hi, greetings everyone. I am Susie. I have a case I would like to brainstorm with all experts.
last Saturday I have placed three unit of megagen implant in relation to 33, 32, 42. we achieved good primary stability of more than 35 Ncm, under surgical guide placement. I placed cover screws and achieve primary closure with PRF.
post operatively, my patient reported of severe pain in relation to lower jaw bone. no numbness/ parenthesis noted. no swelling noted too. today is post op 5th day and the intensity of pain is of the same. according to patient, it doesn’t seem reducing.
the pain is in relation to the implant surgical site ( the gum site ) and the tooth like 34, 42 are very tender, and also( painful ) but less tender on 44 and 35.
I will be seeing my patient two days later this Saturday for a review appointment as he is currently out of stations.
what do you think it could be ?
Severe pain is uncommon after implant placement, typically very little discomfort. When there is significant postoperative discomfort, it’s typically related to high insertion torque in dense bone. The insertion torques that you report are not that high, but I’m still suspicious about high torque causing the pain. Maybe your torque measurements were wrong? Regardless, I would strongly consider removing the implants. Let them heal 3 or four weeks and then replace with new implants.
I think no need to remove the implant because the pain might be referred from other teeth as well therefore wait and do complete examination of remaining teeth in mandible as well as in maxilla… Also one implant is very near to teeth… And also some patients are very sensitive to pain so don’t be nervous
I agree that some folks are just wimps and the subjective report of pain is questionable. What concerns me is the initial torque of greater than 35Ncm. While this is not a high value it is rather vague and could mean anything from 36Ncm to 90+Ncm. I have developed a strong bias over the years in favor of parallel walled implant fixtures inserted at much lower initial torque as they have demonstrated much better long term success in my experience. The particular fixture that you used is one with significant taper and is capable of achieving extremely high torque which is the most likely cause of the subjective report of pain. I would leave it alone but consider a less tapered fixture for future cases as I honestly believe that high insertion torque might be a silent killer…
