Abstract
We report a case of the infection around a subperiosteal implant with intraoral autogenous hemorrhage in a patient recieving maintenance hemodialysis. The patient was recieving hemodialysis for diabetic nephropathy and had other complications such as myocardial infarction. And then the removal of a subperiosteal implant under general anesthesia was associated with extremely high risk, and perioperative management was very difficult.
Progressive anemia attributed to continuous autogenous bleeding around the implant was managed by blood transfusion. Preoperative hemodialysis for the control of serum potassium, BUN, serum creatinine etc was performed until the day before the operation. Postoperatively, intravenous hyperalimentation was given to provide a high calorie intake, to simplify the control of water balance and blood sugar, and maintain good oral hygiene. The operation required 3 hours 8 minutes and the total intraoperative blood loss was 831g. However, blood transfusion was not necessary because the management for the blood loss was successfuly controlled by infusion during the opration. Postoperative hemodialysis could be started on the day after the operation, without bleeding or other problems. The patient gradually recovered and now uses normal upper and lower full dentures without any problem.
This case emphasizes that implantologists have to evaluate not only the oral condition but also the systematic condition and long-term prognosis of patients, particularly when they are medically compromised. It is therefore indispensable to educate physicians about dental implant treatment and to establish a cooperative system for patients who require both dental and medical management.
