Post-Operative Pain for Implant Patient: What Do You Recommend?

Dr. B. asks:
I had placed an internal hex 3.8mm x 12mm implant fixture in the distal root socket of a lower first molar immediately after extraction. The standard protocol of antibiotic cover and curettage of the socket were followed. No bone graft material was used. Sutures were removed after 7 days after implant placement. The patient presented for routine follow up 15 days after implant placement. Routine radiographs for taken for follow up and abnormalities were noted. The implant is not mobile, gingival healing is within normal limits without recession or dehiscence. But the patient complains of episodes of pain and heaviness in the area where the implant was placed and also in the ipsilateral submandibular lymph node. The submandibular lymph node is not enlarged and does not feel any different from the contralateral submandibular lymph node. Should I prescribe another round of antibiotics? Should I prescribe a different antibiotic the second time around? Should I just watch and wait? What do you recommend?

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5 thoughts on “Post-Operative Pain for Implant Patient: What Do You Recommend?

  1. You haven’t posted any radiographs or pictures, so we have no idea of the way things look other than what you tell us.
    Was the implant placed as a one-stage or submerged and covered by the tissue?
    Is the socket of the mesial root exposed?
    Antibiotics is not a standard protocol in a routine extraction, and I don’t think you would put an implant in a socket with an infection. The prudent treatment is to extract and wait, then place the implant.
    If there is no swelling, fever or signs of infection after a regimen of antibiotics, the benefits of a second round of antibiotics is questionable.

  2. I am afraid any prolonged pain is indicative of infection and possible loss of the implant. Be very wary of placement into infected ( or adjacent tooth infection ) sites.
    All my patients never required pain medication by the following day if they do I become concerned.

  3. maybe… just maybe the patient had fatigue of the muscular jaw. sometimes they said around ipsi lateral submandibluar. sometimes they mean from masseter origo insertio. maybe just maybe…. u should ask the patient and listen to the complain, what time , when eating, after wake up etc… and make the diagnose later on.

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