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.