Severe pain after implant placement

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 had the same situation one time. Within a month both implants failed. 44,46. I truly believe it is the pressure nothing else.

Some people very sensitive to pain, give the patient tramadol combine with etoricoxib