Post-op pain associated with implant placement is generally minimal,generally no more than 24 hours as reported by my patients. One or two doses of OTC pain killer is generally adequate. However, each individual 's pain response is different.Going back to your dentist to have a post-op evaluation is advised. Complete healing for an extraction site with or without bone graft takes 3-6 months in general. If bone is not completely healed and implant is placed, primary stability may be compromized.
if I were your treating dentist, I would wait for 3-6 months until complete healing of bone is evident from radiographic imaging. If bone quality is suboptimal, primary stability may be compromised and resulting in higher failure rate.
There are two types of implant surgery in today's practice. One is flap procedure and the other one is flapless.I have employed flap procedure for 20+ years, which never gives my patients problem. Your dentist emploied flap procedure,too. Flapless procedure , to me, is a blindness procedure.This is the procedure that does'nt require sitches.
It appears that your dentist did re-entry, tring to find out why you are suffering from intense post-op pain, which is a rare consequence of implant surgery. Traumatic trigeminal neuropathy associated with implant surgery usually presents with burning or electrical shocking pain quality, along with the inferior nerve supply, which involves lower right lip. I tend to believe what my colleague says, if he says there is no nerve issue, it's probably so. Post-op pain may be managed by tylenol+advil,which yields better pain relief. If there is clinical evidence of infection, which nay be managed by clindamycin+ metronidazole. However, it's your dentist's decision.Implant placed in an incomplete healing site can still achieve complete osseointegration. Removal of implant at this time seems to be unwise, The critical issue is finding out the source of your pain.
If you do have perisitent or intermittent electric shock-like pain, you need to see your dentist to evaluate the proximity of fixture to mandibular canal by panoramic x-ray or ct scan.If there is evidence of encroachment of mandibular canal by fixture, it needs to be corrected. If there is no evidence of structural damage by imaging studies, early intervention of pharmacologic management helps resume normal nerve function. If your dentist is not familiar with pharmacologic management,you may need to see an orofacial pain specialist or neurologist.My experience is amitryptyline, gabapentin,or pregabalin is very helpful. However, it's your cilinician's decision.
Thanks, I think I'll leave the implant in for now.
I think you are right, I think this is what is happening to me. You have explained my symptoms very well in relation to what is happening to me. Thanks again as always.
I do have like an electrical shocking pain; I'll have to read up on this Traumatic Trigeminal neuropathy you are referring to also.
I wish more dentists were as detailed as you are in explaining things, I might be able to comprehend what they are referring to instead of thinking there is a problem all of the time.
Well, sad news, November 11, 2009 back for follow up. He had to remove the implant, it was loose, and had some infection. It wasn't hitting a nerve or anything I guess he said.
He inserted more bone and wants it to heal for about 8 weeks and then try inserting it again. I was really disappointed but I guess that is the chance you take with these kind of things.
He thought it may have come loose from me talking on the phone all day at work and typing. I was so careful not to lift anything, I hardly did anything for 3 weeks except work.
Keep you posted on the outcome at a later date. You have been so helpful and I thank you.
Originally the bone graft was done july 8th, implant inserted October 21st, 2009.
It is now November 1st and I still have radiating pain 11 days later. I went back because I had radiating pain up my ear and it was so bad I wanted to cry. I am still taking the vicodin provided to me.
I went back on the 29th of October due to the pain being so intense at work and I could not stand it and had to leave work. He stated it may just be a healing reaction and gave me steroids Methylprednisolone (Medrol) to take for a week and gave me a higher dose of antibiotics.
It is hurting my #29 tooth also. I asked him why he had to cut my gum again and put stitches the first time he did the implant on the 21st of October, 2009 and he stated because he had to make sure it was in the bone. ?
I find this out of the ordinary but I guess if it is a normal procedure then I will have to believe that. I have talked to others who stated they never had stitches at time of an implant.
I thought they would be able to tell where everything is by taking x-rays and using them to see where or how far down to go by measuring it.
It feels like it is hitting a nerve or something. He states he does not think it is hitting a nerve from what he can see. ?
If he put the implant in too soon and the bone is not healed, can he still leave the implant in and it keep healing along with the bone, or if I am in this much pain now, should I have it taken out and wait until the bone heals and try it again after 6 months or so?
I am in so much pain I am just thinking about having it removed.
Thanks for your response.
Thank you so much Scottma, I will wait until the bone has no more pain in it and then have it done again. I think I would feel better with a 6 month wait myself.