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Just Dental Truths!
Just Dental Truths!, Dentist
Category: Dental
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Experience:  29 year clinical Practioner
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I had an implant put in about a year ago. Lower left

Customer Question

Hi. I had an implant put in about a year ago. Lower left back tooth. The crown was completed a few months ago. for the last 24 hours i have suffered intense aching pain on and off. What's going on?
Submitted: 8 months ago.
Category: Dental
Expert:  Just Dental Truths! replied 8 months ago.
The most probable scenario is that the crown is hitting first (or too high). Since it is nes, it often is high, especailly being new & a back tooth, and needs to be "likely" adjusted by your Dentist! I hope you can get in to see your Dentist tomorrow???
Customer: replied 8 months ago.
But why was it fine for several months and now I have this horrible on-and-off pain? How do I know it's not an infection or nerve damage. I would be very grateful if you could explain (if it's the case) that infection/nerve damage pain do not suddenly happen after several months, with no previous signs. For instance, I see no sign of inflammation around the implant. When the IA nerve is hit by accident, is that something you know right when the implant is put in? Or can it start hurting a year later?
Expert:  Just Dental Truths! replied 8 months ago.
If the inferior alveolar nerve were infringed upon for the past year, you very much would not of been pain free. But rather the opposite. And, if infringed upon, you would have noticed it immediately, not soon after a crown. Rather, the most likely cause of your pain, would be the trauma directly/indirectly caused by the new crown. Particularly, that it is hitting high! That would cause the periodontal ligament (going all around the tooth's root surface area), and would cause you anything from on & off again pain to constant pain. The very best scenario is to get back tomorrow to the Dentist who placed the croen, explain the details of trouble, he'll likely take a small x-ray, and visually check the bite, and do visual tests we can't really perform over the web. And no, I'm NOT 100% positive of what it is. But it certainly does sound like the new crown is hitting high (too tall of crown), which can and often is adjusted with somewhat simplistic techniques.
Expert:  Just Dental Truths! replied 8 months ago.
Sorry, a mechanical/digital problem keeps posting my responses as "customer"...
Expert:  Just Dental Truths! replied 8 months ago.
Does it make sense to you, that a high hitting crown, can make your tooth/implant tender & sore?
Customer: replied 8 months ago.
Thanks, doctor. The site malfunctioned for a bit and I couldn't see your answer. Since I appear to be paying $36 for the privilege (although I'm certainly grateful), a few follow on questions:2. Any reason to suppose it might be an abscess/infection? Would that come on suddenly?
3. If the crown is high-hitting, as you say, why am I only suffering pain now after three months? When you say "That would cause the periodontal ligament (going all around the tooth's root surface area), and would cause you anything from on & off again pain to constant pain" there seems to be a phrase missing - it would cause the periodontal ligament to do what???
4. I have of course been scaring myself silly on the Web. I saw a site that spoke about the importance of doing a CT scan before putting in an implant. I don't think my periodontal surgeon did that - just some panoramic x-rays. Was that sufficient? Perhaps, if it's not nerve damage, there's no issue...
6. One final question. My dentist told me I needed an implant because when the original root canal had been done (30 years ago), one of the root canals had not been entirely filled in, so I had been having bone loss for years, and that was why the tooth was starting to get a bit loose. Does that sound right? I remember the dentist in London all those years ago saying he was going to fill in the root canals with gutta-percha. Would that look like it was not filled in properly on an x-ray (because gutta percha might not show up the way some more typical substance would?
Expert:  Just Dental Truths! replied 8 months ago.
You are correct, it could be an abscess. I'm sorry you are hurting. But I don't know why specifically it is occurring. I only say "likely" hitting high, because that seems most likely case scenario - that's all. I certainly could be wrong, and it would not be the first time!An abscess could come on suddenly. However, you mentioned you had the crown done in the past few months, and the pain has been since the crown placement correct? The periodontal ligament, if affected, is generally "a shot across the bow", a warning of pain, your tooth screamin' I hurt, fix me, often because a tooth/crown is too high.I'm 99.9% certain your Periodontist did a CT or comparable x-ray prior to the implant placement. Further, if he did not, you'd of had immediate PAIN from the I.A. nerve being damaged from the initial placement of the implant in the improper place a year ago. That pain would have begun the day of implant placement & continued for the past year. However, your pain, as I understand it, are more closely associated with the time scenario of when the crown was placed, correct? Gutta percha is opaque (white)on an x-ray. And, there is a possiblity that if your tooth's root canal, was not 100% filled in properly, that it too could be the cause of this problem for you. But, again, that can often be fixed. True, would have been better to fix it from the top of the tooth going down towards the root. But, it can be fixed from the root upward (via an apicoectomy and retrograde filling - by an Endodontist). I know, who wants that? Well, no body does want anything, we both realize that, but I'm merely stating that it could be done - if needed.My suggestions:1) I do not know for sure what is wrong!2) If I were betting, I'd give the prognosis most likely, to be that of the crown hitting high. High enough that it's made your tooth sore!3) It could be, but likely is not, your unfilled in portion of your root canal with gutta percha.4) The very least likely case scenario is that the implant is infringing upon your IA nerve. 99.9% of me says no way!___________________________________ What would I suggest?I'm sorry, I sound like I'm perhaps trying to shovel this away or something. But I'm NOT. I'd go to the Dentist who placed your crown asap... he will take a periapical x-ray or two, and visually look at it, which will reap more promising positive notes than we can conjure up here on this site by conversing alone.Again, I'm NOT pawning you off. I just totally feel you need to see your Dentist who placed the crown for a more definitive diagnosis. Does that make sense? Dr. Rampton
Customer: replied 8 months ago.
Thanks, Dr. I will see the dentist tomorrow. I'm sorry to hear it *could* be an abscess. But I guess I'll find out tomorrow.Two last things and I think I need not bother you further...1. Lately, I have been experiencing pain when the implant is hit by something cold (ice water, etc.) The dentist says that's not really possible because of the nerves are dead under the implant. So where is the pain coming from, because the implant is where I feel it.
2. Re: the gutta percha: that was a historical question -- the root canal and crown has been replaced by the implant. I was asking whether gutta percha was an unusual solution from 30 years ago that would show up the same as bone erosion would on the x-ray when in fact it was OK. It's true the tooth was a bit loose, and I guess that means it had to go anyway.Thanks for your help...
Customer: replied 8 months ago.
I missed on thing: no the pain has not been continuous since the crown. I had no pain (except post-op) until yesterday. Then a really brutal on-and-off ache I've been treating with advil. Worst "dull pain" I've ever had. Gone for the moment - presumably the last dose of Advil.
Expert:  Just Dental Truths! replied 8 months ago.
You are not bothering me a bit. I'm just sorry you are hurting.1) I'm not saying you are having this, but it is a real phenomenon - "referred pain". It's when you feel pain in one area, and due to nerve cross over and other unknown variables, the pain is actually coming from often an adjacent tooth, or more rarely, a tooth that isn't even close in proximity at all. I know, referred pain, sounds crazy! But, truth be told it is real, and I've seen countless patients with it. I'm just saying... I'm not inferring that you are for sure experiencing it. More reason to see the Dentist tomorrow huh? And, pain from cold? I concur with what your Dentist said. Logically, it doesn't sound plausible, unless there "may" be some referred pain???2) I see, the root canal, is not an adjacent tooth, but has been extracted & replaced by the implant & crown. I think you are asking if gutta percha could cause bone erosion or other similar problems? Possible, but very, very unlikely. It would tend to stay to itself, and be dormant. Not really causing trouble as a rule of thumb. And yes, if there were residual gutta percha, it could readily be seen on the x-ray/s. Gutta percha is still very commonly used & works very well for the majority of root canals. I hope I've helped at least alleviate some of your concerns. Other than referred pain, I do not know why your implant would be feeling all of this cold pain though - I'm sorry to say. But please DO, go see your Dentist. Fresh eyes, a second opinion, and with the enhanced ability to properly diagnose some perplexing situations. I must say, you ask some very good questions... I hope indeed that your pain can be suppressed asap via your Dentist, hopefully tomorrow! All the best to you! *PS- I'd love to know what your Dentist says tomorrow or whenever, if you can tell me! I'm quite curious...
Customer: replied 8 months ago.
Thank you, doctor. I'll let you know what the dentist says. Hearing that it isn't an IA nerve problem has been very helpful. I hope you are right that the crown needs adjusting (tho' I wasn't clear why it would be OK for three months and then suddenly yesterday not OK). I hope it's not an abscess. As I say, I'll let you know. Saul
Expert:  Just Dental Truths! replied 8 months ago.
Please do Saul, as I too am curious what they find.By the way, you can come back to this website & converse with me, for no additional fees incurred from Just Answer for the next 6 days - OK?
Expert:  Just Dental Truths! replied 8 months ago.
Saul,Might you have heard back any increments of knowledge of what to do - from your Dentist yet?Dr. Rampton