The inadvertent ingestion or aspiration of dental instruments-particularly implant-related components-poses serious medical risks and legal implications. However, there is a lack of standardized protocols or professional guidelines for these adverse events. This article reviews current literature, highlights common preventive practices, and proposes a practical, step-by-step management algorithm. Emphasis is placed on early identification, emergency response, and, most importantly, appropriate referral to minimize patient harm. The authors, drawing from clinical and legal experience, advocate for ethical responsibility, improved intraoperative precautions, and standardized protocols to address this potentially fatal event in dental practice.
Hess et al. (Wed,) studied this question.