Hello, I had an implant placed in tooth #13 a few months ago. The implant surgery went well and everything healed with no problems. My dentist recently put the crown on and thats when my problems began. The first 3 weeks seemed ok, but then I started to feel a lot of pressure around the crown area. I feel a tightness and even have a slight tingling feeling in my lip on that side. My dentist sanded down the crown a little but that did nothing. I feel like either the crown is on too tightly or pushing against my gums and causing some kind of pressure. The dentist only put temporary glue under the crown as he said it had a tight fit. I'm wondering if it would be easy for him to take the crown off- but he seems to be reluctant to do that. Has anyone ever had this happen before? Should I get a second opinion from someone else? Any suggestions?

Hi Illana,

When you had the implant placed in the bone, did you wear a temporary crown or was the area just left open?

If the area was left open, then the adjacent teeth may have shifted a bit towards that opening so the implant crown may be too large for the size of the opening. Sometimes the incisal (side) areas of the crown can be reduced so the fit is less snug. The crown should not be pressing on the gum tissue nor should it be too far away from the tissue. It should fit precisely at the edge of the gum line called the gingival margin.

Does the implant feel lose to you? Are you able to floss on both sides without any problems? Are you getting floss or food stuck in between the adjacent teeth?

Bryanna

Hi Bryanna, I did not have a temporary crown placed while the implant was healing. I had an abutment screw which was flush with my gums. This did not seem to cause any problems. I do feel like maybe the implant is either pushing on the gum tissue. The implant does not feel lose. It is easy for the dentist to remove the crown? At this point, I feel like it might help to take the crown off for a few days to make sure there is nothing going on underneath the crown that is causing problems.

Hi Illana,

If there was no temporary crown on the abutment, then the adjacent teeth may have shifted towards that opening a bit. Depending on when the impressions were taken for the implant crown, this subtle movement could make the implant crown feel tight. Or the crown could be too large for that space.

It is not ideal to keep taking off the crown even if it is on with temporary cement as the dental implant itself is still integrating with the jaw bone. It takes a year for the implant to integrate completely with the jaw bone. But anything that is putting unnecessary pressure on the implant could eventually cause the implant to fail.

If the discomfort and other symptoms do not calm down completely in a reasonable amount of time, like this week, then please see your dentist to re evaluate the fit of the crown and don't let him cement it permanently until it feels perfect. He can take an xray with the implant crown on and see where the interproximal (in between the teeth) margins of the crown fit against the gum tissue. It will also show if the crown is seated properly on the implant.

Hi Bryanna,

Unfortunately the pain has gotten worse. I went to get a second opinion at another dentist and he saw a problem at the base of the implant. He sent me to an oral surgeon immediately who said I probably have an infection at the base of the implant. This may be causing some pressure around the crown area. I'm wondering why the dentist who placed the implant could say everything looks fine, and two other people (the second opinion dentist and the oral surgeon) took one look at the x-ray and said there is a problem. They advised me to get a ct-scan and if all else fails I guess the implant would have to be removed.

Hi Illana,

Had tooth #13 been previously root canaled? Had it developed an abscess or a fistula (bump) on the gum above the tooth at any time prior to being extracted? When was #13 extracted and did the general dentist extract it?

Did the second dentist or the oral surgeon see the pre op (prior) xrays of that area prior to the extraction of the tooth as well as xrays taken just prior to the placement of the dental implant?

The reason I bring up these questions is because the area in question may have been present prior to the placement of the implant. So it would behoove you for the oral surgeon to have the pre op xrays to view a "history" of this area so that he can determine if the "infection" was there prior to the implant or if it developed after the implant was placed. If it was there prior to the implant then based on the dates of the pre op xrays he can get some idea of the duration of the "infection" which can give him some insight into how extensive it may be. If the area was not present prior to the placement of the implant, then he may feel the problem is not as extensive. The CT scan
will give some clarity to the location and proliferation of the problem but the pre op xrays are also very helpful in the whole scheme of things.

If the tooth had been root canaled or abscessed, it is typical to see something brewing at the end of the root because the bacteria living inside of the tooth eventually spreads beyond the tooth and into the jaw bone. Unfortunately, because it is a "typical expectation" to see this with a root canaled tooth many conventional dentists will consider this pathology as "common" or "normal" until the patient complains of a toothache or there is a large abscess or a periodontal problem has occurred.

Did the oral surgeon mention anything about involvement with the sinus? If not, then it would behoove you to ask him if there is any sinus communication associated with the "infection" as that could result in some further exploration and it is your right to be informed of the problem in its entirety.

Hi Bryanna, I do appreciate your assistance. Yes, tooth #13 was previously root canaled and did have a large infection at the time. It was extracted by a general dentist. On your second question, he did not see any problem with the sinus. Unfortunately he said when the implant was placed it may have been in close contact with the root of the tooth in front of it and that may be causing some issues.

Hi Illlana,

I suspected that tooth #13 had been root canaled, thank you for confirming that it was.

You may notice that the majority of posts on this forum pertain to root canaled teeth. The stories are pretty much repetitive or similar in that the cause of the infection originated with the root canaled tooth and in many instances lingering infection seems to proceed the removal of the root canaled tooth. Another commonality is that most people here proclaim that there dentist(s) did not inform them of the lingering infection. So it is not uncommon for the person to walk away puzzled as to why they have pain or discomfort or are not feeling well until they eventually stumble upon a dentist who makes the diagnosis. I just want to point out those commonalities to you and to others reading this who are seeking to make some sense of what I politely refer to as the root canal debacle.

Another commonality seen here is post operative complications after extractions are done by a general dentist. Most people do not realize that general dentists have much less surgical education and technical experience compared to an oral surgeon. So whenever a root canaled or infected tooth needs to be extracted, it is probably better to have that oral surgery done by a dentist who is well educated and extensively experienced in oral surgery which in most cases would be an oral surgeon.

What may have occurred in your case as with many others here, it is possible that the bony socket was not scraped thoroughly after the tooth was extracted so the infection lingered after the tooth was removed. The dental implant was then placed in bone that was not very healthy. This could explain some of the post operative complications that you are now having.

Another commonality is dental implants being placed too closely to the adjacent teeth or put in at odd angles. This can occur from inexperience with placing implants or misjudgement and/or due to the individuals bone structure.

It is common practice in many oral surgeon offices for the patients to have a dental ct scan done prior to the placement of the implant to rule out infection in that quadrant, check the health and location of the sinus in the upper arch or the mandibular canal in the lower arch, and to determine the health and density of the bone. In your case the oral surgeon, not being the dentist who performed the extraction or placement of the implant, is suggesting a post operative CT scan because as you have stated he suspects infection at the site of the implant and is concerned about the location of the implant. Rather than just go in and remove it, he wants to get a clearer view of what is happening so he knows the extent of the situation.

Are you scheduled for the CT scan?

Hi Byranna, I am scheduled to meet with the office who did the implant tomorrow. I will keep you posted as to the outcome. Yes, the oral surgeon who evaluated me saw something of concern that could be an infection and wanted me to get a CT scan to confirm if this was the case. Thanks again and I will let you know how everything goes. Unfortunately if that is the case the implant, as I understand will have to be removed.