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Oral Surgery/Pain after final restoration

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Question
QUESTION: Dear Dr. Teig,

On July of 2012 I had bone grafting done on tooth 23-26 in preparation for 2 implants and then a 4-tooth bridge.

On Feb. 2013 I had impressions for the 4-tooth bridge.

On May 2013 I had two implants placed on #23 and #26.

On July 2013 the implants were uncovered and healing caps put on.

I never had any pain with the dental work above.

On September 2013 I had two zirconia abutments and a 4-tooth bridge put on.  I am in a tremendous amount of pain.  After week #1 I went back to the dentist and he did an adjustment.  After a 5 days I couldn't stand the pain anymore and I went back.  He took off the bridge and said everything looked beautiful.  Cleaned it up and cemented it back in with temp cement.  The pain is still there.  It's deep pressure and almost feels like a vice around my teeth.  It feels like the abutments are screwed in way too tight, but he said that's impossible.  I'm at a loss as to what I should do.  I'm almost ready to say take out the zirconia abutments and put the healing caps back on and the removable bridge back in so I can get rid of the pressure.  Please help.

ANSWER: Shay - Immediately find an oral and maxillofacial surgeon to evaluate what is going on.  The dentist obviously is not sure.  If you don't know of a surgeon, you live in New York and there is an oral and maxillofacial surgical residency at a number of hospitals.  Contact a residency and have them evaluate you, unless you already know of a surgeon.  You could ask the dentist for a referral to a surgeon.  Don't wait.

---------- FOLLOW-UP ----------

QUESTION: I first went to my dentist who did the final restoration.  He said everything looked perfect.  He sent me to the oral surgeon who took a 3-d image and said everything looked good.  

They then both discussed my case on the phone while I was there.  They just think time will take away my pain, but if I get desperate he will take the bridge off and loosen the zirconia abutments, but I risk having them fracture if loosened and I will have to pay for the replacement.  At this point I agreed (but will try to hang on a week more), while both thought it wasn't the problem or solution.  I just thought the difference with zirconia and titanium were the esthetics.  Which is better for the bottom front teeth?

How can I go through the whole process with no problems and then the final restoration cause so many problems?

Thank you!

Answer
Shay - It really doesn't matter between those two materials.  They are both good.

I too wonder why the pain suddenly began after the bridge was placed.  It is possible that the process of placing the bridge might have damaged the implant.  The bridge might have altered your bite and that could produce excess forces.  I just don't know.  If you do not improve I suggest you get a second opinion from a different surgeon.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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