Post-Op Pain from Implants: What Do You Recommend?

Last Updated: Sep 13, 2010

Dr. K asks

I recently placed a Sybron XRT implant 3.5x11mm into #28 site [mandibular right first premolar; 44]. I used a long buccal nerve injection and no other local anesthesia. The apical terminus of the implant is radiographically distant from the mental nerve. I placed the implant head at the alveolar crest and torque to 35Ncm. The procedure was routine â€“ nothing out of the ordinary. My only concern was the buccal cortical plate was thin at the crest of the ridge where I placed the implant head and I was concerned about having sufficient blood flow to the area for healing. At the two weeks post-operative visit, the patient complained of â€˜dry socketâ€™ kind of pain for the last 3 days. The soft tissue is slightly inflamed and erythematous. Could these symptoms be indicative of some type of necrosis of the surrounding bone? I already have the patient on steroids and an antibiotic. Should I just continue the antibiotic? Use a different antibiotic? What would you recommend I do at this point?

7 Comments on Post-Op Pain from Implants: What Do You Recommend?

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sb oms

09/13/2010

sounds like a wound dehiscence. what are the steroids for??? steroids prevent inflammation. inflammation is a precursor to healing. i recommend basic wound irrigation and analgesics. the blood supply to the mouth is so rich that these should start healing relatively soon with a minor loss of soft tissue. if there is dead tissue remove it. if no change in a week, remove the implant, induce bleeding, and let the wound heal. just curious as to why you put the patient on steroids?? what are you hoping for? pain relief???

peter Fairbairn

09/14/2010

Any long term pain even the next day but especially 2 weeks later can spell possible issues and maybe loss of the implant. Was there previous pathology at the site or has the adjacent tooth previously had RCT? Also was there full soft tissue closure or a spontaenous exposure as sb mentioned?

Neda Moslemi

09/15/2010

In addition to above comments, check systemic condition of your patient again; did you rule out diabetes, WBC deficiency, or using some medications like bisphosphonates? If systemically he/she is Ok: If antibiotics did not resolve the pain after 3 days, remove the implant, undoubtedly. It is inevitable! As you mentioned, sequester of buccal bone may be occurred. Hope you success, Neda Moslemi

Dr.Joshua Shieh

09/16/2010

Dear Dr. K, I concur to all the above comments... However have you considered an injury to the mandibular nerve. Considering the fact that the implant has been placed in the mandibular premolar region which is located close to mental foramen.. Kindly do post a post operative radiograph of the implant. Or if NSAIDs or antibiotics have not helped...a CT scan should be able to detect the proximity of the implant to the nerve.

Dr. Mehdi Jafari

09/16/2010

Sir, Prepare a buccal flap and look into it.You'll see some threads exposed within the buccal cortical plate, some bone debris and remnants of drilling surrounded by granulation tissue and evident periosteal irritation.That would be the cause of your pain.

Paul

12/21/2010

Yup...almost guaranteed the crestal buccal plate is gone (ask me how I know)...sounds like you will probably need to remove the implant and graft

Paul

12/21/2010

sb oms...steroids reduce inflammation which decreases post-op pain (but you already knew that)...inflammation is not necessary for healing and, in fact, studies show faster healing with steroids and less use narcotics...as a common-sense example, consider the treatment for a sprained ankle - ice, compression, elevation, ibuprofen (all things to decrease inflammation/swelling)...i follow the Misch protocol which includes pre-op, and sometimes post-op, steroids...Contemporary Implant Dentistry has a more cerebral overview on the subject if your comments about steroids were strictly in regards to the infection then...i agree...i assumed the OP had the patient on steroids before the infection was noted

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