Dr. P. asks:
A 68 yr female patient has had 4 single-piece dental implants placed in the mandible by another dentist. All four are in the anterior mandible between the mental foramen nerves. These four implants have retained an overdenture now for three years. The implant in the mandibular left first premolar site has become painful. Examination revealed lack of attached gingiva and inflammation related to the implant. There was no mobility and no evidence of resorption radiographically. The patient has an implant supported upper denture. The lower denture was relieved around the implant and a connective tissue graft placed. The attached gingiva is now healthy but the patient now reports pain only at night when the mandibular overdenture is out of the mouth. She sleeps well only when the overdenture is in the mouth. I would appreciate your comments please on this case. Thanks.
Pain Without Overdenture in Mouth: Thoughts?
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Any top teeth? just wonder about parafunction against the abutment.
Thanks for the thought. The patient has an implant supported maxillary denture which she leaves out at night. I thought that the opposing implants could be in contact in sleep but they do not contact without the dentures.
This sounds like a strange thing. Is the pain present in the daytime too if she is not wearing the overdenture?
The patient was not prepared to keep the overdentures out during the daytime. I must mention that there was a lack ot attached gingiva in relation to all the lower implants -but no associated bone loss. I must also report that she now has relief -after wedging a piece of cotton coated with ligncaine gel between two of the inplants and keeping the overdenture out at night. Do not ask me how it works!
If there is a bar involved, unscrew said bar and evaluate and treat. You may want to take some PA’s to determine if everything is bolted down or not. I would also gently probe to see if there is any bone loss about the implants, that you cannot see with radiographs.