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Oral Surgery/Soreness over gums 4 months after Bone Graft


gum over right maxillary incisor
gum over right maxilla  
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...

Dear Audrey

I understood the whole history. Assuming that you had placement of the implant and the graft in a prior way, there should not be any reason why you are still sore.
In addition, I would have avoided bovine bone specially in the anterior region. Keep in mind that the bone is very seldom replaced by your own and usually forms small scar tissue which might explain your symptoms.
If you really want to make sure about all steps, I would :
1- Remove the tooth which I suppose was temporarily cemented
2-Check the stability of the implant (sometimes they are not fully integrated and might be the cause of the pain)
3-If the implant is stable then go ahead and explore again the implant to see if the metal part is still not in contact with the gums
4-If its in contact then add some autogenous bone taken from the back pf your mandible or your chin which is the only guarantee that you will  have a perfect integration and healing.

I hope this helps!


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Chawket MANNAI, DDS,Ph.D Diplomate ABOMS


I am a US board certified Oral & Maxillofacial Surgeon trained at UCLA and Parkland Memorial Hospital (Dallas) with more than 25 years of experience and will provide answers to all questions pertaining to the Oral& Maxillofacial Surgery region including Orthognathic Surgery, Trauma,TMJ, Implantology, tumour surgery (excluding cancer and Oral Dermatology),reconstructive surgery...


Extensive in all fields for the past 25 years hospital and office based.

American Association of Oral & Maxillofacial Surgeons American College of Oral & Maxillofacial Surgeons British Association of Oral & Maxillofacial Surgeons

2006: Mannai Chawket Early implant loading in severely resorbed maxilla using xenograft, autograft, and platelet-rich plasma in 97 patients. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2006;64(9):1420-6. Bayonne, France. 1998: Bell W H; Mannai C [An interview with Dr. W.H. Bell and Dr. C. Mannai. Interview by Colette Orival-Demange.] L' Orthodontie franšaise 1998;69(1):225-9. 1988: Abemayor E; Zemplenyi J; Mannai C; Webb D J; Canalis R F The fixation of malar fractures with the transnasal Kirschner wire. The Journal of otolaryngology 1988;17(4):179-82. Division of Head and Neck Surgery, Harbor-UCLA Medical Center, Torrance 90509. 1988: Wald R M; Abemayor E; Zemplenyi J; Mannai C; Lesavoy M A The transoral treatment of mandibular fractures using noncompression miniplates: a prospective study. Annals of plastic surgery 1988;20(5):409-13. Division of Plastic Surgery, Harbor/UCLA Medical Center. 1988: Di S; Bell W H; Mannai C; Seale N S; Hurt W C; Taylor J; Waite D E Long-term evaluation of human teeth after Le Fort I osteotomy: a histologic and developmental study. Oral surgery, oral medicine, and oral pathology 1988;65(4):379-86. Division of Oral and Maxillofacial Surgery, University of Texas Health Science Center, Dallas. 1988: Bell W H; Mannai C; Luhr H G Art and science of the Le Fort I down fracture. The International journal of adult orthodontics and orthognathic surgery 1988;3(1):23-52. 1986: Mannai C; Schwartz H C Juvenile nasopharyngeal angiofibroma presenting as a facial swelling. A case report. Journal of maxillofacial surgery 1986;14(6):329-31. 1986: Mannai C; Leake D; Pizzoferrato A; Ciapetti G; Sangiorgi C Histologic evaluation of purified bovine tendon collagen sponge in tooth extraction sites in dogs. Oral surgery, oral medicine, and oral pathology 1986;61(4):315-23.

DDS,Ph.D Fellow and Diplomate American Board of Oral & Maxillofacial Surgery Residency training:Harbor-UCLA MedicalCenter 1982-1985 Fellow OMFS Parkland Memorial Hospital Dallas Texas with William H.BELL

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