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Sakka S, Krenkel C. J Oral Implantol 2013; 39: 603 607

This report adds yet another reminder to the implant dentist about the risk of damaging the sublingual artery, or possibly endosseous arterial branches, during the placement of implants in the mandibular anterior sextant. The authors describe the treatment of a patient that resulted in bleeding after an alveolar crestal incision. The bleeding was controlled by electrical cauterisation. It is noted in this case report, in an attempt to avoid sublingual bleeds, that distraction osteogenesis (Mono-Endo Distractor Krenkel®) was employed to augment bone vertically. The authors state that patients with extensive sublingual hematomas should be referred immediately to secondary care for treatment that may include endotracheal intubation. Others, however, have suggested that because such haemorrhages are superior to the mylohyoid muscle, there is 'little risk of serious morbidity'. This is in contrast to bleeding in the submandibular space which is life-threatening. The diagnostic application of CBCT is advised pre-operatively although again this has been challenged.