Dr. E. asks:
I am not new to dental implants. I was using an established, but, new to me, system for an upper first molar edentulous region. I was expecting D4 quality bone for the posterior maxilla. The patient is a frail middle aged lady. It turned out to be as tough as D2. I didn’t have the wisdom to unscrew it and use a bone tap. I tightened the implant beyond 45 Ncm. It’s the fourth post-operative day and the patient still has pain which is relieved with analgesics. No swelling though. Have I cause compression necrosis by tightening so much? What should I do now if the pain persists? If this is compression necrosis, when should I expect to see radiologic signs?