Pain around osseoinegrated implant when touching crown: Causes?

I installed a single, free standing implant in the maxillary right posterior site and allowed it to osseointegrate for 4.5 months. There was less than 2mm of space between the implant and the walls of the osteotomy site so I did not place a bone graft material or membrane. Healing progressed uneventfully without any pain, purulence, mobility soft tissue pathosis, etc.

After placement of the prosthetic crown, patient complained of pain when touching the implant on the buccal side and during eating moderate to hard food. Patient was asked to refrain from hard food and prescribed anti-inflammatory for a period of 10 days. The crown was also removed and replaced with the previous healing cap. Unfortunately after replacement of the prosthetic crown, the pain did not go away.

Knocking on the implant the sound is sharp indicating an osseointegrated implant. There is no mobility, pus, inflamation or bleeding around the implant. Probing is natural. Periapical x ray reveals a slight radiolucency across the one side of the implant surface.

I would like to have your opinion what can be causing this pain and what is most advisable thing to do. What is the reason, you think for the pain and discomfort?

7 Comments on Pain around osseoinegrated implant when touching crown: Causes?

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CRS

3/17/2015

Get a CBCT to assess the bone, the implant could be failing.

Gerald Rudick

3/17/2015

CRS's comment is a good idea....... get the cone beam scan and check out the bone implant contact in all dimensions......you may possibly have a fenestration, and if that is the case, open a flap, view the problem, detoxify the implant surface, and place a particulate graft over the buccal wall and cover with a membrane.... if you are into regenerative technology, then adding PRP, PRF, etc would enhance the healing. I would use a double layer of PRF pressed membranes to cover the particulate, as well as using the vitreonectin and fibronectin to paint on to the buccal bone and as a wetting agent for the particulate biomaterials.

mwjohnson dds, ms

3/17/2015

Does the patient use a sonicare toothbrush? I have found that if a patient is too vigorous with an ultrasonic toothbrush they can irritate and/or damage the tissue around an implant. There's no Sharpey's fibers to attach the tissue to the tooth so gingiva around an implant is much more susceptible to trauma. I also do not recommend trying to cram a scaler or probe under healthy, tight tissue around an implant. These instruments too can damage or irritate the circumferential fibers and the weak hemidesmasomal attachment that forms the gingival cuff. If the implant appears integrated but still "painful" then 1) check occlusion 2) stress only light hand brushing and gentle flossing 3) stress no poking around the implant with proxybrushes, toothpicks etc. See them back in 7-10 days and hopefully the pain is resolved.

Tony Collins AM

3/17/2015

Not sure a cone beam will give much info because of beam hardening and scatter around the titanium. The poster mentions the lucency on the pa - PLEASE post the radiograph if you want an accurate diagnosis rather than guesses. It sounds like you performed an immediate placement if you had <2mm gap. What was the problem with the original tooth? Was there periapical pathology, or a root fracture conducting bacteria down the socket? What is the opposing dentition? Again, if you want an accurate diagnosis, give us fuller information. About 2 decades ago Eugene Roberts discovered that as little as 25% bone-implant contact (bic) could give reliable long term integration and there never is 100% bic. It is possible to have bic on one side of an implant, so it will tap soundly, and have a dehiscence on the other, where there is only fibrous tissue adjacent to the implant. This fibrous tissue can grow slow twitch nerve fibres into it. These tend to give a dull pain sensation rather than a sharp pain. You might try raising a buccal flap and debriding. If the pain persists after healing, then consider removing the implant.

Dr Daneshgar

3/17/2015

If discomfort is only when crown is in place it has nothing to do with the Implant. Just check for the over extension of the crown in the buccal side . If it's cemented type excess cement also could be the cause. Check for premature contact (high points) too. Maybe it's not a bad idea to change the crown. Let the pt massage the area too.

Dr Daneshgar

3/17/2015

Dr Temerek

3/19/2015

I agree that we have to assess the bone around the implant but using CBCT will not generate a conclusive image due to metal artifact.