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Oral Surgery/Is it normal to have sore gums 4 months after Bone graft surgery?

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Right Maxillary Incisor implant
Right Maxillary Inciso  
I am a 25 year old female doctor, non-smoker; In 2005 I underwent a root canal on the right central maxillary tooth .
All was well until 5 years later I felt discomfort over the tooth again and another root canal was attempted. This process could not bee finished because I kept feeling pain and 6 months in of starting the root canal I got a small abscess over the tooth.
I proceeded to an Apicoectomy. This went well but 6 months later I felt pain again. There were no signs of infection over the gum and CT showed no abscess, apart from a slightly dark shadow over buccal plate of the bone.  Another procedure was done, where exploration of the apicoectomy was done,  which showed there was mild bone resorption where the dark shadow stood but no signs of infection.
I was still in pain but oral surgeon said it might be 'scar tissue'.
I visited another oral surgeon a few months later who realised there was redness over the gum. We proceeded to a Dental Implant;
July 2014 - extraction and 'gel foam'(?) to keep  root shape. I felt better but was still feeling uncomfortable up until February 2014. I underwent a bone graft (bovine) with PRP and titanium implant inserted. I was completely pain free for a full 5 months up until the crown was loaded onto abutment. 8 days after the placement of the crown (when I was still pain free) I started feelin discomfort over the root again and noted that my lower tooth was hitting the implant(this was fixed). Another CT done which showed bone resorption. Gum flap raised in another procedure and oral surgeon noticed that part of the screw was in contact with gum due to bone resorption(!). Another bone graft placed with PRP ( crown was never removed) but 4 months down the line I am still very sore over the gums. Xrays show no abscess, there is no redness over the gums or signs of infection and it is described as a dull  ache; oral surgeon noted bone remodelling still occuring over the titanium implant. I am at my wit's end, and I shall be moving to the states in 3 months time so this has come at a very bad time. I am constantly focused on the tooth and I cannot concentrate on anything else.  Any suggestions on how one would proceed would be greatly appreciated

Answer
Audrey - Of course, without directly examining you I cannot be completely sure, but just looking at the picture of your front teeth, I see a thickening of the gum tissue over the right central incisor.  I cannot tell without feeling that tissue, but it looks soft.  

Okay, what am I saying?  It looks like there is an infection along the front of that tooth.  It appears that there is a minimal amount of bone there and the gum tissue covering the area acts as pocket for bacteria from the mouth to accumulate.  

You didn't say if that incisor is loose, but with the bone loss I think that the implant might be failing.  Well what can you do?  I think the implant might need removing and allow the area to heal.  At that point, after about 4 months after the implant removal, either a new implant might be able to be placed, but I worry about the healing will produce bone that is not very strong and probably has soft tissue infiltrating.  I might be wrong, but I don't thing that new bone will cover that implant.  It might and be functional, but time will tell.  I wish you well and hope the implant completely heals, but if the gum tissue overlying the tooth is sore to a little pressure other options should be considered.

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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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