Continuos Pain at Implant Site: Any Ideas?

Last Updated: Apr 15, 2012

I placed an implant on #13 [maxillary left second premolar; 25] about a year ago without any complications. Â The implant appeared to be fully integrated without any signs of disease. Â The abutment screw is torqued down completely and is as solid as a rock. Â Radiographically all signs are normal. Â But as soon as I insertedÂ the prosthetic component, the patient start complaining of pain at the site of the implant. Distance from the implant to sinus is 2-2.5mm. There is no evidence of intraoral swelling or erythema at the implant site and no inflammation. There is impingement on the gingiva and the occlusion had been relieved. I removed the crown and replace it with the healing cap. Â Any ideas on what is causing the pain and what I can do to alleviate the problem?

8 Comments on Continuos Pain at Implant Site: Any Ideas?

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Rodgeru

04/15/2012

Gingival impingement is a no-no. The prosthetic should seat passively. Either re-contour the sub-gimgival area of the prosthetic or fabricate a custom abutment to ultimately mimic the sub-gimgival contours.

Rick Tittle CDT

04/17/2012

Make sure there is no impingement of bone from base of the abutment if implant is a bone level implant. If so reshape that area of the abutment. In our laboratory we like to have a perioapical radiograph of that area so we can avoid this complication when making the abutment. We also model the soft tissue with the abutment rather than the crown. We push tissue sub-gingival with the abutment to move gingiva proximally. If you push with crown the tissue will probably recede.

Richard Hughes, DDS, FAAI

04/17/2012

Take several radiographs from different angles to R/O infection.

jon

04/17/2012

It most likely is gingival impingement. Adjust the crown or gingiva and you should be fine.

Steven Geller

04/18/2012

Please include a PAX of area with crown and/or abutment in place so we can provide you with more accurate information. This will give you better feedback and it will be more educational for others on this chat. Thank you. DrT

CMJohnson, DDS

04/18/2012

I would like to hear how patient is doing after healing cap is on for a while?

Alejandro Berg

04/23/2012

This sounds as a gingiva problem. Maybe you should try athe Hebel technique. Basically under anesthesia make an H flap , small release with very small periostal elevator and insert the prosthesis. torque and let the gum heal in place, normally no stitches needed.

Baker vinci

04/25/2012

If it looks like a duck, I would suggest, that it's a duck! Bv

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