Will The Puzzles Never Cease?
363 days ago by Steve Ratcliff | 8 Comments
This 44-year-old woman came into my practice yesterday with a chief complaint of non-painful throbbing at the area of her implant. Also, she didn’t like the “feel of the shape” of the existing provisional.
She had the implant placed two years ago and last November started noticing the throbbing while exercising.
It never hurts but often occurs during exercise and now at times is spontaneous. The shape of the crown on the implant is the easy part, but what’s up with the throbbing?
What questions would you ask and what do you see on the films that I took?
Is there any bone on buccal of the implant? It looks like she starting to lose bone interproximally on the PA radiograph? Any fremitus or is she bracing her lower jaw against her upper front teeth when she exercises?
Great catch, yes there is fremitus.
Is she reading 50 Shades of Grey??
Sorry I didn’t mean to send that last one. Is she wearing any sports guard or doing anything eg parafunctional during her exercise?
Yeah, there looks like there is no buccal bone. There looks like there is cement on the mesial. The clue I’m thinking about is the throbbing on exertion. It looks like it might be impinging a bit on the nasopalatine canal. If we look at the implant design, it looks like a NobelActive fixture, which is placed with extremely high insertion torque, compressing the bone. Under load, when combined with vasodilation from exertion, you might get a bit of soreness. Plus she’s in hyperocclusion, if there’s fremitus. Bad signs all around.
When was the provisional placed? Has it ever been changed? Did the soreness occur around the time the provisional placement? What did she have before the current provisional?
Look at the PA closely, looks like the abutment isn’t down all the way. Is there soft-tissue caught underneath it?
It actually seems to be little bone on the buccal. Did you ever try to insert something on the palatal side and ask her to bite on it to see if the force to the implant does not reproduce the pain .. if so, may be it is the force she exerce to the implant during her periods of exercises that can create discomfort. Treatment??