Continuos Pain at Implant Site: Any Ideas?

I placed an implant on #13 [maxillary left second premolar; 25] about a year ago without any complications.  The implant appeared to be fully integrated without any signs of disease.  The abutment screw is torqued down completely and is as solid as a rock.  Radiographically all signs are normal.  But as soon as I inserted 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.  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?

New comments are currently closed for this post.
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
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
Take several radiographs from different angles to R/O infection.
It most likely is gingival impingement. Adjust the crown or gingiva and you should be fine.
Steven Geller
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
I would like to hear how patient is doing after healing cap is on for a while?
Alejandro Berg
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
If it looks like a duck, I would suggest, that it's a duck! Bv

Featured Products

OsteoGen Bone Grafting Plug
Combines bone graft with a collagen plug to yield the easiest and most affordable way to clinically deliver bone graft for socket preservation.
CevOss Bovine Bone Graft
Make the switch to a better xenograft! High volume of interconnected pores promotes new bone. Substantially equivalent to BioOss and NuOss.