The lower left first molar had been missing for some time. A Nobel Biocare implant was placed into the site in November of 2017. The bone was type 4. There were no problems immediately post-op. There was no dysesthesia on day 1 or 2 post-op. On day 3 post-op she began to feel some dysesthesia with pins and needles feeling of the area innervated by the inferior alveolar nerve. She was given ibuprofen to take at that time.
The dysesthesia was gone when she presented for an impression for the implant restoration in March of 2018. A screw retained crown was placed a few weeks later. 2-3 weeks after the crown placement the dysesthesia returned. The screw retained crown was removed and a healing cuff was placed and the patient had immediate relief.
After some month symptoms returned and upon probing suppuration was found. In December of 2018 the healing cuff was removed, full thickness flaps raised and cratering was evident around the implant. All granulation tissue was removed, the implant surface was decontaminated and the site grafted and the implant buried. Normal healing occurred over the next few months. She had discomfort from time to time and took ibuprofen for the pain. Three days ago she stopped taking ibuprofen and the dysesthesia returned (pins and needle feeling). A periapical x-ray was taken and no signs of infection were evident. The soft tissue over the implant had no redness, swelling or fistulas.
Do any of you have any thoughts on what could be causing the dysesthesia that comes and goes? Your help would be appreciated!
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