Submental abscess following anterior mandibular implantation: A case report and comprehensive literature review

Abstract

Dental implants are a predictable treatment for tooth loss; however, infections extending into deep fascial spaces are rare and potentially life-threatening. This case highlights the importance of early diagnosis and multidisciplinary management of an implant-related submental abscess in a diabetic patient. A 33-year-old female with type 2 diabetes mellitus (HbA1c: 8.1%) presented with submental swelling five months after anterior mandibular implant placement. Clinical examination revealed erythema, tenderness, and purulent discharge around implant #41. Cone-beam computed tomography (CBCT) showed complete resorption of the lingual cortical plate and a radiolucent tract extending into the submental space, indicating abscess formation. The implant system used was Megagen AnyOne® (4.0×10 mm). The patient was treated with amoxicillin–clavulanic acid 1 g every 12 hours for 5 days, and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control, followed by extraoral drainage with Penrose drain placement. The infected implant was removed surgically under local anesthesia, followed by thorough debridement of the cavity and local irrigation with rifamycin SV solution (250 mg/3 mL). The postoperative course was uneventful, and CBCT at the 3-month follow-up confirmed complete bone healing without recurrence. This case suggests that implant-related submental infections may result from a combination of surgical errors, anatomical factors such as lingual plate perforation, and systemic risk factors, including diabetes mellitus. CBCT plays a vital role in detecting cortical perforation and deep-space extension. Careful preoperative imaging, proper implant angulation, and timely combined medical-surgical management are critical for preventing serious complications and achieving favorable outcomes.

Keywords: Dental implants, Neck abscess, Peri-implantitis, Postoperative complications, Submental space