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Dental implant pain: what can it be?

Carie denti

Although implantology has achieved success levels very close to 100%, there are small percentages of complications, such as dental implant pain or even implant failure.

Peri-implantitis is usually associated with implant failure, but there are cases, albeit very sporadic, in which the dental implant remains very sensitive to tactile pressure or to pressure due to masticatory load. Cases where the implant remains sore despite no diagnosed inflammation or infection.

Dental implant pain in these cases is not due to a particular clinical condition or a problem with osseointegration. These are very rare cases that can be counted in a percentage that is between 0.1 and 0.5% of all implants inserted.

What can cause abnormal dental implant pain?

The causes of abnormal dental implant pain are still unknown. The scientific community working on the etiology of these particular clinical cases has hypothesized that it could be due to low-level hidden infections due to atypical bacteria or to microfractures of the bone in which the implant has been inserted.

Other hypotheses formulated concern the presence of traumatic neuromas that may have been caused by a previous dental extraction. By neuromas we mean a hyperplastic proliferation of cells and nerve fibers that are produced by the body following the lesion of a peripheral nerve as an attempt by the body itself to regenerate the damaged nerve.

Sensitive dental implants

In a research recently published in Oral surgery, Oral medicine, Oral pathology and Oral radiology, an attempt was made to analyze and understand why, although some dental implants have had correct osseointegration and are free from signs of infection, they remain sensitive to percussion, creating discomfort and pain to the patient.

To carry out the study, 5 patients with dental implant pain and sensitivity to percussion were identified. In the 7 identified implants, the absence of particular pathologies or osteointegration problems was ascertained using different diagnostic instruments.

All patients had high-definition cone beam computed tomography scans.

The results of the research

Of the 5 patients, 4 females and 1 male, aged 48 to 71 years, no significant underlying medical conditions were identified. None of the patients experienced tooth or facial pain prior to implant placement.

Cone beam computed tomography scans revealed the presence of radiolucent channels running from the closest nerve trunk to the vicinity of the sensitive implants. These may represent neurovascular canals, which originally supplied the natural teeth present before implantation and which may have terminal neuromas potentially irritated by the presence of the implant.

In all cases, removal of the offending implant resulted in substantial relief or complete regression of the discomfort.

How to intervene on permanent dental implant pain

In the presence of clinical cases where there is evidence of the diagnosis of terminal neuromas within the jaws that can be the cause of dental implant pain and persistent sensitivity despite the dental implant itself being well integrated and free of disease, the removal of the implant offending seems to be the only treatment for the resolution of the disorder.

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