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Too Much Insertion Pressure When Placing Implants Leading to Pain?

Last Updated: Jun 28, 2009

Anon. asks:

I placed a parallel wall cylinder implant 4×11.5 at #29 site [mandibular right second premolar] on a 37 year-old healthy woman. The osteotomy was uneventful and the mental foramen was 2 mm away from the apical portion of the implant. The insertion torque was 50 Ncm at 20 rpm. The implant did not go all the way in, only about 2/3 of its length. The rest was inserted using a manual rachet but it did not feel too hard or resist the manual ratcheting.

The patient did not experience pain or swelling for the first 48 hours. After that, she started having severe pain and a very hard encapsulated swelling in the bicuspid area. The initial prescription was Amoxicillin 750mgs every 12 hours and 500 mgs of Metronidazole every 8 hours. I then prescribed Diclofenac sodium 75mg for 3 days I.M. for the pain and swelling.

The patient did not improve. After 6 days post-op, I unscrewed the implant 2mm and prescribed Prednisone 10 mgs every 8 hours. The patient seems to be improving but not totally. Do you think the pressure when placing the implant was too strong? Have you had any case similar to this? What should I do at this point?

4 Comments on Too Much Insertion Pressure When Placing Implants Leading to Pain?

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Dutchy

6/30/2009

If I read your comments well, I think you compress the bone to much. This compression has gone also to the apex portion of the implant and giving a pressure compression on the nerve. I had it once with a rootcanal treatment where there was close contact between the nerve and the apex/granuloma. I put in temporary material with much pressure and I had the same symptoms. These symptoms fade away in time by releaseing the pressure as soon as possible. I think when you didn't wait to long to take the pressure away the symptoms will fade away in time, but it will take a while because nerve tissue seems to recover very slowly. Sometimes soft laser therapy will give some benefits although this isn't totaly evidence based. I hope this will give you some answers

David Levitt

6/30/2009

You mentioned pain and swelling rather than just pain. You also mentioned that loosening the implant did not help. You did not mention if this was a flapped or flapless surgery. If this was flapless you may have a dehiscence you cannot see. IF so you need to flap it and repair it. Your initial description sounds like osteitis or infection rather than bone compression. Add to that the fact that loosening did not help and you most have an infectious or inflammatory process. You are on the right antibiotics and the prednisone will take care of any inflammation. Osteitis takes at least a week to calm down. As long as things seem to be improving I would wait it out.

Bruce Laurie

7/1/2009

If one considers that lack of motion is the goal in having a smaller osteotomy than implant a spade 0.2mm smaller than the implant will do the job nicely. Bicon has spades with slightly more taper in the apical portion than along the body. This works well with Implant Direct's Screwplant, the best system in my humble opinion. One ends up with very little compression in the less vascular cortex and a little more in the more able to heal marrow space. The spades are used at 50 RPM (no heat) and the bone can be collected for grafting. Dexamethasone injected into the anesthtized vestible nearly always eliminates the need for analgesics stronger than Advil. 6 to 10 mg is all that is needed. This is the strongest antinflamitory in humans and a single large dose is almost without risk.

Andrej Meniga

7/16/2009

If there is a recomantation not to force the implant (even for the immediate loading) why would anyone try to screw an implant in the underprepared osteotomy with more than 40 Ncm and risk the bone compression complications? I would recommend reinstalling the same size implant after checking and cleaning the preparation site and submerge it for at least four months. In the case of the bone loss try to install next implant size if the lingual cortical plate permits but with LESS insertion torque.

too narrow space 0917 too close to proximal tooth