingestion and must always be treated as an emergency situation.
| Case Report|| |
A 70-year-old male patient reported to the department of prosthodontics for the replacement of missing 13, 12, 11, 21, and 22. Implant placement (13, 12, and 22 region) and second-stage surgery were carried out uneventfully. Open tray splinted implant level impression technique was planned. On unscrewing the guide pin of the open tray impression coping to retrieve the set impression, accidental slippage of the hex driver (Adin dental implant system Ltd., Industrial Zone AlonTavor, Israel) from the operator's hand occurred. Immediately after the incident, the dental chair was uprightened and the patient was asked to cough vigorously. Despite several attempts, the patient no longer felt the screwdriver at the back of his throat. The patient was asymptomatic and was not aware of the incident. There was no sign of coughing, wheezing, choking, or shortness of breath. The patient was informed of what had occurred. With the help of another hex driver, the guide pin was loosened and the set impression was removed from the patient's mouth. To rule out if the patient has aspirated or ingested the hex driver, chest and abdominal X-rays were immediately taken. Chest radiograph showed the absence of hex driver. Subsequent abdominal radiographs of the anteroposterior [Figure 1] and lateral views [Figure 2] revealed that the hex driver was ingested and located in the stomach.
|Figure 1: Anteroposterior abdominal radiograph revealed that the hex driver was ingested and located in the stomach|
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|Figure 2: Lateral abdominal radiograph revealed the hex driver in the stomach|
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The patient was referred to a gastroenterologist for further management. The gastroenterologist visually assessed the hex driver replica for its shape, size, and sharpness. Endoscopic retrieval of the ingested driver was planned under local anesthesia. Consent for endoscopy was obtained. On endoscopic examination, dental implant hex driver was found in the body of the stomach. The sharp tip of the hex driver was clamped with the clamping device attached to the end of the endoscopic instrument to prevent injury of the esophageal mucosal lining [Figure 3]. Endoscopic removal of the hex driver was done successfully, and the patient was discharged on the same day.
|Figure 3: Sharp tip of the hex driver was clamped with the clamping device attached to the end of the endoscopic instrument|
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Follow-up was done after 2 days and the patient had minor throat discomfort on the day of retrieval, which subsided on the next day.
| Discussion|| |
Aspiration or ingestion of the instruments and material can occur in any dental procedure. Immediately after the instrument leaves the oropharynx, it is important to determine whether the foreign body is located in the gastrointestinal (GI) tract or in the respiratory system. Imaging is mandatory to identifying the location of aspirated and ingested foreign objects and in tracking its passage through the GI tract. Imaging is crucial to determine the definitive methods for the treatment. Anteroposterior and lateral chest, lateral neck, and supine abdominal radiographs should be made to complete the evaluation of the foreign body from the nasopharynx to the rectum., For materials lacking radiopacity, diagnostic bronchoscopy, endoscopy, or computed tomography is required for localization.,
Aspiration of foreign body and its management
Aspiration of the dental instruments can result in obstruction, erosion, infection, pneumonia, fever, coughing, hemoptysis, and/or atelectasis. Sharp instruments pose risks of lung perforation. In aspirated cases, foreign objects were found more at right bronchus or lung because the connection from the trachea to the right bronchus is a less marked angle and the right bronchus has a greater diameter than the left.
Delayed treatment can result in increased inflammation, edema, and granulation tissue, which can complicate bronchoscopic examination and subsequent retrieval. Bronchotomy or segmental resection of the lungs may be considered when all other attempts of retrieval are unsuccessful.
Ingestion of foreign body and its management
Most ingested foreign bodies are expelled in stools without causing any complications, for which conservative management of serial radiographs and fiber-rich diet is an initial protocol. If serial radiographs depict the same location of foreign body or there is a sign of abdominal tenderness or hemorrhage, then most likely there is retention, obstruction, or intestinal perforation, for which an invasive procedure is indicated and has to be done as early as possible through gastroscopy for its retrieval. In ingestion cases, the site of involvement was probably related with the time after the accident.
Endoscopic retrieval techniques carry risks and may result in complications, such as deep lacerations with minor bleeding (16%), ulcer (5.7%), perforation (1.5%), and abscess (0.5%). The risk of perforation is higher in the upper esophagus. Prior GI tract surgery or congenital gut malformations increases the risk for obstruction or perforation.
Colonoscopic extraction is indicated during obstruction, contained perforation, failure of the object to pass through the ileocecal valve, and the presence of a pointed or elongated foreign body.
Protection of the oropharynx with rubber dam whenever possible is advised. In cases where rubber dam is not possible, throat packs and gauze may be used to seal the oropharynx. Ligation of dental instruments with lengthy floss or silk suture material is the most effective method of prevention., Prevention should also include positioning the patient in a more upright position. Patient should be instructed not to change the head position or increase mouth opening until removal of all tools or instruments from the oral cavity. A firm grip of all objects by a clinician is advised.
| Conclusion|| |
One of the complications during routine dental treatment is the accidental ingestion or aspiration of the instruments, which can happen when proper precautions are not taken. Preventive measures should be taken during any dental treatment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Schuldt Filho G, de Souza JG, Tosin CA, Ouriques FD, Dalago HR, Bianchini MA. Management of accidental aspiration of foreign bodies in implant dentistry. Int J Stomatol Occlusion Med 2014;7:22-4.
Kim A, Ahn KM. Endoscopic removal of an aspirated healing abutment and screwdriver under conscious sedation. Implant Dent 2014;23:250-2.
Santos Tde S, Antunes AA, Vajgel A, Cavalcanti TB, Nogueira LR, Laureano Filho JR. Foreign body ingestion during dental implant procedures. J Craniofac Surg 2012;23:e119-23.
El Wazani B, Nixon P, Butterworth CJ. Accidental ingestion of an implant screwdriver: A case report and literature review. Eur J Prosthodont Restor Dent 2018;26:184-9.
de Souza JG, Schuldt Filho G, Pereira Neto AR, Lyra HF Jr., Bianchini MA, Cardoso AC. Accident in implant dentistry: Involuntary screwdriver ingestion during surgical procedure. A clinical report. J Prosthodont 2012;21:191-3.
Jain A, Baliga SD. Accidental implant screwdriver ingestion: A rare complication during implant placement. J Dent (Tehran) 2014;11:711-4.
Zitzmann NU, Elsasser S, Fried R, Marinello CP. Foreign body ingestion and aspiration. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:657-60.
Souza FÁ, Statkievicz C, Guilhem Rosa AL, da Silveira Bossi F. Management of accidental swallowing in implant dentistry. J Prosthet Dent 2015;114:167-70.
Ismael G, Alameida LD, Lacerda TS. Prevention from swallowing or aspiration in dentistry for elderly patients. MOJ Gerontol Ger 2018;3:141-3.
Ratnaditya A, Ravuri S, Tadi DP, Kandregula CR, Kopuri RC, Pentakota VG. A simplified method of preventing implant hex drive from aspiration or accidental swallowing during stage two implant recovery. J Int Soc Prev Community Dent 2014;4:S23-5.
[Figure 1], [Figure 2], [Figure 3]