Top 5 Sources of Dental Implant Pain When "There's Nothing Wrong with the Implant"- By Dr Amir Mostofi, DDs Dip MSc

If you've recently had a dental implant and are experiencing pain even though everything seems normal, you're not alone. This article aims to explain the top 5 reasons behind dental implant pain when there's no apparent issue with the implant itself, in a way that's easy for patients to understand.

1. Violations of the Inferior Alveolar Canal (IAC):

The IAC is a canal that houses the inferior alveolar nerve (IAN), which plays a crucial role in sensation for your lower jaw. Sometimes, the IAN takes a unique path, forming what's called an "anterior loop." Trauma to this area during implant placement can lead to sensory disturbances, bleeding, and pain. Recent research suggests that getting closer to the IAC may not be as risky as previously thought, as long as the nerve isn't directly affected.

2. Violations of Branches in the Mandibular Canal:

Traditionally, we've considered the IAC as a single canal to be avoided during implant surgery. However, it's now known that smaller branches can exist alongside the main canal, creating a network. If these branches are accidentally disturbed during surgery, it can result in pain. These branches are often missed because they aren't widely recognized, but they can show up on X-rays or CT scans.

3. Inadequate Keratinized Tissue:

Keratinized tissue is the protective, tough tissue that surrounds your implant crown. Some studies suggest that not having enough of this tissue (usually at least 2 mm wide) can lead to pain, especially when you touch or use the implant, like when brushing or eating. Fortunately, this issue can often be resolved by adding more tissue through a soft-tissue graft.

4. Poor Bone-to-Implant Contact:

Even if an implant looks fine on X-rays and CT scans, it's possible that the bone around it isn't providing a secure foundation. This can happen when fibrous tissue forms around the implant instead of sturdy bone. This may not be visible in regular exams, but patients can still feel pain when using their implant, especially when it's fitted with a crown. A resonance frequency analysis machine can help diagnose this issue by measuring the strength of the implant-bone connection.

5. Predisposing Risk Factors:

Sometimes, pain after implant surgery can be linked to factors that exist within your medical or genetic makeup. Conditions like fibromyalgia, temporomandibular disorders, and depression/anxiety can make you more prone to experiencing pain. This type of unexplained pain often falls under the category of "peripheral painful traumatic trigeminal neuropathy" (PPTTN).

In summary, if you're feeling pain after a dental implant, even when everything looks fine, it's important to consider these factors before assuming it's psychosomatic. There are various reasons behind implant-related pain, and a thorough evaluation is essential to pinpoint the cause accurately. Your dental professional can help you identify and address the issue, ensuring your dental implant journey is as comfortable as possible.

Root Canal Treatment: Common Questions Answered

Root canal treatment, also called endodontic treatment, is used to treat the inside of a tooth when the pulp has become inflamed or infected. This article answers common questions in general terms. An examination and, where appropriate, X-rays are needed before a dentist can confirm the cause of symptoms or recommend treatment.

For information about assessment and treatment at our private Worthing practice, see our root canal treatment service page.

What symptoms should be assessed?

Persistent toothache, pain when biting, prolonged sensitivity to hot or cold, swelling, tenderness, or a tooth that has become darker can have several causes. A cracked or heavily filled tooth can also need assessment. These signs do not by themselves confirm that root canal treatment is required.

How is the need for root canal treatment assessed?

A dentist will ask about symptoms, examine the tooth and surrounding tissues, and may use tests and X-rays. The findings help identify whether the pulp is inflamed or infected, whether the tooth is restorable and what options are reasonable. Suitability can only be confirmed after examination.

What happens during root canal treatment?

Root canal treatment removes inflamed or infected tissue from inside the tooth. The canals are cleaned, shaped and disinfected before being filled and sealed. A temporary or permanent restoration may be placed as part of the plan. The exact approach depends on the tooth and its condition.

Will root canal treatment hurt?

Local anaesthetic is normally used to make treatment more comfortable. Sensations vary, and the tooth may feel tender afterwards. Tell the clinician if you feel uncomfortable. The practice will explain what to expect and provide aftercare advice for your situation.

How many appointments will be needed?

The number and length of appointments depend on the tooth, its anatomy, the extent of infection, whether it has been treated before and the restoration required. One or more appointments may be needed. Timing is confirmed after examination and may be reviewed as treatment progresses.

Can root canal treatment always save the tooth?

No. Treatment aims to retain the tooth where this is clinically appropriate, but not every tooth can be treated or restored. Cracks, remaining tooth structure, gum and bone support, canal anatomy and response to treatment can affect the outlook. Further treatment, referral or extraction may sometimes be needed, and success cannot be guaranteed.

What happens after root canal treatment?

The tooth may need a filling or crown to restore it and reduce the risk of fracture. Follow the personalised aftercare advice provided and attend any planned review. Contact the practice if symptoms worsen or you are concerned after treatment.

How much does root canal treatment cost?

Our Fees page lists the current fee for root canal treatment. A filling or crown may be needed afterwards and is usually priced separately. The final treatment plan and cost depend on examination, X-rays where appropriate, complexity and the restoration required. Costs will be explained before treatment is agreed.

What alternatives might be discussed?

The options depend on the diagnosis and condition of the tooth. They may include monitoring, a different restoration, root canal treatment, referral, or extraction with or without a later tooth-replacement discussion. A dentist will explain the relevant benefits, limitations and costs before you decide.

What should I do next?

If you have tooth pain, swelling, sensitivity or a damaged tooth, contact a dentist for an assessment. This article provides general information and cannot replace individual clinical advice. To contact the Clinic for Implant & Orthodontic Dentistry, 7 Chapel Road, Worthing, West Sussex BN11 1EG, call 01903 821822.