27Evidenced a published case, with its figures

3Shown indirectly the anatomy at risk, or a chart

16Numbers only covered in text, never pictured

1No case the literature here is silent

166Figures all CC BY, all credited

How to read this. Each complication carries one of four labels, and the difference between them is the point of the atlas. Evidenced means a published case, photographed. Shown indirectly means the figures are the anatomy at risk or a meta-analysis — 200 measured lingual concavities are evidence about floor-of-mouth haemorrhage, not a picture of one. Numbers only usually means the best sources are licence-blocked from reproduction. No case means the literature assembled here does not document it at all. The taxonomy was checked by reading each paper rather than by searching it for words: an automated first pass returned three findings that were false, including eight papers on grey show-through that turned out to be “grey literature” and Gray’s Anatomy in a reference list.

ABiological 9

Disease of the tissues around an integrated implant. The 2017 World Workshop case definitions are the ticket barrier: you pass through them to enter this branch, and they are why prevalence figures disagree.

Numbers onlyPeri-implant mucositisBleeding on probing with no bone loss beyond initial crestal remodelling. The reversible one — and the only westbound service on this branch.4 papers, no image EvidencedPeri-implantitisBleeding or suppuration on probing, increased probing depth, and radiographic bone loss beyond initial crestal remodelling. 2017 World Workshop.40 figures EvidencedRetrograde and lateral peri-implantitisInfection starting away from the crest. Retrograde begins apically and travels coronally; lateral begins on the side of the implant body.5 figures Shown indirectlyProgressive marginal bone lossCrestal bone lost beyond initial remodelling, measured rather than diagnosed. The outcome variable most of the corpus actually reports.2 figures EvidencedResidual and excess cementCement left subgingivally at delivery. The cement river starts at the decision to cement-retain.5 figures EvidencedPeri-implant soft-tissue dehiscence and fenestrationLoss of mucosal cover over an integrated implant, with the body or the restoration showing through.6 figures EvidencedMRONJ around implantsExposed necrotic bone for more than eight weeks in a patient on antiresorptive, immunosuppressant or anti-angiogenic drugs, with no radiotherapy and no metastatic disease to the jaws.16 figures Numbers onlyOsteoradionecrosis and implants in irradiated boneNecrosis of irradiated bone, with or without an implant in it. Distinguished from MRONJ by cause, not appearance.4 papers, no image EvidencedProsthesis infraposition in the growing patientAn implant placed before growth finished behaves as an ankylosed tooth. The jaw keeps growing; the crown does not come with it.3 figures

BMechanical and prosthetic 8

The hardware and the thing screwed to it. The corpus is thinnest here, and what it does hold comes mostly from the zygomatic literature rather than from conventional implants.

Numbers onlyAbutment screw looseningLoss of preload at the abutment screw. The commonest mechanical complication in most series, and the one least represented here.4 papers, no image EvidencedAbutment screw fractureThe screw shears, usually after a period of repeated loosening nobody treated as a warning.2 figures EvidencedRetrieval of fractured componentsGetting the fragment out without destroying the connection you are trying to save.8 figures EvidencedAttachment wear and loss of retentionThe overdenture stops holding. Wear, not failure — and it arrives on a schedule rather than as an event.1 figure Numbers onlyAbutment fractureThe abutment itself fails, rather than the screw holding it.4 papers, no image Numbers onlyVeneer chipping and ceramic fractureThe layer breaks off the framework. Usually survivable, usually recurrent.3 papers, no image Numbers onlyFramework fractureThe metal substructure fails. Rare, expensive, and usually the end of that prosthesis.2 papers, no image Numbers onlyImplant (fixture) fractureThe implant body itself fractures. The one mechanical failure with no conservative option.4 papers, no image

CSurgical and early 23

Everything between the incision and osseointegration, plus the structures a drill can reach that are not bone.

Numbers onlyFailure of primary stabilityThe implant does not hold at placement. Everything downstream is now a different operation.5 papers, no image Numbers onlyEarly loss of osseointegrationFailure before loading. Distinguished from late failure by timing, and usually by cause.4 papers, no image EvidencedInferior alveolar nerve injuryNumbness, dysaesthesia or pain in the distribution of the IAN after placement. The complication most likely to end in a claim.8 figures Numbers onlyLingual nerve injuryRarer than IAN injury at implant placement, and harder to attribute.6 papers, no image EvidencedCanalis sinuosus and nasopalatine neurovascular injuryInjury to the anterior superior alveolar neurovascular bundle, or to the contents of the nasopalatine canal, during anterior maxillary placement.17 figures Shown indirectlyFloor-of-mouth haemorrhage and sublingual haematomaPerforation of the lingual plate in the anterior mandible tearing a sublingual or submental vessel. Swelling advances faster than the airway can tolerate.4 figures Shown indirectlyPosterior superior alveolar artery injuryBleeding from the PSAA during lateral-window sinus surgery. Rarely dangerous, reliably alarming, and predictable from a CBCT.6 figures EvidencedSinus membrane (Schneiderian) perforationA tear in the sinus lining during elevation. Graded, repaired, or — as here — deliberately left.5 figures EvidencedImplant displaced into the maxillary sinusThe implant leaves the alveolus. Usually at second stage, usually into an atrophic posterior maxilla.11 figures EvidencedImplant displaced into the nasal cavityRarer than the sinus, and reached through a different specialty’s door.4 figures EvidencedMaxillary sinusitis after implant or sinus surgerySinus disease caused by, or complicating, implant treatment in the posterior maxilla.6 figures Numbers onlyOroantral fistulaA permanent communication between mouth and sinus at the implant site.3 papers, no image EvidencedAspiration or ingestion of a componentThe component leaves the field entirely. An airway question until proven otherwise.1 figure Numbers onlyOrbital and infratemporal penetrationThe recognised catastrophic risk of zygomatic and pterygoid anchorage.4 papers, no image EvidencedMalpositionThe implant is where it should not be. The commonest avoidable complication, and the cause of most of the others in this atlas.5 figures EvidencedBarrier membrane and titanium mesh exposureThe barrier becomes exposed to the mouth. The regenerative complication that decides whether the graft survives.13 figures EvidencedWound dehiscence and flap breakdownPrimary closure fails. Tension, blood supply, or both.3 figures Numbers onlyGraft failure and resorptionThe augmentation does not take, or does not stay.5 papers, no image Numbers onlyDonor-site morbidityThe bill the donor site sends. Pain, altered sensation, gait, contour — and it is consent material, not a footnote.5 papers, no image EvidencedPostoperative infection and abscessInfection of the surgical site or around the implant, short of established peri-implantitis.2 figures EvidencedMandibular fracture, pathological and iatrogenicThe atrophic mandible breaks. Sometimes the reason the patient arrives, sometimes the reason they return.6 figures Numbers onlyThermal necrosis of the osteotomyBone killed by drilling heat. The 47 °C threshold is one of the oldest numbers in the field.5 papers, no image Numbers onlySurgical emphysemaAir forced into the tissues, usually by an air-driven handpiece or an air-water syringe in an open flap.2 papers, no image

DAesthetic 4

Failures that are neither infection nor fracture. The three best sources the corpus has are all licence-blocked for figures.

EvidencedMucosal recessionThe margin migrates apically and the restoration lengthens. Usually announced by the patient, not the recall.3 figures EvidencedPapilla lossThe interdental or inter-implant papilla does not fill. Between two adjacent implants it frequently cannot.1 figure No caseGrey show-throughTitanium read through a thin mucosa, or through a recession that has exposed the platform.nothing in the corpus EvidencedEmergence and contour failureThe restoration emerges wrongly — over-contoured, impossible to clean, or with the margin in the wrong place. Badly underrated, and the point where prosthetics hands the problem to biology.11 figures

EThe return service 3

Explantation is not the end of the line. The passenger rejoins the bone line one zone worse, and the next rung up the anchorage ladder is what rescues them.

EvidencedExplantationTaking it out. Reverse torque, trephine or piezo — and the removal torque tells you what you are dealing with before the implant is out.6 figures EvidencedThe compromised ridge after explantationThe passenger rejoins the bone line one zone worse than they left it. This is the connection the whole taxonomy exists to make.5 figures EvidencedRescue by the next rung upWhen the ridge cannot be repaired, anchorage moves outward. This is where the complications atlas hands the patient to the anchorage ladder.10 figures

!Blocked by licence

Four papers document a complication and may not have their images reproduced. Two of them are the only case in this collection for theirs — two independent reports of a life-threatening bleed, with opposite management. They are named and linked on their pages; their numbers are quotable and their figures are not.

Paper	Licence	Complication	What it shows
Hwang 2013	CC BY-NC	floor-of-mouth haemorrhage	angiographic embolisation of a sublingual artery bleed
Barrientos-Lezcano 2021	CC BY-NC-SA	floor-of-mouth haemorrhage	sublingual haematoma with respiratory distress, managed by tracheostomy
Favia 2015	CC BY-NC-ND	MRONJ around implants	breast-cancer metastasis found inside an MRONJ lesion
Sudhakar 2017	UNKNOWN	donor-site morbidity	iliac crest harvest morbidity in 12 patients

Nothing matches that. Clear the filters.

Branch A · Biological

Peri-implant mucositis

Bleeding on probing with no bone loss beyond initial crestal remodelling. The reversible one — and the only westbound service on this branch.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Monje 2025 systematic review	CC BY	AO/AAP consensus systematic review on the surgical and implant-related factors that drive onset and progression; carries the composite clinical and radiographic case definition.	doi
Zhang 2025 systematic review and meta-analysis	CC BY-NC-ND	systematic review and meta-analysis — numbers only, CC BY-NC-ND.	doi
Lee 2024 systematic review	CC BY-NC	systematic review — CC BY-NC.	doi
Afrashtehfar 2023 commentary	CC BY	commentary on the evidence base.	doi

What is missing

No case in this corpus photographs mucositis as its own entity. It appears only as the baseline state in peri-implantitis cases, where by definition it has already progressed. A case series photographing mucositis that resolved would close this — and it is the entry a room is most likely to ask to see, because it is the one stage that is still reversible.

← All 47 complications

Branch A · Biological

Peri-implantitis

Bleeding or suppuration on probing, increased probing depth, and radiographic bone loss beyond initial crestal remodelling. 2017 World Workshop.

Evidenced A published case, with its figures.

Hakkers 2025all 18 published figures

Electrolytic Cleaning as Part of Surgical Reconstructive Peri-Implantitis Treatment: A Case Series Dentistry Journal 2025 case series doi:10.3390/dj13060237

Three patients, anterior maxilla, surgical reconstructive treatment with electrolytic cleaning. The complete sequence is photographed: baseline mucosa, crown removal, flap, granulation tissue removal, decontamination, the implant surface immediately after cleaning, graft and membrane, and follow-up to twelve months with matched baseline/outcome pairs for two cases.

Hakkers et al. 2025. Reproduced under CC BY 4.0.

baseline status peri implant mucosa — **Figure 2**Baseline status of the peri-implant mucosa

crown removal pre operatively — **Figure 3**Crown removal pre-operatively

flap reflection exposure implant surface — **Figure 4**Flap reflection, exposure of the implant surface

granulation tissue removal — **Figure 5**Granulation tissue removal

surface decontamination electrolytic cleaning — **Figure 6**Surface decontamination using electrolytic cleaning

implant status directly electrolytic cleaning — **Figure 7**Implant status directly after electrolytic cleaning

application bone substitute collagen membrane — **Figure 8**Application of bone substitute and collagen membrane

surgery site directly suturing — **Figure 9**Surgery site directly after suturing

two weeks postoperatively — **Figure 10**Two weeks postoperatively

three months postoperatively — **Figure 11**Three months postoperatively

directly crown replacement surgery — **Figure 12**Directly after crown replacement surgery

six months crown replacement — **Figure 13**Six months after crown replacement

peri implant bone level over time left — **Figure 14**Peri-implant bone level over time (from left to right: TPre, T2, T6, T12)

baseline tpre left postoperative t12 right — **Figure 15**Baseline (TPre, (left)) and postoperative (T12, (right)) clinical situation, Case 1

Fernandes 202519 of 24 published figures

The Novel iMPACT Tool and Quadrant Protocol for Peri-Implantitis: Surface Refinement and Re-Osseointegration Validated by SEM/EDS and Long-Term Clinical Case Reports Medicina 2025 case series doi:10.3390/medicina61061094

Three quadrant cases treated by implantoplasty with the iMPACT planer. Periapical films carry arrows marking platform-to-bone distance at baseline, 14 months and 43 months, which is the thing to look at rather than the device. Figures 1-5 are the in-vitro device evaluation and are deliberately not shown here.

Fernandes et al. 2025. Reproduced under CC BY.

initial clinical assessment sites — **Figure 6**Initial clinical assessment of sites #46 and #47

periapical taken region complaint relevant bone — **Figure 7**The periapical image taken for #46 and #47 (region of the complaint) shows relevant bone loss around the implants (red arrows showing the bone loss found, considering as reference the implant platform)

**Figure 8**The initial panoramic radiograph reveals oral rehabilitation and bone loss in the lower posterior teeth

removing screwed crowns site evaluation — **Figure 9**Removing the screwed crowns and for the site evaluation

bsf incision raised moved buccal lingual — **Figure 10**(a) BSF incision; (b) BSF raised; (c) BSF moved from buccal to lingual; (d) BSF raised exposing the implants and local bone

quadrant protocol steps novel impact tool — **Figure 11**Quadrant protocol’s steps for the novel iMPACT tool application

bone graft allograft xenograft place collagen — **Figure 12**The bone graft (allograft + xenograft) is in place, and the collagen membrane covers the bone graft for the GBR

interrupted suture bridge reattachment ensuring surgical — **Figure 13**Interrupted suture and bridge reattachment, ensuring surgical site protection and oc-clusal function

periapical evolution red arrows distance implant — **Figure 14**Periapical images showing the evolution of the case (red arrows show the distance from the implant platform to the bone—(A) Baseline; (B) After 14 months; (C) After 43 months)

clinical findings months — **Figure 15**Clinical findings after 43 months

panoramic radiographic cone beam computed tomography cbct — **Figure 16**Panoramic radiographic view (a) and cone-beam computed tomography (CBCT) (b), revealing bone loss at baseline at tooth #41, respectively, 8.5 mm and 9.0 mm (red arrows)

step by step treatment peri implantitis impact quadrant protocol — **Figure 17**Step-by-step treatment for peri-implantitis using the iMPACT and Quadrant protocol. (a) Initial clinical evaluation; (b) Removing the abutments for peri-implantitis treatment; (c,d) BSF raised for implant exposition; (e) Insertion of the hinge (pin), which was crewed into the implant; (f) Hinge in position; (g,h) iMPACT adapted to the hinge; (i) iMPACT spinning for implantoplasty; (j) The implant surface was smoothed, and bone around the implant was gently cut (osteotomy); (k) occlusal view showing the osteotomy; (l) implantoplasty finished—implant surface is completely smoothed (machined); (m) Bone graft; (n) Suture and abutments were repositioned

month follow up — **Figure 18**12-month follow-up (#41)

initial clinical assessment periapical x ray presenting — **Figure 19**(a) Initial clinical assessment; (b) Periapical X-ray presenting the measurements (red arrows) from the platform to the bone; (c) The panoramic view shows the vertical bone loss found at baseline

fourth quadrant condition fixed prosthesis removal — **Figure 20**Fourth-quadrant condition after fixed prosthesis removal

bsf performed raised reflected lingual side — **Figure 21**(a) BSF performed; (b) BSF raised and reflected to the lingual side, exposing the implants

impact tool placed implantoplasty spinning remove — **Figure 22**(a) iMPACT tool was placed for implantoplasty; (b) iMPACT spinning to remove the contaminated threads, machining the implant surface; (c) Result obtained after treatment

radiographic bone level probing depth comparing — **Figure 23**Radiographic bone level and probing depth comparing the baseline and 12-month results

clinical follow up months radiographic outcome — **Figure 24**(a) Clinical follow-up after 12 months; (b) Radiographic outcome after 12 months

Sangkhamanee 2024all 3 published figures

Correction of Peri-Implant Soft Tissue Fenestration With Bony Dehiscence Associated With Intrabony Defect: A 2-Year Case Report Case Reports in Dentistry 2024 case report doi:10.1155/2024/5895661

Peri-implantitis presenting as a 3 x 3 mm labial soft tissue fenestration at a maxillary canine, with 6 mm probing depth and a 5.56 mm intrabony defect on CBCT.

Sangkhamanee et al. 2024. Reproduced under CC BY.

soft tissue fenestration labial site maxillary — **Figure 1**(a) Soft tissue fenestration of 3 × 3 mm at the labial site of the maxillary left canine implant, 2 mm apical to the mucosal margin. (b) CBCT radiographs showing apical labial bony dehiscence and vertical bone loss of 5.56 mm in depth at the mesial and distal surfaces of the implant. (c) The implant presented soft tissue dehiscence of 4 × 4 mm exposing the fixture at 2 weeks after initial debridement

recipient site partial thickness flap creating — **Figure 2**(a) Recipient site with partial thickness flap creating an envelope. (b) Donor site for harvesting the soft tissue graft of 16 × 8 mm. (c) Graft placement

clinical appearance follow up periods surgery cbct — **Figure 3**(a) Clinical appearance at the follow-up periods after surgery. (b) CBCT radiographs at 2 years after surgery demonstrating the remaining intrabony defect depth 3.75 mm at the mesial and 4.95 mm at the distal surfaces of the implant. The width of the intrabony defect was narrower than the pretreatment

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Monje 2025 systematic review	CC BY	the prevention review — which surgical and implant-related factors actually drive it.	doi
Lin 2025 systematic review and meta-analysis	CC BY-NC-ND	systematic review and meta-analysis, CC BY-NC-ND.	doi
Afrashtehfar 2023 commentary	CC BY	commentary.	doi
Bertolini 2019 systematic review	CC BY	lists submucosal cement, hygiene-hostile positioning, occlusal overload, titanium particles, compression necrosis, overheating and biocorrosion as risk indicators whose role "remains to be determined" — worth quoting exactly, because it is more honest than most lists of causes.	doi

← All 47 complications

Branch A · Biological

Retrograde and lateral peri-implantitis

Infection starting away from the crest. Retrograde begins apically and travels coronally; lateral begins on the side of the implant body.

Evidenced A published case, with its figures.

Park 2023all 5 published figures

Lateral Peri-Implantitis: Successful Management via Guided Bone Regeneration at Mandibular First Molar Implant Medicina 2023 case report doi:10.3390/medicina59091691

The first report of LATERAL peri-implantitis — bone resorption on the side of the implant body, 26 months after lateral bone augmentation, originating in an infection of the augmented bone rather than at the crest. Treated by enucleation, detoxification and GBR instead of removal. The removed specimen measured 13 x 11 mm and is photographed.

Park et al. 2023. Reproduced under CC BY 4.0.

periapical lesion distal root tooth observed — **Figure 1**(a) A periapical lesion on the distal root of tooth #30 was observed. The mesial root was removed 3 years ago; (b) panoramic radiograph after 4 months of tooth extraction. A wide bone defect

clinical findings gbr post 5 months site — **Figure 2**(a) Clinical findings of GBR post-5 months. The GBR site was not exposed; (b) uncovering was performed 5 months post-GBR procedure. Bone regeneration was well performed in the crestal portion of the implant–abutment junction. Of the buccal labial augmentation sites, only the mesial side showed a yellowish hue, and bone sounding with a periodontal probe presented with a soft consistency (black arrow); (c) the final prosthesis was inserted 1 month post-uncovering

there gingival bleeding swelling present months — **Figure 3**(a) There is gingival bleeding and swelling present 26 months after lateral bone augmen-tation. The prosthesis was disconnected by removing the internal screw through a screw channel located on the occlusal table; (b) after buccal flap reflection, the granulation tissue extended from the GBR site and penetrated up to the implant surface; (c) bone regeneration at the implant–abutment junction was well performed. The buccal implant body was exposed. Peri-implant bone defect occurred on the mesial side; (d) decontamination was performed on the exposed implant body using a titanium brush; (e) tetracycline HCl was mixed with saline and applied to the exposed implant surface; (f) after sufficient saline irrigation, a synthetic bone graft substitute was filled; (g) a resorbable collagen membrane was adapted to cover the bone graft site; (h) flap closure; (i) the previous prosthesis was reinserted following 1 month

removed specimen measuring left side area — **Figure 4**(a) Removed specimen measuring 13 × 11 mm. The left side is the area in contact with the implant and the right side is the area subjected to bone decortication; (b) in the decalcified H–E stained specimen, the area in contact with the implant is the granulation tissue containing a large amount of inflammatory cells; (c) in the undecalcified H–E stain specimen, graft particles did not contact the implant body; (d) osteoclasts appeared around the graft particle (black arrow); (e) abundant inflammatory cells in the granulation tissue

panoramic radiograph lower right first molar — **Figure 5**Panoramic radiograph lower right first molar region and CBCT images of the procedure: (a) the prosthesis was delivered 6 months post-implant placement; (b) 26 months after prosthesis delivery, an ovoid-type bone resorption was observed around the implant; (c) panoramic radiograph images taken 20 months after surgical re-entry showed no bone resorption around the implant; (d) in the cross-sectional image of the CBCT scan taken before the surgical re-entry, broad bone resorption was observed on the buccal side of the implant; (e) there was no evidence of bone resorption around the implant in the cross-sectional image of the CBCT scan 20 months after surgical re-entry

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Kaur 2021 systematic review and meta-analysis	CLOSED	systematic review and meta-analysis on retrograde peri-implantitis. CLOSED — quote the numbers, link the DOI.

← All 47 complications

Branch A · Biological

Progressive marginal bone loss

Crestal bone lost beyond initial remodelling, measured rather than diagnosed. The outcome variable most of the corpus actually reports.

Shown indirectly The figures here are the anatomy at risk or the meta-analysis — evidence about this complication, not a picture of it.

Alenezi 2025a chart, not a photograph2 of 7 published figures

Effectiveness of Short Implants Versus Long Implants With Sinus Floor Elevation in Patients With Atrophic Posterior Maxilla: A Systematic Review and Meta-Analysis Cureus 2025 systematic review and meta-analysis doi:10.7759/cureus.89103

Forest plot of marginal bone loss and its leave-one-out sensitivity analysis. A chart, not a photograph — but it is the form the evidence on this complication actually takes.

Alenezi et al. 2025. Reproduced under CC BY 4.0.

forest plot marginal bone loss — **Figure 3**Forest plot of marginal bone loss

leave one out sensitivity analysis plot marginal bone — **Figure 4**Leave-one-out sensitivity analysis plot of marginal bone loss

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Mojaver 2025 systematic review	CC BY	systematic review; the densest single treatment of MBL in the corpus.	doi
Zita Gomes 2016 retrospective multicentre clinical study	CC BY	Table 3 gives peri-implant MBL between groups at baseline, 4 months and 1 year, implant level.	doi
Lin 2025 systematic review and meta-analysis	CC BY-NC-ND	splinted implants showed higher MBL than non-splinted — CC BY-NC-ND, numbers only.	doi
Bertolini 2019 systematic review	CC BY	systematic review.	doi
Sánchez-Sánchez 2021 systematic review	CC BY	systematic review.	doi

← All 47 complications

Branch A · Biological

Residual and excess cement

Cement left subgingivally at delivery. The cement river starts at the decision to cement-retain.

Evidenced A published case, with its figures.

Leventis 20255 of 15 published figures

Supracrestal Complex Prosthetic Modification and Topical Oxygen Therapy for Peri-implant Mucositis Resolution in an Infrapositioned Implant: A Case Report With Three-Year Follow-Up Cureus 2025 case report doi:10.7759/cureus.90181

Cement-induced inflammation at a maxillary canine crown: 6-7 mm pocketing with haemorrhagic and purulent discharge, poor marginal adaptation, subgingival porcelain exposure and residual cement — and yet crestal bone levels preserved, which is the part worth arguing about.

Leventis et al. 2025. Reproduced under CC BY.

continued skeletal growth resulted partial submergence — **Figure 1**Continued skeletal growth resulted in partial submergence of the implant crown into the soft tissues

bleeding probing pocketing hemorrhagic purulent discharge — **Figure 2**Bleeding on probing and 6-7 mm pocketing with hemorrhagic and purulent discharge

measurement distance implant platform soft tissue — **Figure 3**Measurement of the distance from the implant platform to the soft tissue zenith

removal implant restoration — **Figure 4**Removal of the implant restoration

comparison between old white arrow new — **Figure 12**Comparison between the old (white arrow) and the new (orange arrow) implant restorations

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Lin 2025 systematic review and meta-analysis	CC BY-NC-ND	CC BY-NC-ND — numbers only.	doi
Bertolini 2019 systematic review	CC BY	names submucosal cement among the risk indicators for peri-implantitis.	doi

← All 47 complications

Branch A · Biological

Peri-implant soft-tissue dehiscence and fenestration

Loss of mucosal cover over an integrated implant, with the body or the restoration showing through.

Evidenced A published case, with its figures.

Sangkhamanee 2024all 3 published figures

Labial soft tissue fenestration 2 mm apical to the mucosal margin, with underlying bony dehiscence and intrabony defect. Managed by soft tissue modification alone; CBCT at two years shows the intrabony defect still there.

Sangkhamanee et al. 2024. Reproduced under CC BY.

Wen 2024all 3 published figures

Palatal Pedicle Connective Tissue for Reconstruction of Through-and-Through Soft Tissue Defects in Esthetic Zone Around a Dental Implant: An 8-Year Follow-Up Case Report Case Reports in Dentistry 2024 case report doi:10.1155/2024/9936222

A fistula with mesial papillary recession three months after immediate placement, and the peri-implant tissue horizontally and vertically collapsed. Treated by pedicled connective tissue flap, followed to eight years.

Wen et al. 2024. Reproduced under CC BY.

clinical radiographic views months postoperative immediate — **Figure 1**Clinical and radiographic views 3 months postoperative of immediate implant placement. (a) The labial view showing a fistula and papillary recession mesial and distal to the 11. (b) The occlusal view displaying labial peri-implant soft tissue contour collapse. (c, d) The radiographic view 3 months postoperative of implant placement exhibiting no radiolucent lesion around the implant and no resorption of the peri-implant bone. (e) The labial view showed soft tissue recession of TTSD. (f) The lingual view showed soft tissue recession of TTSD

surgical procedures transplantation ppctf labial ttsd — **Figure 2**Surgical procedures for transplantation of PPCTF. (a) The labial view of TTSD showing subsided inflammation but horizontally and vertically collapsed peri-implant soft tissue contour. (b) The occlusal view of TTSD revealing recession on the labial–palatal dimension of peri-implant soft tissue and the multidimensional penetrating dehiscence. (c) The peri-implant soft tissue was deepithelialized using a rotating diamond burr (arrow), and incisions on the palatal side were made to raise a partial thickness flap with proper thickness. (d) A PPCTF was elevated to cross the labial–palatal dimension and restore the deepithelialized area around the implant. (e) The PPCTF was mobilized and sutured into the partial thickness flap pocket labial to the implant. (f) Suture fixation around the implant. (g) The vacuum-formed palatal plate with dual functions of wound protection and compression shaping. (h) The labial view 2 weeks postoperative PPCTF transplantation displaying satisfactory horizontal and vertical soft tissue augmentation. (i) The rehabilitation and reconstruction of the labial–palatal dimension of the soft tissue contour. Despite a tiny dehiscence at the crest of the implant, overall peri-implant soft tissue health had been restored

peri implant soft tissue condition moment implant — **Figure 3**Peri-implant soft tissue condition at the moment of implant crown placement and 8-year follow-up. (a, b) The labial and occlusal view directly after placement of the implant crown, with black triangles visible mesial and distal to the crown. (c, d) The labial and occlusal view at the 8-year follow-up demonstrating a favorable esthetic outcome. (e) A slight overcontouring of the labial soft tissue was present, with no bleeding on probing. (f) The sagittal CBCT image 8 years after implant placement demonstrating a successful osseointegration

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Ravidà 2022 systematic review, meta-analysis and trial sequential analysis	CC BY-NC-ND	systematic review and meta-analysis. CC BY-NC-ND — no figures, no crops.	doi

← All 47 complications

Branch A · Biological

MRONJ around implants

Exposed necrotic bone for more than eight weeks in a patient on antiresorptive, immunosuppressant or anti-angiogenic drugs, with no radiotherapy and no metastatic disease to the jaws.

Evidenced A published case, with its figures.

Goker 2023all 6 published figures

Zygomatic Implant Insertion in MRONJ: A Case Report with a Follow-Up of 3 Years Journal of Clinical Medicine 2023 case report doi:10.3390/jcm12093300

A 78-year-old woman who developed osteonecrosis in the fourth year of bisphosphonate treatment. Necrotic tissue resected, conventional implants removed, then rehabilitated with two zygomatic implants — the lesion, the removal, the zygomatic preparation and three-year follow-up are all photographed. This is branch A handing the patient to the anchorage ladder.

Goker et al. 2023. Reproduced under CC BY.

radiographic mronj lesion posterior left side — **Figure 1**(A) Radiographic image from the patient showing an MRONJ lesion on the posterior left side of the maxillary bone. (B–D) Clinical images from the patient showing an MRONJ lesion on the posterior left side of the maxillary bone

intra operative removal maxillary dental implants osteonecrotic — **Figure 2**(A,B) Intra-operative image from the patient showing removal of the maxillary dental implants and osteonecrotic lesion. (C) Intra-oral post-operative view of the patient after a month showing healthy tissues. (D) The radiographic image shows the post-operative situation with the previous prosthesis adjusted to the new situation

clinical new mronj lesion posterior right — **Figure 3**(A) Clinical images from the patient showing a new MRONJ lesion on the posterior right side of the mandibular bone. (B,C) Intra-operative image from the patient showing the removal of the sequester. (D) The radiographic image shows the post-operative situation

intra operative steps two zygomatic implant preparations — **Figure 4**(A,B) Intra-operative images of the patient showing the steps of two zygomatic implant preparations on the posterior left side of the maxillary bone. (C) Insertion of two zygomatic implants. (D) Intra-operative image showing the mucoperiosteal flap being repositioned and sutured

radiographic healing mronj lesions two zygomatic — **Figure 5**(A) Radiographic images from the patient showing healing of the MRONJ lesions with two zygomatic implants inserted after one month of follow-up. (B) Clinical images from the patient showing healing of the MRONJ lesions with two zygomatic implants inserted. (C) Intra-oral view showing the final prosthesis

panoramic radiograph years follow up clinical occlusion — **Figure 6**(A) Panoramic radiograph of the patient after 3 years of follow-up. (B) Clinical image from the patient showing occlusion

Ottesen 2022all 5 published figures

Medication-related osteonecrosis of the jaw and successful implant treatment in a patient on high-dose antiresorptive medication: A case report Clinical and Experimental Dental Research 2022 case report doi:10.1002/cre2.620

Prostate cancer with bone metastases, on high-dose denosumab, with previous MRONJ resection. Four maxillary implants placed. Photographed through a minor peri-implant abscess, then peri-implantitis, then necrotic bone facial to two implants at six months and their removal. Read it as the case for saying no.

Ottesen et al. 2022. Reproduced under CC BY.

implantsurgery before clinicalphoto andpanoramic rad — **Figure 1**Implant surgery. (a, b) Before implant surgery, clinical photo, and panoramic radiograph. (c‐f) Implant surgery. (g, h) Healing before abutment surgery, clinically and on panoramic radiograph. No signs of bone degeneration around dental implants. (I, k) Periapical radiographs immediately after abutment surgery.

prosthetictreatment abutmentsatreferral implant supp — **Figure 2**Prosthetic treatment. (a) Abutments at referral. (b) and (c) Implant‐ supported restorations. (d) Installation using individual guide. (e‐g), and (h). Clinical and radiographic situation immediately after installation. Erythematous mucosa was observed in region.

treatmentofminorperi implant abscessfaciallytoimplan — **Figure 3**Treatment of minor peri‐implant abscess facially to implant 24. (a) Right side, no signs of any pathological conditions. (b) Minor abscess facially to dental implant 24. (c) Panoramic radiograph revealed no signs of bone degeneration around the dental implants. 1064 | OTTESEN ET AL.

peri implantitistreatment right side nosignsofpathol — **Figure 4**Peri‐implantitis treatment. (a) Right side, no signs of pathologic conditions. (b) Left side, edematous mucosa facially to dental implant 24. (c) Panoramic radiograph shows sign of bone degeneration approximal to implants 23 and 24 (arrows). (d, e) Periimplantitis operation, no signs of bone necrosis, picture taken after removal of granulation tissue.

removalofdentalimplantsand resectionofnecroticbone s — **Figure 5**Removal of dental implants and resection of necrotic bone. (a, b) Six months follow‐up revealed necrotic bone (arrows) facially to implants 23 and.

Ku 2024all 5 published figures

Demineralized Dentin Matrix Incorporated with rhBMP-2 Composite Graft for Treating Medication-Related Osteonecrosis of the Jaw Journal of Clinical Medicine 2024 case report doi:10.3390/jcm13164830

Sequestrectomy with fluorescence-guided selective removal of red-fluorescent bone, CBCT showing a corticocancellous complex regenerated at four months, and H&E histology of the sequestrum. The only histology of necrotic bone in the corpus.

Ku et al. 2024. Reproduced under CC BY 4.0.

preoperative bone exposure right maxilla panoramic — **Figure 1**Preoperative images. (A) Bone exposure on right maxilla. (B) Preoperative panoramic x-ray. (C) Pre-operative SPECT/CT

intraoral necrotic bone exposed right maxilla — **Figure 2**Intraoral images. (A) Necrotic bone was exposed on right maxilla. (B) Removal of sequestrum. (C) Red fluorescent bone was selectively removed by using Qray Pen-C. (D) HuBT incor-porated with rhBMP-2 graft. (E) Primary closure. (F) Four months post-surgery. (G) Seven months post-surgery. (H) Fourteen months post-surgery

cone beam computed tomography four months — **Figure 3**Cone beam computed tomography of this patient. At four months post-surgery, new bone formation with corticocancellous complex was identified at the location of the grafted Allo-DDM incorporated with rhBMP-2, with the subsidence of sinusitis

cone beam computed tomography regenerated new — **Figure 4**Cone beam computed tomography after of this patient. The regenerated new bone allowed for dental implantation without complications

hematoxylin eosin staining specimens sequestrum chronic — **Figure 5**Hematoxylin and eosin staining of the specimens. (a) Sequestrum (×10), showing chronic inflammation (asterisk) and bone matrix destruction (B). (b) Red fluorescent bone tissue (×20), show-ing destructed bone matrix (B) with actinomycosis infection (Black arrow). (c) Non-red fluorescent bone tissue (×20), showing vital bone matrix (B) with osteocytes without matrix destruction or bacterial invasion

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Favia 2015 case report	CC BY-NC-ND	a breast-cancer metastasis found WITHIN an MRONJ lesion, invisible on every image. CC BY-NC-ND: named and linked, figures not reproduced.	doi
Alla 2023 systematic review	CC BY	systematic review touching MRONJ risk.	doi

← All 47 complications

Branch A · Biological

Osteoradionecrosis and implants in irradiated bone

Necrosis of irradiated bone, with or without an implant in it. Distinguished from MRONJ by cause, not appearance.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Luo 2026 case series	CC BY	mentions ORN twice in a jaw-in-a-day case series.	doi
Van Der Kelen 2025 case series	CC BY	one mention, mandibular reconstruction.	doi
Sass 2021 case series	CC BY	one mention.	doi
Bayram 2023 randomised controlled trial	CC BY	one mention.	doi

What is missing

There is no osteoradionecrosis case in this corpus. Four papers mention ORN in passing and none documents one. An earlier automated scan of this corpus reported "15 papers, 4 strong" for ORN; that count was spurious and is recorded here so it is not rediscovered. Irradiated bone is on the risk line at Z4 and the day teaches it, so this is a real hole rather than a tidy one.

← All 47 complications

Branch A · Biological

Prosthesis infraposition in the growing patient

An implant placed before growth finished behaves as an ankylosed tooth. The jaw keeps growing; the crown does not come with it.

Evidenced A published case, with its figures.

Leventis 20253 of 15 published figures

An implant placed at 18, presenting at 30. Continued skeletal growth has partially submerged the crown into the soft tissues; the distance from implant platform to soft tissue zenith is measured, and the old and new restorations are photographed side by side. Twelve years is the follow-up interval that makes the point, and almost nothing in the corpus runs that long.

Leventis et al. 2025. Reproduced under CC BY.

← All 47 complications

Branch B · Mechanical and prosthetic

Abutment screw loosening

Loss of preload at the abutment screw. The commonest mechanical complication in most series, and the one least represented here.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Kämmerer 2023 systematic review	CC BY	Table 2 is the corpus’s only tabulated prosthetic-complication column — abutment screw loosening among them, across 33 zygomatic studies. Every cell proved against the PDF text layer.	doi
Zita Gomes 2016 retrospective multicentre clinical study	CC BY	records prosthetic complications from provisional placement onward in 25 patients, 40 implants.	doi
Al-Nawas 2023 consensus report	CC BY	consensus report naming it among the long-term mechanical complications of zygomatic reconstructions.	doi
Fan 2023 meta-analysis	CC BY	Table 4, survival and complication report.	doi

What is missing

No photograph, and no case. Note what the sources have in common: the numbers come from the ZYGOMATIC literature, not from conventional implants. Quoting them as general prosthodontic complication rates would be wrong. A conventional full-arch maintenance series would close this entry and four others below.

← All 47 complications

Branch B · Mechanical and prosthetic

Abutment screw fracture

The screw shears, usually after a period of repeated loosening nobody treated as a warning.

Evidenced A published case, with its figures.

Alwaqyan 20262 of 10 published figures

Atraumatic Retrieval of a Fractured Implant Screw in a Maxillary Locator-Retained Overdenture: A Longitudinal Case Report Cureus 2026 case report doi:10.7759/cureus.110170

A 67-year-old woman with diabetes, heavy smoking and years of documented prosthetic maintenance problems on a maxillary locator-retained overdenture. The panoramic shows the rehabilitation; the periapical shows the fractured screw sitting inside the implant connection.

Alwaqyan et al. 2026. Reproduced under CC BY 4.0.

panoramic radiographic evaluation demonstrating maxillary mandibular — **Figure 1**Panoramic radiographic evaluation demonstrating maxillary and mandibular implant-supported prosthetic rehabilitation

periapical radiographic fractured prosthetic screw within — **Figure 2**Periapical radiographic view of the fractured prosthetic screw within the maxillary implant connection

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Kämmerer 2023 systematic review	CC BY	Table 2, prosthetic complications.	doi
Al-Nawas 2023 consensus report	CC BY	consensus.	doi
Huang 2024 case report	CC BY	one mention.	doi

← All 47 complications

Branch B · Mechanical and prosthetic

Retrieval of fractured components

Getting the fragment out without destroying the connection you are trying to save.

Evidenced A published case, with its figures.

Alwaqyan 20268 of 10 published figures

Atraumatic Retrieval of a Fractured Implant Screw in a Maxillary Locator-Retained Overdenture: A Longitudinal Case Report Cureus 2026 case report doi:10.7759/cureus.110170

The conservative retrieval sequence in full: laser-assisted soft tissue access, ultrasonic mobilisation of the fragment, adhesive-assisted engagement with a flexible micro-applicator tip, atraumatic retrieval, then the connection inspected and radiographed afterwards. The paper is candid that ultrasonics risks overheating, apical displacement of the fragment and damage to the internal threads — which is the argument for photographing the connection after, not just the fragment out.

Alwaqyan et al. 2026. Reproduced under CC BY 4.0.

laser assisted soft tissue management initial clinical — **Figure 3**Laser-assisted soft tissue management and initial clinical access to the fractured prosthetic screw site

ultrasonic mobilization fractured prosthetic screw fragment — **Figure 5**Ultrasonic mobilization of the fractured prosthetic screw fragment

adhesive assisted engagement fractured prosthetic screw fragment — **Figure 6**Adhesive-assisted engagement of the fractured prosthetic screw fragment using a flexible micro-applicator tip

atraumatic retrieval fractured prosthetic screw fragment — **Figure 7**Atraumatic retrieval of the fractured prosthetic screw fragment from the implant connection

clinical evaluation implant connection fractured screw — **Figure 9**Clinical evaluation of the implant connection following fractured screw retrieval

postoperative radiographic evaluation implant fixture — **Figure 10**Postoperative radiographic evaluation of the implant fixture

← All 47 complications

Branch B · Mechanical and prosthetic

Attachment wear and loss of retention

The overdenture stops holding. Wear, not failure — and it arrives on a schedule rather than as an event.

Evidenced A published case, with its figures.

Alwaqyan 20261 of 10 published figures

Atraumatic Retrieval of a Fractured Implant Screw in a Maxillary Locator-Retained Overdenture: A Longitudinal Case Report Cureus 2026 case report doi:10.7759/cureus.110170

Mandibular Unilateral Paresthesia Following Implant Placement and Clinical Management: Clinical Case Report Cureus 2024 case report doi:10.7759/cureus.64001

A 65-year-old man, two years after an implant at 46, with numbness of the right lip and drooling. OPG and CBCT show the implant apex resting on the mandibular canal. The well-integrated implant was retrieved, and neurosensory function returned completely over six weeks — the paper plots the recovery. The site was then restored with a three-unit fixed partial denture: the honest end of this story is a bridge, not another implant.

Baskaran et al. 2024. Reproduced under CC BY 4.0.

clinical photograph prosthetic crown signs inflammat — **Figure 1**Clinical photograph of 46 with a prosthetic crown and 45 with clinical signs of inflammation

orthopantanogram implant apex impinging inferior alv — **Figure 2**Orthopantanogram showing implant apex impinging on the inferior alveolar nerve canal

cone beam computed tomography implant apex — **Figure 3**Cone beam computed tomography image showing implant apex impinging on the inferior alveolar nerve canal

intra operative photograph implant circumferential b — **Figure 4**Intra-operative photograph showing the implant and circumferential bone loss in relation to 46 after elevation of the periodontal flaps

surgically retrieved implant — **Figure 5**Surgically retrieved implant

extracted socket implant retrieval — **Figure 6**Extracted socket after implant retrieval

postoperative photograph provisional three unit fixe — **Figure 7**Postoperative photograph showing provisional three-unit fixed partial denture in relation to 45, 46, and 47 and complete re- establishment of neurosensory function

diagrammatic representation neurosensory re establi — **Figure 8**Diagrammatic representation of neurosensory re- establishment as experienced by the patient over the six weeks period

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Froum 2021 retrospective study	CLOSED	retrospective study, the densest treatment of nerve injury in the corpus. CLOSED — numbers and DOI only.	doi
Bayram 2023 randomised controlled trial	CC BY	randomised controlled trial of piezo versus conventional ramus harvest. The nerve was exposed in five patients, three piezo and two conventional; paraesthesia lasted up to six weeks and none was permanent. The authors attribute it to osteotome separation of the block rather than to the drill.	doi
Mistry 2021 in vitro pilot study (3D-printed models)	CC BY	in-vitro 3D-printed model study. In case 6 both freehand and fully guided placement finished closer to the IAN than planned, and the authors state the drill tip would likely have damaged it — a guide is not a guarantee.	doi
Sen 2025 retrospective study	CC BY	CBCT anatomy of the mylohyoid ridge, lingual concavity and their relationship to the mandibular canal in 200 patients.	doi
Cimen 2025 observational study	CC BY	anterior loop of the mental foramen against the maximum symphysis block, 408 CBCTs.	doi

← All 47 complications

Branch C · Surgical and early

Lingual nerve injury

Rarer than IAN injury at implant placement, and harder to attribute.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Bayram 2023 randomised controlled trial	CC BY	one mention in a ramus-harvest RCT.	doi
Fernandes 2025 case series	CC BY	one mention.	doi
Baskaran 2024 case report	CC BY	one mention.	doi
Hwang 2013 case report	CC BY-NC	one mention. CC BY-NC.	doi
Urban 2023 narrative review	GREEN	two mentions. GREEN — no reuse rights.	doi
Sanz-Sánchez 2022 narrative review	CLOSED	one mention. CLOSED.	doi

What is missing

Six single mentions, no case. Every source that discusses it does so while discussing something else.

← All 47 complications

Branch C · Surgical and early

Canalis sinuosus and nasopalatine neurovascular injury

Injury to the anterior superior alveolar neurovascular bundle, or to the contents of the nasopalatine canal, during anterior maxillary placement.

Evidenced A published case, with its figures.

McCrea 2017all 12 published figures

Aberrations Causing Neurovascular Damage in the Anterior Maxilla during Dental Implant Placement Case Reports in Dentistry 2017 case report doi:10.1155/2017/5969643

An implant at 21 that invaded the nasopalatine duct and an aberrant neurovascular canal below the canalis sinuosus. The occlusal film showing both incisive canal orifices, the labial glove reflection showing xenograft that never ossified, the implant unscrewed with Adams pliers and almost no removal torque, and a probe passed into the patent aberrant canal. UK author.

McCrea et al. 2017. Reproduced under CC BY.

periapical radiographs taken initial consultation re — **Figure 2**Periapical radiographs taken at initial consultation, showing a restored dental implant in position 21 (FDI-Notation) with no obvious signs of peri-implantitis. That restored implant carried a two-crown distal cantilever bridge

standard occlusal radiograph taken initial consultat — **Figure 3**Standard occlusal radiograph taken at initial consultation. The orifices of bilateral nasopalatine canals can be seen clearly apical to the central incisor teeth—the incisive canals: one at the apex of the implant and the other at the apex of natural tooth 11

clinical presentation initial consultation displayin — **Figure 4**Clinical presentation at initial consultation displaying the erythematous buccal mucosa at implant position 21 (FDI-Notation)

classical labial glove reflection buccal mucosa — **Figure 7**Classical labial “glove” reflection of buccal mucosa displaying the lack of osteogenesis of the xenograft at the buccodistal surface of the implant in position 21 with the lack of coverage of the implant surface

implant has been simply unscrewed minimal — **Figure 8**The implant has been simply “unscrewed” with minimal removal torque applied via Adams Orthodontic Pliers

probing implantotomy site demonstrate apical portion — **Figure 9**Probing of the implantotomy site to demonstrate that the apical portion was in the nonresistant nasopalatine canal

xenograft easily debrided osteotomy site display — **Figure 10**The xenograft was easily debrided from the osteotomy site to display the very patent aberrant canal present between the nasopalatine duct and the aberrant vascular canal

membrane bio gide has been secured under — **Figure 11**The membrane Bio-Gide has been secured under the palatal tissue at the operative site. Bio-Gide has also been placed at the perforation of the NPD and the distal opening of the conduit inferior to the multiple foramina. The xenograft Bio-Oss has been packed into the “conduit” and then used to augment the deficient buccal bony surface

bio gide has been folded over bio oss — **Figure 12**Bio-Gide has been folded over the Bio-Oss granules

labial glove has been replaced secured — **Figure 13**The “labial glove” has been replaced and secured with interrupted 5.0 PROLENE sutures

temporary adhesive bridge has been placed — **Figure 14**Temporary adhesive bridge has been placed, replacing teeth 21 and 22 and protecting the surgical site

surgicalsite8monthspostoperatively — **Figure 15**Surgical site 8 months postoperatively. 8 Case Reports in Dentistry.

Volberg 2019all 2 published figures

Canalis Sinuosus Damage after Immediate Dental Implant Placement in the Esthetic Zone Case Reports in Dentistry 2019 case report doi:10.1155/2019/3462794

A 45-year-old woman, immediate placement at an upper left lateral incisor, implant removed at sixteen days for pain and paraesthesia. Figure 5 is palatal mucosal necrosis after removal. Pair it with McCrea: two independent teams, the same missed structure, which is a systematic blind spot rather than bad luck.

Volberg et al. 2019. Reproduced under CC BY.

intraoperative immediate implant placement upper lef — **Figure 2**Intraoperative view. Immediate implant placement in the upper left lateral incisor region after GBR and soft tissue grafting. The healing abutment was placed and ﬂaps were sutured

palatal mucosa necrosis dental implant extraction — **Figure 5**Palatal mucosa necrosis after dental implant extraction

Yılmaz 2025the anatomy at risk, not the injuryall 3 published figures

Examination and Relationship of Posterior Superior Alveolar Artery and Canalis Sinuosus Using Cone Beam CT Biomimetics 2025 retrospective study doi:10.3390/biomimetics10060352

Not a complication case — the anatomy behind both of them. 323 CBCT scans measuring the canalis sinuosus and the posterior superior alveolar artery, including the distance from the CS to the nasal floor.

Yılmaz et al. 2025. Reproduced under CC BY 4.0.

evaluation psaa parameters diameter distance sinus — **Figure 1**Evaluation of PSAA parameters: (a) diameter of PSAA, (b) distance of PSAA from sinus floor, (c) distance of PSAA from alveolar crest, (d) distance of PSAA from midline

evaluation parameters distance nasal cavity floor — **Figure 2**Evaluation of CS parameters: (a) distance to nasal cavity floor from CS, (b) distance to buccal bone from CS, (c) distance to alveolar crest from CS

research diagram flow study — **Figure 3**Research diagram flow of this study

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Alqhtani 2025 retrospective study	CC BY	one mention alongside the PSAA analysis.	doi

← All 47 complications

Branch C · Surgical and early

Floor-of-mouth haemorrhage and sublingual haematoma

Perforation of the lingual plate in the anterior mandible tearing a sublingual or submental vessel. Swelling advances faster than the airway can tolerate.

Shown indirectly The figures here are the anatomy at risk or the meta-analysis — evidence about this complication, not a picture of it.

Sen 2025the anatomy at risk, not the injuryall 4 published figures

Anatomical Relationship of the Mylohyoid Ridge, Lingual Concavity, and Mandibular Canal: A Retrospective CBCT Study Diagnostics 2025 retrospective study doi:10.3390/diagnostics15172233

Not the complication — the anatomy that causes it. Lingual concavity depth and height, mylohyoid ridge position, and their distances to the mandibular canal, measured between the first and second molar roots in 200 patients.

Sen et al. 2025. Reproduced under CC BY.

sagittal cross sectional hemimandible cbct point between — **Figure 1**Sagittal and cross-sectional hemimandible on CBCT: (A) Point between the second molar and first molar tooth root in the sagittal image; (B) Cross-sectional images showing mylohyoid ridge (MR), lingual concavity (LC), mandibular canal (MC)

diagrammatic representation reference points horizontal depth — **Figure 2**Diagrammatic representation of reference points: (1) LC horizontal depth; (2) LC height; (3) LC depth; (4) MR height; (5) MR depth; (6) MR-MC; (7) LC-MC. Mylohyoid ridge (MR), lingual concavity (LC), mandibular canal (MC)

diagram mean measured variables left right — **Figure 3**Diagram of mean measured variables on the left and right sides

diagram mean measured variables males females — **Figure 4**Diagram of mean measured variables in males and females

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Hwang 2013 case report	CC BY-NC	a mandibular anterior implant bleed controlled by angiographic embolisation before swelling obstructed the airway, avoiding intubation or tracheostomy. CC BY-NC: named and linked, figures not reproduced.	doi
Barrientos-Lezcano 2021 case report	CC BY-NC-SA	sublingual haematoma with breathing difficulty and falling saturations, managed by percutaneous tracheostomy under local anaesthesia with no surgical approach to the haematoma, which resolved spontaneously. CC BY-NC-SA: named and linked, figures not reproduced.	doi
Alqhtani 2025 retrospective study	CC BY	PSAA anatomy — the posterior equivalent risk.	doi

What is missing

This is the sharpest licence casualty in the atlas. The corpus holds TWO good cases of a life-threatening complication, from two countries, with opposite management — embolisation versus tracheostomy — and neither may have its images reproduced. The anatomy is shown instead. Anyone teaching this should read both papers at their DOI and consider requesting permission.

← All 47 complications

Branch C · Surgical and early

Posterior superior alveolar artery injury

Bleeding from the PSAA during lateral-window sinus surgery. Rarely dangerous, reliably alarming, and predictable from a CBCT.

Shown indirectly The figures here are the anatomy at risk or the meta-analysis — evidence about this complication, not a picture of it.

Alqhtani 2025the anatomy at risk, not the injuryall 6 published figures

CBCT-Based Retrospective Analysis of Posterior Superior Alveolar Artery Anatomy in a Saudi Population Diagnostics 2025 retrospective study doi:10.3390/diagnostics15232999

117 CBCT scans, 234 sinuses: prevalence, visibility, diameter, and distance of the PSAA from the alveolar crest, sinus floor, medial wall and septa, with associations tested against age, sex and smoking.

Alqhtani et al. 2025. Reproduced under CC BY 4.0.

outcomes included measuring coronal section distance — **Figure 1**The outcomes included measuring the following in the coronal section: the distance from the artery to the (A) ridge crest; (B) floor of the maxillary sinus; (C) medial wall of the sinus. (D) The height of the alveolar ridge and (E) the diameter of the artery were also measured, as well as the presence or absence of the septa in the sinus. The measurements were taken at two locations corresponding to the premolar and molar regions

location psaa categorized outer cortex lateral — **Figure 2**The location of the PSAA is categorized as (A) on the outer cortex of the lateral sinus wall, (B) intraosseous, or (C) below the membrane at locations corresponding to the premolar and molar regions

mean distance posterior superior alveolar artery — **Figure 3**Mean distance from the posterior superior alveolar artery (PSAA) to the alveolar crest in premolar and molar regions on both right and left sides (in millimeters)

distribution psaa diameters smoking status — **Figure 5**Distribution of PSAA Diameters by Smoking Status

mean distance psaa sinus floor septa — **Figure 6**Mean Distance from PSAA to Sinus Floor by Septa Presence

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Yılmaz 2025 retrospective study	CC BY	PSAA diameter and its distances from the sinus floor, alveolar crest and nasal septum in 323 scans.	doi

What is missing

The corpus can show you where the artery is, in two populations, and cannot show you one bleeding.

← All 47 complications

Branch C · Surgical and early

Sinus membrane (Schneiderian) perforation

A tear in the sinus lining during elevation. Graded, repaired, or — as here — deliberately left.

Evidenced A published case, with its figures.

Park 2022all 4 published figures

Tomographic Imaging of Mucociliary Clearance Following Maxillary Sinus Augmentation: A Case Series Medicina 2022 case series doi:10.3390/medicina58050672

Four patients whose Schneiderian membrane was perforated during augmentation and NOT repaired, so graft particles entered the sinus. Serial CBCT tracks them: the particles migrate to the ostium along the sinus wall immediately, and by one week none is visible. Mucociliary clearance photographed rather than asserted — which is a much better argument than a rule about perforation size.

Park et al. 2022. Reproduced under CC BY 4.0.

cbct mucociliary clearance mcc coronal left — **Figure 1**CBCT images of mucociliary clearance (MCC) in case 1: (a) A coronal image of the left

cbct mcc coronal tooth large mass — **Figure 2**CBCT images of MCC in case 2: (a) In the coronal image of tooth #15, a large mass of bone

cbct mcc coronal immediately — **Figure 3**CBCT images of MCC in case 3: (a) The coronal image of the CBCT immediately after the

cbct mcc coronal implant site taken — **Figure 4**CBCT images of MCC in case 4: (a) The coronal image of #26 implant site on CBCT taken

Park 20241 of 6 published figures

Surgical Drainage and Simultaneous Sinus Floor Augmentation in Patients with Chronic Maxillary Sinusitis Medicina 2024 case report doi:10.3390/medicina60081256

A Prichard elevator used to protect the perforated sinus floor during simultaneous implant placement.

Park et al. 2024. Reproduced under CC BY 4.0.

caseprichard elevator surgical proceduresprotect per — **Figure 5**of a CasePrichard 2. elevator Surgical to proceduresprotect perforated including (a) site, sinus (b) floorimplant placement

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Assiri 2025 cross-sectional study	CC BY	maxillary sinus septa in 350 CBCTs — the anatomical variation most likely to tear a membrane.	doi
Dotia 2024 case report	CC BY	dynamic navigation for lateral window design, planning the window rather than repairing it.	doi
Raouf 2024 systematic review	CC BY	one mention.	doi

← All 47 complications

Branch C · Surgical and early

Implant displaced into the maxillary sinus

The implant leaves the alveolus. Usually at second stage, usually into an atrophic posterior maxilla.

Evidenced A published case, with its figures.

Kasapoglu 2026all 8 published figures

Dental Implant Displacement Into the Maxillary Sinus Ostium: A Case Report of Customized Surgical Management Cureus 2026 case report doi:10.7759/cureus.106421

A 75-year-old woman, implant displaced intraoperatively during full-arch rehabilitation, initially at the sinus floor and found a week later AT THE OSTIUM on CBCT — it moved, probably with head movement. Retrieved intraorally through a lateral window using a custom-notched explorer and rhodium-coated mirrors, sealed with a Bichat fat pad. The migration is the teaching point: the follow-up scan is not a formality.

Kasapoglu et al. 2026. Reproduced under CC BY 4.0.

periapical radiograph dental implant displaced into — **Figure 1**Periapical radiograph showing the dental implant displaced into the left maxillary sinus

radiological views displaced implant panoramic radiograph — **Figure 2**Radiological views of the displaced implant. Panoramic radiograph showing the displaced implant oriented horizontally and extending toward the orbital floor and nasal cavity (A). Coronal section from CBCT confirming proximity to the nasal cavity (B). Axial CBCT section showing horizontal orientation of the implant within the sinus

custom modified dental explorer notched tip designed — **Figure 3**Custom-modified dental explorer with a notched tip, designed to engage the implant threads for retrieval

intraoperative creation bony window lateral wall — **Figure 4**Intraoperative image showing the creation of a bony window in the lateral wall of the maxillary sinus

intraoperative use rhodium coated dental mirror indirect — **Figure 5**Intraoperative use of rhodium-coated dental mirror for indirect visualization of the implant within the maxillary sinus

retrieval implant intraoral within maxillary sinus — **Figure 6**Retrieval of the implant. Intraoral view showing the implant within the maxillary sinus prior to retrieval (A). Postoperative panoramic radiograph taken after retrieval of the implant (B). Clinical photograph of the removed implant (C)

closure surgical site placement bichat fat — **Figure 7**Closure of the surgical site. Placement of a Bichat fat pad graft at the surgical site (A). Mucosal closure of the bony window area (B). Final view after primary closure (C)

clinical follow up three months demonstrating uneventful — **Figure 8**Clinical follow-up at three months demonstrating uneventful healing and intact mucosal integrity

Bär 20243 of 4 published figures

Displacement of maxillary dental implants: a case series on various scenarios BMC Oral Health 2024 case series doi:10.1186/s12903-024-05022-x

Case 1, displacement into the sinus with immediate removal under local anaesthesia. Case 3, displacement with a removal attempt 72 hours later under general anaesthesia — and the abdominal film that found it, because by then the patient had swallowed it. Delay is the variable the series is actually about.

Bär et al. 2024. Reproduced under CC BY 4.0.

implant displacement into maxillary sinus immediate — **Figure 1**Case 1 - Implant displacement into maxillary sinus and immediate removal under local anaesthesia. a Baseline Panoramic radiograph showing limited vertical residual bone in the right upper second molar area. b Postoperative radiograph taken after completion of osteotome sinus floor elevation and implant insertion. c Panoramic radiograph taken immediately before removal procedure: shows implant migration into the right maxillary sinus following second-stage surgery four months later, along with mucosal thickening indicative of maxillary sinusitis. d Intraoperative endoscopic view of the displaced dental implant though the upper maxilla after creating a bony window and e Endoscopic-assisted removal of the implant using Blakesley forceps

implant displacement into maxillary sinus removal — **Figure 3**Case 3 – Implant displacement into the maxillary sinus and removal attempt 72 hours later under general anaesthesia imaging of implant surgery. a Baseline CBCT of the Maxilla: The CBCT for Case 3 illustrates progressive pneumatization of the maxillary sinuses and advanced alveolar ridge atrophy (Cawood and Howell VI) on both sides. The lower images detail the residual alveolar ridge height of less than 1.5 mm in the left maxillary second molar region. b Postoperative Panoramic radiograph taken after completion of sinus floor elevation on both sides with bone grafting and simultaneous insertion of dental implants in the maxilla and mandible. The radiograph shows bilateral lifting of the sinus membrane and a residual bone height of less than 1.5 mm, with poor initial stability in the left maxillary second molar region. c CBCT taken immediately after Implant Displacement into the Maxillary Sinus during Second-stage surgery five months later: The CBCT scan indicated the presence of the implant from the left upper second molar region within the left maxillary sinus, proximal to the wide ostium. Additionally, the scan showed bilateral mucosal thickening, indicative of chronic sinusitis

postoperative imaging detection migrated implant intraoperative — **Figure 4**Case 3 – postoperative imaging for detection of the migrated implant. a Intraoperative C-arm X-ray. b Postoperative Abdominal X-ray: Revealed the displaced implant in the ascending colon, suggesting spontaneous expulsion and ingestion. c Postoperative Panoramic radiograph: Displays the osseointegrated implants and the bony defect in the left upper second molar region

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Sun 2023 retrospective study	CC BY	retrospective study, two mentions.	doi
Giasimakopoulos 2026 case report	CC BY	three mentions.	doi

← All 47 complications

Branch C · Surgical and early

Implant displaced into the nasal cavity

Rarer than the sinus, and reached through a different specialty’s door.

Evidenced A published case, with its figures.

Bär 20241 of 4 published figures

Displacement of maxillary dental implants: a case series on various scenarios BMC Oral Health 2024 case series doi:10.1186/s12903-024-05022-x

Case 2, displacement into the nasal cavity with a removal attempt under general anaesthesia the following day. CBCT localisation.

Bär et al. 2024. Reproduced under CC BY 4.0.

implant displacement into nasal cavity removal — **Figure 2**Case 2 - Implant displacement into Nasal Cavity and removal attempt under general anaesthesia the following day. a-c Cone-beam computed tomography (CBCT) taken immediately after displacement revealed the implant on the floor of the nasal cavity, left to the nasal septum. The scan also indicated discrete bilateral mucosal thickening, suggestive of chronic sinusitis. a axial view, (b) coronal view (arrow indicates the bony destruction), (c) volume rendering. d Anterior Rhinoscopy showing protrusion of the posterior nasal floor with slight obstruction of the lower nasal meatus. Lower raw: Postoperative Imaging for Detection of the Migrated Implant: e CT of the paranasal sinuses (PNS): The topogram displays the four osseointegrated implants but does not show the migrated one. f CT PNS coronal view: Features partial opacification of the ethmoidal cells bilaterally. There is wide, concentric mucosal swelling in the left maxillary sinus, along with broad mucosal swelling at the medial wall of the right maxillary sinus and in the septated right portion of the sphenoidal sinus. g Chest X-Ray: Shows no evidence of foreign body aspiration

Giasimakopoulos 2026all 3 published figures

Endoscopic Removal of a Displaced Dental Implant From the Tail of the Inferior Nasal Concha Cureus 2026 case report doi:10.7759/cureus.104341

An 11 x 4 mm implant lodged beneath the tail of the left inferior nasal concha after placement at 23, with haemorrhagic collection in the nasal cavity and ipsilateral sinus, and a failed prior retrieval attempt. Removed endoscopically under local anaesthesia with ENT. The endoscopic intraoperative view is the figure that earns its place.

Giasimakopoulos et al. 2026. Reproduced under CC BY 4.0.

scan sagittal coronal axial views cylindrical — **Figure 1**CT scan (A: sagittal, B: coronal, and C: axial views). A cylindrical, hyperdense foreign body measuring approximately 11 × 4 mm situated beneath the tail of the left inferior nasal concha, extending posteriorly toward the choana (red arrow). Evidence of hemorrhagic collection within the left nasal cavity and the ipsilateral maxillary sinus (yellow arrow)

scan sagittal coronal axial views initial — **Figure 2**CT scan (A: sagittal, B: coronal, and C: axial views). Initial implant site, positioned approximately in the site of the upper left canine #23, communicating with the nasal cavity (red arrow). Evidence of hemorrhagic collection within the left nasal cavity and the ipsilateral maxillary sinus (yellow arrow)

endoscopic intraoperative displaced dental implant lodged — **Figure 3**Endoscopic intraoperative view showing the displaced dental implant lodged beneath the left inferior nasal concha prior to removal

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Li 2020 case report	CC BY-NC	a 23-year-old man, implant migrated to the nasal cavity, removed with endoscope, bayonet forceps, curved hooks and suction under local anaesthesia in an ambulatory setting. CC BY-NC: named and linked, figure not reproduced.	doi

← All 47 complications

Branch C · Surgical and early

Maxillary sinusitis after implant or sinus surgery

Sinus disease caused by, or complicating, implant treatment in the posterior maxilla.

Evidenced A published case, with its figures.

Park 2024all 6 published figures

Surgical Drainage and Simultaneous Sinus Floor Augmentation in Patients with Chronic Maxillary Sinusitis Medicina 2024 case report doi:10.3390/medicina60081256

Two patients needing sinus floor augmentation who already had chronic maxillary sinusitis — one nasal in origin, one dental. Two weeks of antibiotics changed little, both refused endoscopic sinus surgery, and both were managed by intraoral surgical drainage through a large lateral window. Augmentation went ahead. This is the pre-existing-disease case, not the caused-it case.

Park et al. 2024. Reproduced under CC BY 4.0.

preoperative radiographs severe atrophy — **Figure 1**Case 1. 1. Preoperative radiographs.. (a) (a) Severe atrophy of

surgical procedures mucoperiosteal flap reflection — **Figure 2**Case 1. 1. Surgical procedures.. (a) (a) Mucoperiosteal flap reflection

figure case1 postoperative postoperativeradiographs — **Figure 3**3.Case Figure Case1.1.Postoperative Postoperativeradiographs. radiographs.(a) (a)Panoramic radiograph of thethe right

preoperative panoramic radiograph apical lesion — **Figure 4**Case 2.2. (a) (a) Preoperative panoramic radiograph showing panoramic radiograph showing the apical lesion at

panoramic cbct before surgery immediately figure — **Figure 6**Case 2. Panoramic CBCT images before surgery (a), immediately after surgery (b), and 1 Figure year

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Kämmerer 2023 systematic review	CC BY	Table 2 has a dedicated sinusitis column across 33 zygomatic studies.	doi
Gracher 2021 systematic review	CC BY	Table 2 tabulates sinusitis, paraesthesia, local infection and fistulae at implant level across 42 zygomatic studies. Every cell proved against the PDF.	doi
Al-Nawas 2023 consensus report	CC BY	consensus report; sinusitis is the defining long-term zygomatic complication.	doi
Park 2022 case series	CC BY	the mucociliary clearance mechanism that usually prevents it.	doi

← All 47 complications

Branch C · Surgical and early

Oroantral fistula

A permanent communication between mouth and sinus at the implant site.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Kämmerer 2023 systematic review	CC BY	Table 2, oroantral fistula formation column.	doi
Gracher 2021 systematic review	CC BY	Table 2, fistulae at implant level across 42 zygomatic studies.	doi
Kasapoglu 2026 case report	CC BY	explicitly records that this patient had NO oroantral communication despite the displacement — a negative finding worth keeping.	doi

What is missing

Counted in two zygomatic reviews, photographed nowhere.

← All 47 complications

Branch C · Surgical and early

Aspiration or ingestion of a component

The component leaves the field entirely. An airway question until proven otherwise.

Evidenced A published case, with its figures.

Bär 20241 of 4 published figures

Displacement of maxillary dental implants: a case series on various scenarios BMC Oral Health 2024 case series doi:10.1186/s12903-024-05022-x

Case 3: the intraoperative C-arm film, then the postoperative ABDOMINAL radiograph that located the displaced implant after the patient swallowed it during a delayed retrieval attempt. One of the three implants in this series was never located at all.

Bär et al. 2024. Reproduced under CC BY 4.0.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Park 2024 case report	CC BY	two mentions.	doi

← All 47 complications

Branch C · Surgical and early

Orbital and infratemporal penetration

The recognised catastrophic risk of zygomatic and pterygoid anchorage.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Kämmerer 2023 systematic review	CC BY	systematic review of zygomatic insertion techniques.	doi
Al-Nawas 2023 consensus report	CC BY	consensus report.	doi
Grecchi 2021 cadaver study	CC BY	cadaver study with planned-versus-placed zygomatic overlays — the closest the corpus comes to showing where a zygomatic implant actually ends up.	doi
Kasapoglu 2026 case report	CC BY	the displaced implant was oriented toward the orbital floor, which is why it was retrieved rather than watched.	doi

What is missing

No case. The corpus teaches this risk through cadaver overlays and consensus statements, which is probably the only ethical way it gets taught, but it means there is no photograph.

← All 47 complications

Branch C · Surgical and early

Malposition

The implant is where it should not be. The commonest avoidable complication, and the cause of most of the others in this atlas.

Evidenced A published case, with its figures.

Baskaran 20242 of 8 published figures

Mandibular Unilateral Paresthesia Following Implant Placement and Clinical Management: Clinical Case Report Cureus 2024 case report doi:10.7759/cureus.64001

OPG and CBCT with the implant apex resting on the mandibular canal. Malposition photographed as a position, before it is photographed as a consequence.

Baskaran et al. 2024. Reproduced under CC BY 4.0.

McCrea 20173 of 12 published figures

Aberrations Causing Neurovascular Damage in the Anterior Maxilla during Dental Implant Placement Case Reports in Dentistry 2017 case report doi:10.1155/2017/5969643

The occlusal film showing the implant apex at an incisive canal orifice, then a probe passed into the non-resistant nasopalatine canal, then the patent aberrant canal exposed.

McCrea et al. 2017. Reproduced under CC BY.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Monje 2025 systematic review	CC BY	positioning that does not permit hygiene as a driver of peri-implant disease — malposition arriving late, as biology.	doi
Mistry 2021 in vitro pilot study (3D-printed models)	CC BY	freehand versus fully guided deviation on 3D-printed replicas of real patients.	doi
Fan 2023 meta-analysis	CC BY	meta-analysis, accuracy of dynamic navigation.	doi
Kämmerer 2023 systematic review	CC BY	three mentions.	doi

← All 47 complications

Branch C · Surgical and early

Barrier membrane and titanium mesh exposure

The barrier becomes exposed to the mouth. The regenerative complication that decides whether the graft survives.

Evidenced A published case, with its figures.

Heggendorn 2022all 6 published figures

Complications in the guided bone regeneration technique associated with the d-PTFE membrane: case report RGO — Revista Gaúcha de Odontologia 2022 case report doi:10.1590/1981-86372022004620200217

The case the corpus was missing until 2022. A d-PTFE membrane over a tenting screw and autogenous platelet graft, exposed at three months, membrane and screws removed at seven, three implants placed, exposed threads covered and re-membraned, and the whole sequence followed radiographically. The project had previously concluded no CC BY photograph of an exposed membrane existed and adopted a chart fallback; this is the photograph.

Heggendorn et al. 2022. Reproduced under CC BY.

note 6 of these have no published caption in our index and carry our own description.

cone beam computed tomography performed prior — **Figure 1***our description* Cone beam computed tomography performed prior

clinical radiographic tomographic condition presented evaluation — **Figure 2***our description* Clinical radiographic tomographic condition presented evaluation

gbr surgery correct bone defect extraction — **Figure 3***our description* Gbr surgery correct bone defect extraction

postoperative period membrane exposure three months — **Figure 4***our description* Postoperative period membrane exposure three months

second surgical intervention gbr placement integrated — **Figure 5***our description* Second surgical intervention gbr placement integrated

post surgical control radiograph suggestive implant osseointegration — **Figure 6***our description* Post surgical control radiograph suggestive implant osseointegration

Zita Gomes 2016all 7 published figures

Alveolar Ridge Reconstruction with Titanium Meshes and Simultaneous Implant Placement: A Retrospective, Multicenter Clinical Study BioMed Research International 2016 retrospective multicentre clinical study doi:10.1155/2016/5126838

25 patients, 40 implants, titanium meshes placed with the implants and fixed over them: the fenestration at a right-side site, the meshes in place, their removal at second stage, CBCT, and the provisional restorations. Mean horizontal bone gain 3.67 mm.

Zita Gomes et al. 2016. Reproduced under CC BY.

note 7 of these have no published caption in our index and carry our own description.

presurgical clinical situation elevation full thickness flap — **Figure 1***our description* Presurgical clinical situation elevation full thickness flap

preparation surgical sites placement implants anyridge — **Figure 2***our description* Preparation surgical sites placement implants anyridge

details implant sites right site fenestration — **Figure 3***our description* Details implant sites right site fenestration

placement titanium meshes gen megagen gyeongbuk — **Figure 4***our description* Placement titanium meshes gen megagen gyeongbuk

second stage surgery removal titanium meshes impressions — **Figure 5***our description* Second stage surgery removal titanium meshes impressions

cone beam computed tomography cbct scans — **Figure 6***our description* Cone beam computed tomography cbct scans

prosthetic rehabilitations provisional restoration situ two — **Figure 7***our description* Prosthetic rehabilitations provisional restoration situ two

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Ng 2025 umbrella review	CC BY	umbrella review — the densest treatment of exposure in the corpus.	doi
Zhang 2022 network meta-analysis	CC BY	network meta-analysis of 11 interventions; figure 9 is a dedicated complication analysis.	doi
Soares 2025 retrospective case series	CLOSED	retrospective case series. CLOSED.	doi
Urban 2023 narrative review	GREEN	narrative review. GREEN — readable, no reuse.	doi
Sanz-Sánchez 2022 narrative review	CLOSED	narrative review. CLOSED.	doi

← All 47 complications

Branch C · Surgical and early

Wound dehiscence and flap breakdown

Primary closure fails. Tension, blood supply, or both.

Evidenced A published case, with its figures.

Heggendorn 20221 of 6 published figures

The membrane exposed in the postoperative period at three months.

Heggendorn et al. 2022. Reproduced under CC BY.

note 1 of these have no published caption in our index and carry our own description.

Sangkhamanee 20242 of 3 published figures

Soft tissue fenestration over an implant, and the partial-thickness envelope and graft used to close it.

Sangkhamanee et al. 2024. Reproduced under CC BY.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Zhang 2022 network meta-analysis	CC BY	network meta-analysis with a complication analysis figure.	doi
Calciolari 2023 network meta-analysis	CC BY-NC-ND	network meta-analysis. CC BY-NC-ND.	doi
Urban 2023 narrative review	GREEN	GREEN.	doi
Sanz-Sánchez 2022 narrative review	CLOSED	CLOSED.	doi

← All 47 complications

Branch C · Surgical and early

Graft failure and resorption

The augmentation does not take, or does not stay.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Sánchez-Sánchez 2021 systematic review	CC BY	systematic review.	doi
Soares 2025 retrospective case series	CLOSED	retrospective case series. CLOSED.	doi
Urban 2023 narrative review	GREEN	narrative review. GREEN.	doi
Sanz-Sánchez 2022 narrative review	CLOSED	narrative review. CLOSED.	doi
Zita Gomes 2016 retrospective multicentre clinical study	CC BY	horizontal bone gain measured against implant survival.	doi

What is missing

Three of the five best sources on this are licence-blocked for figures, and the two that are not do not photograph a failure. The corpus can tell you how often grafts fail and cannot show you one that did.

← All 47 complications

Branch C · Surgical and early

Donor-site morbidity

The bill the donor site sends. Pain, altered sensation, gait, contour — and it is consent material, not a footnote.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Daoud 2024 cohort study	CC BY	the consent slide: the mandibular donor site refills 64.5% at six months and 89.2% at one year, measured by segmentation and Boolean subtraction on CT.	doi
Bayram 2023 randomised controlled trial	CC BY	randomised controlled trial, piezo versus conventional ramus harvest — no difference in the primary outcome; nerve exposed in five patients, paraesthesia up to six weeks, none permanent.	doi
Sudhakar 2017 case series	UNKNOWN	iliac crest harvest morbidity in 12 patients — the only dedicated donor-site morbidity study in the corpus. Licence UNKNOWN, so its four figures are NOT reproduced pending verification at the publisher.	doi
Sass 2021 case series	CC BY	fibula harvest in three reconstructions.	doi
Sánchez-Sánchez 2021 systematic review	CC BY	systematic review.	doi

What is missing

The one dedicated study is licence-unknown and therefore blocked. Resolving Sudhakar’s licence at the publisher is the single cheapest way to add a case page to this atlas.

← All 47 complications

Branch C · Surgical and early

Postoperative infection and abscess

Infection of the surgical site or around the implant, short of established peri-implantitis.

Evidenced A published case, with its figures.

Ottesen 20222 of 5 published figures

A minor abscess facial to implant 24 in a patient on high-dose denosumab, then the same site as established peri-implantitis with oedematous mucosa. The right side, photographed alongside with no pathology, is the control.

Ottesen et al. 2022. Reproduced under CC BY.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Kaur 2021 systematic review and meta-analysis	CLOSED	systematic review and meta-analysis. CLOSED.
Gracher 2021 systematic review	CC BY	Table 2, local infection across 42 zygomatic studies.	doi
Kämmerer 2023 systematic review	CC BY	Table 2, soft tissue infection column.	doi
Heggendorn 2022 case report	CC BY	infection complicating the exposed membrane.	doi

← All 47 complications

Branch C · Surgical and early

Mandibular fracture, pathological and iatrogenic

The atrophic mandible breaks. Sometimes the reason the patient arrives, sometimes the reason they return.

Evidenced A published case, with its figures.

Sass 2021all 6 published figures

Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up Head & Face Medicine 2021 case series doi:10.1186/s13005-021-00297-9

Three large mandibular defects with basal continuity maintained — two from pathological fracture of an extremely atrophic mandible, one from oncological resection. Vertical augmentation with free microvascularised fibula, then implant-retained prosthetics, followed five to six years with no complications. Case 1 is photographed from the fracture on the day she presented through to her mouth six years after the fibula.

Sass et al. 2021. Reproduced under CC BY 4.0.

panoramic x ray top preoperative situation pathological — **Figure 1**Case 1. Panoramic X-ray images. Top: the preoperative situation. The pathological fracture of the right side of the extremely atrophied mandible with fractured mini plate. The right side was so extremely atrophied in this case that the mandibular bone underwent resorption after the augmentation. Bottom: panoramic X-ray at the 6-year follow-up: the entire body of the mandible was reconstructed with free vascularised fibula flap; dental rehabilitation was provided with two osseointegrated implants

clinical presentation physical before top years — **Figure 2**Case 1. Clinical presentation. A: physical presentation before (top) and 6 years after the reconstructive surgery (bottom). The pathological fracture caused marked facial asymmetry (top left) and an orocutaneous fistula had also formed (top right). The surgery eliminated the orocutaneous fistula and brought lasting improvement in the patient’s facial symmetry. B: preoperative status-the floor of the mouth protrudes because of the extreme atrophy and the lack of keratinised gingiva. C: status at the 6-year follow-up. No signs of inflammation or pocket formation around implants

panoramic x ray preoperative situation pathological fracture — **Figure 3**Case 2. Panoramic X-ray images. A: the preoperative situation. The pathological fracture of the left side of the extremely atrophied mandible. B: panoramic X-ray at the 5-year follow-up: the entire body of the mandible was reconstructed with free vascularised fibula flap. The patient received a screw-retained bridge on six osseointegrated implants. No bone resorption was noted around the implant sites

clinical presentation before surgery top year — **Figure 4**Case 2. Clinical presentation. A: before the surgery (top) and at the 5-year follow-up (bottom). B: The denture at the 5-year follow-up. The buccal aspect of the skin paddle was successfully thinned to an extent that - via the removal of the subcutaneous fat - it was possible to make an esthetically favorable outcome (C shows that the skin paddle is still visible in the floor of the mouth). At the same time, this method yields a sufficient amount of keratinised gingiva

panoramic x ray status radical cancer surgery — **Figure 5**Case 3. Panoramic X-ray images. A: status after the radical cancer surgery and before osseous reconstruction; B: status at the 5-year follow-up: the mandible was reconstructed with free vascularised fibula flap. No bone resorption was observed at the implant sites

clinical presentation three years radical cancer — **Figure 6**Case 3. Clinical presentation. A: three years after the radical cancer surgery. Clinical picture after gingivoplasty. The implants were surrounded by keratinised gingiva. Neither inflammation nor pocket formation was observed. B and C: clinical presentation at the 5-year follow-up

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Van Der Kelen 2025 case series	CC BY	one mention, mandibular reconstruction series.	doi
Favia 2015 case report	CC BY-NC-ND	one mention. CC BY-NC-ND.	doi

← All 47 complications

Branch C · Surgical and early

Thermal necrosis of the osteotomy

Bone killed by drilling heat. The 47 °C threshold is one of the oldest numbers in the field.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Albrektsson 1986 narrative review and proposed criteria	CLOSED	the source for controlled surgical technique and a maximum drill speed of 1,500 rpm to avoid overheating. CLOSED — © Quintessence. Quote the numbers, no figures. Note that the five success criteria are a bitmap in this PDF and are deliberately absent from the proved tables.
Bertolini 2019 systematic review	CC BY	lists overheating among risk indicators for peri-implantitis whose role "remains to be determined".	doi
Bayram 2023 randomised controlled trial	CC BY	piezosurgery generates low heat, minimising the possibility of thermal necrosis.	doi
Mistry 2021 in vitro pilot study (3D-printed models)	CC BY	irrigation used to stop the resin model overheating — a methods note, not a finding.	doi
Alwaqyan 2026 case report	CC BY	overheating listed as a risk of ultrasonic fragment retrieval.	doi

What is missing

No case, no histology, and the 47 °C threshold itself is not in this corpus — it sits in decks/live/deck-3d.html, sourced elsewhere. An earlier automated scan implied six papers covered thermal necrosis; all six mention heat while discussing something else. If this is to be taught as a number it needs a source acquired for the purpose.

← All 47 complications

Branch C · Surgical and early

Surgical emphysema

Air forced into the tissues, usually by an air-driven handpiece or an air-water syringe in an open flap.

Numbers only Covered in text or tables; nothing shown.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Kämmerer 2023 systematic review	CC BY	one mention.	doi
Al-Nawas 2023 consensus report	CC BY	one mention.	doi

What is missing

Two mentions, no case, no number. Present in the atlas because it is on the taxonomy and a reader should not have to wonder whether it was forgotten or is genuinely absent.

← All 47 complications

Branch D · Aesthetic

Mucosal recession

The margin migrates apically and the restoration lengthens. Usually announced by the patient, not the recall.

Evidenced A published case, with its figures.

Wen 2024all 3 published figures

Three months after immediate placement in the aesthetic zone: a labial fistula with mesial papillary recession, then peri-implant tissue collapsed horizontally and vertically. Reconstructed with a pedicled connective tissue flap and followed to eight years, with the labial and occlusal views at crown placement and at eight years side by side.

Wen et al. 2024. Reproduced under CC BY.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Gaddale 2024 systematic review and meta-analysis	CLOSED	systematic review and meta-analysis, the densest treatment of recession in the corpus. CLOSED, © British Dental Association — quote numbers, link the DOI, do not redistribute.	doi
Ravidà 2022 systematic review, meta-analysis and trial sequential analysis	CC BY-NC-ND	systematic review and meta-analysis. CC BY-NC-ND — a crop would be a derivative.	doi
Hakkers 2025 case series	CC BY	recession recorded alongside the peri-implantitis outcomes.	doi
Sangkhamanee 2024 case report	CC BY	recession with fenestration.	doi

← All 47 complications

Branch D · Aesthetic

Papilla loss

The interdental or inter-implant papilla does not fill. Between two adjacent implants it frequently cannot.

Evidenced A published case, with its figures.

Wen 20241 of 3 published figures

Papillary recession mesial to an immediately placed implant at three months, with a labial fistula.

Wen et al. 2024. Reproduced under CC BY.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Ravidà 2022 systematic review, meta-analysis and trial sequential analysis	CC BY-NC-ND	CC BY-NC-ND — numbers only.	doi

What is missing

One figure, in a case that is really about soft-tissue collapse. The corpus holds nothing on the inter-implant papilla, which is the version of this problem that cannot be grafted away.

← All 47 complications

Branch D · Aesthetic

Grey show-through

Titanium read through a thin mucosa, or through a recession that has exposed the platform.

No case The corpus does not document this.

Nothing in this corpus

NOTHING. Not a single paper in this corpus discusses grey show-through. This entry exists to record that, because an automated scan of the corpus reported eight papers covering it and every hit was false: "grey literature" in a search strategy, a grey contour line in a Mimics screenshot, and Gray’s Anatomy in a reference list. Absence of evidence in the corpus, not absence of the complication.

← All 47 complications

Branch D · Aesthetic

Emergence and contour failure

The restoration emerges wrongly — over-contoured, impossible to clean, or with the margin in the wrong place. Badly underrated, and the point where prosthetics hands the problem to biology.

Evidenced A published case, with its figures.

Leventis 202511 of 15 published figures

An infrapositioned crown with poor marginal adaptation, subgingival porcelain exposure and residual cement, producing 6-7 mm pockets with purulent discharge. Rebuilt with a chair-side customised anatomical healer, then a customised abutment and new restoration, followed to three years — the old and new restorations are photographed together.

Leventis et al. 2025. Reproduced under CC BY.

initial clinical steps fabrication customized anatomical — **Figure 5**Initial clinical steps in the fabrication of the customized anatomical healer

chair side fabrication customized anatomical healer — **Figure 6**Chair-side fabrication of the customized anatomical healer

clinical outcome placement customized anatomical abutment — **Figure 9**Clinical outcome following the placement of the customized anatomical abutment

final prosthesis — **Figure 11**Final prosthesis

evaluation fitting final restoration — **Figure 14**Evaluation at fitting of the final restoration

three year follow up — **Figure 15**Three-year follow-up

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Lin 2025 systematic review and meta-analysis	CC BY-NC-ND	CC BY-NC-ND — numbers only.	doi
Monje 2025 systematic review	CC BY	prosthesis contour and access for cleaning as a driver of peri-implant disease.	doi
Todaro 2023 case report	CC BY	the full digital workflow, as the counter-example of contour designed rather than discovered.	doi

← All 47 complications

Branch E · The return service

Explantation

Taking it out. Reverse torque, trephine or piezo — and the removal torque tells you what you are dealing with before the implant is out.

Evidenced A published case, with its figures.

McCrea 20171 of 12 published figures

Aberrations Causing Neurovascular Damage in the Anterior Maxilla during Dental Implant Placement Case Reports in Dentistry 2017 case report doi:10.1155/2017/5969643

The implant "simply unscrewed" with minimal removal torque via Adams orthodontic pliers. An implant that comes out that easily was never integrated, and the photograph makes the argument faster than the text does.

McCrea et al. 2017. Reproduced under CC BY.

Baskaran 20242 of 8 published figures

Mandibular Unilateral Paresthesia Following Implant Placement and Clinical Management: Clinical Case Report Cureus 2024 case report doi:10.7759/cureus.64001

The opposite case: a WELL-osseointegrated implant retrieved deliberately because its apex sat on the nerve, and the socket left behind. Retrieval took about seven days.

Baskaran et al. 2024. Reproduced under CC BY 4.0.

Volberg 20191 of 2 published figures

Canalis Sinuosus Damage after Immediate Dental Implant Placement in the Esthetic Zone Case Reports in Dentistry 2019 case report doi:10.1155/2019/3462794

Palatal mucosal necrosis after removal at sixteen days — the cost of the explantation itself.

Volberg et al. 2019. Reproduced under CC BY.

Ottesen 20221 of 5 published figures

Removal of implants with resection of necrotic bone at six months, in a patient on high-dose antiresorptives.

Ottesen et al. 2022. Reproduced under CC BY.

Goker 20231 of 6 published figures

Zygomatic Implant Insertion in MRONJ: A Case Report with a Follow-Up of 3 Years Journal of Clinical Medicine 2023 case report doi:10.3390/jcm12093300

Maxillary implants removed together with the osteonecrotic lesion.

Goker et al. 2023. Reproduced under CC BY.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Froum 2021 retrospective study	CLOSED	retrospective study. CLOSED.	doi
Khamees 2012 controlled clinical trial with histomorphometry	CC BY-NC-SA	controlled clinical trial. CC BY-NC-SA.	doi
Alwaqyan 2026 case report	CC BY	surgical implant removal as the fallback when fragment retrieval fails.	doi

← All 47 complications

Branch E · The return service

The compromised ridge after explantation

The passenger rejoins the bone line one zone worse than they left it. This is the connection the whole taxonomy exists to make.

Evidenced A published case, with its figures.

Baskaran 20242 of 8 published figures

Mandibular Unilateral Paresthesia Following Implant Placement and Clinical Management: Clinical Case Report Cureus 2024 case report doi:10.7759/cureus.64001

The socket after retrieval, then the definitive answer: a three-unit fixed partial denture at 45, 46 and 47. The site was not re-implanted, and the paper does not apologise for that.

Baskaran et al. 2024. Reproduced under CC BY 4.0.

Park 20233 of 5 published figures

Lateral Peri-Implantitis: Successful Management via Guided Bone Regeneration at Mandibular First Molar Implant Medicina 2023 case report doi:10.3390/medicina59091691

GBR five months on at a site that had already failed once, the removed 13 x 11 mm specimen, and the sequence from prosthesis delivery through re-treatment.

Park et al. 2023. Reproduced under CC BY 4.0.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Ku 2024 case report	CC BY	CBCT at four months showing regenerated corticocancellous bone that later allowed implantation without complications — the ridge recovering, which is the rarer story.	doi

← All 47 complications

Branch E · The return service

Rescue by the next rung up

When the ridge cannot be repaired, anchorage moves outward. This is where the complications atlas hands the patient to the anchorage ladder.

Evidenced A published case, with its figures.

Goker 20234 of 6 published figures

Zygomatic Implant Insertion in MRONJ: A Case Report with a Follow-Up of 3 Years Journal of Clinical Medicine 2023 case report doi:10.3390/jcm12093300

A second MRONJ lesion on the right mandible, then two zygomatic implants placed on the left maxilla where no conventional implant and no conventional prosthesis was possible. Healing at one month, and occlusion at three years.

Goker et al. 2023. Reproduced under CC BY.

Sass 20216 of 6 published figures

Free microvascularised fibula for mandibular defects at least 5 cm long, then implants in transplanted bone. Case 1 runs from the pathological fracture on the day she presented to her face and mouth six years later.

Sass et al. 2021. Reproduced under CC BY 4.0.

What else the corpus holds

Text and numbers. No figures are taken from these — either the licence forbids it, or the paper does not picture this complication.

Paper	Licence	What it contributes
Anitua 2024 systematic review	CC BY	subperiosteal implants — 97.8% survival with 25.6% partial exposure, which is the trade this rung makes.	doi
Van den Borre 2023 cohort study	CC BY	AMSJI custom subperiosteal maxilla.	doi
Al-Nawas 2023 consensus report	CC BY	zygomatic consensus.	doi
Luo 2026 case series	CC BY	robot-assisted jaw-in-a-day, five mandibular tumours.	doi
Van Der Kelen 2025 case series	CC BY	mandibular reconstruction and oral rehabilitation.	doi

← All 47 complications