Lasting pain (for weeks) after seating of crown on implant abutment

[HumanInPain]

Problem
Since the crown has been seated on the implant (with maxillary sinus lift) abutment I’m in constant pain in the area around the implant. The pain increases when force is applied to the crown/implant. Clindamycin brought no pain relief.
Tooth number 15 (ISO)

Symptoms
Constant moderate pain. Increased pain when force (vertical to the head of crown, horizontal on front/back) is applied (e.g. with tongue, chewing) to the crown. No pain when crown is removed (= no force applied to the implant).

History of Events

April 2014

• First root channel treatment
  Pain completely gone

November 2014

• Root channel was redone (different dentist)
  Note from dentist: channel was not clean
  Clindamycin for several (6 days)
• Pain back as soon as antibiotics treatment was over

November 2014

• root channel redone (unsure what was the reasoning. missed extra channel?)
  DVT/CBCT was taken. Analysis did not show any findings.

December 2014

• root channel redone with extra injection of a high dose substance (unknown)
  Pain relief for only 1 day.
• Tooth was extracted
  Pain completely gone.

August 2016

• Placement of implant (Ankylos C/X) with "small" maxillary sinus lift + bone grafting
• No (noticeable) complications and no pain after 1 day

End of November 2016

• Seating of crown on implant abutment
• Immediate severe pain

December 2016

• After 5 days, crown was taken off and sanded to decrease pressure on neighboring teeth
• Some pain remained

End of December

• Pain still persistent
• Clindamycin (12 x 600mg) for 6 days
  Antibiotics did not bring any (also not temporary) pain relief

 

[zeezee22]

Has your bite been checked? Is the tooth knocking against others when you chew or catching when you chew laterally? Also maybe if it is an infection, then Clindamycin may not be healing the infection and perhaps another antibiotic may be more suitable for your particular infection. I note that only Clindamycin has bee tried and maybe something like Metronidazole would be a choice to treat any anaerobic infection or Doxycycline if the the infection is bone related. You must speak to the dentist to see what he thinks could work. Perhaps you could discuss these options to check what your dentist thinks would be suitable. Otherwise, perhaps your body is still healing and needs a bit more time

 

[HumanInPain]

Hello zeezee

Thank you for your time looking at my case.

>Has your bite been checked?
Yes. According to the dentist all contact points (occlusal and approximal) are good. He strongly recommends against sanding the contact points any further.

>infection
There are no indications of an acute infection. Clindamycin was prescribed to rule out a possible lingering infection in the sinus.

>dentist visit
I was posting the case here because the dentist/implantologist has no explanation for the described pain. He never came across a similar case before and stated that it was very atypical that I had severe pain for 5 days after the crown has first been seated. This pain was only relieved after the approximal contact points of the crown have been sanded.

I’m wondering whether a restricted orthodontic movement could explain the symptoms.

I have also attached a new x-ray.