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Hello Guys,

This patient was referred by a friend. I have been discussing this with her for the past year and a half. She has implants which were placed about 2 years ago by another dentist in site #7 and #10. Since then, she has had constant pain in the area of a 5 or 6 out of 10, which lead to symptoms of irreversible pulpitis and two root canals on #6 and #11. She has also reported pain to air and chewing on #8,9, and when she presses on her palate and buccal areas she also feels pain. She reports getting some smell or pus or something when she presses on the facial of tooth #10,11. I was unable to replicate this.

There is no mobility, the radiographs appear fairly normal, the periodontist has flapped and debrided the teeth and did not have an explanation.

There is also gingivitis along the facial margin of teeth #6 and #11 which also appears to be a biologic width violation. The periodontist did not mention this or act like this was the case. She is in provisional crowns now on #6 and #11 with a smooth interface to tooth, but temp cement.

From what I can see, the implants were placed very close to the canines with very little interproximal bone. There is also very thin bone on the facial of each implant. The radiograph along the apical half of implant #7 does have some cortical irregularities but does not appear severely inflamed or abscessed. I have taken a CBCT to look for pathology and nothing stood out.

At this point she is either facing: 1) removal of implants with high reverse torque by the periodontist (likely leading to loss of facial bone and grafting)

2) tolerating the pain until something more defined is seen.

She goes back and forth on what she would like to do ( I don't blame her), but at this point I would like some advice from someone who has experienced a similar situation, or someone with more implant experience than I.

If in fact the implants being too close to the canines is "choking" the papilla, and since the canines now are non-vital, I had the idea to use a flame finishing bur to remove 1-2mm of the mesial of each canine to open the area up some and see if that helps to resolve the pain, inflammation, and other problems...giving them a little room to breath. (This is not backed by research that I know of so please let me know what you think about this idea. Waste of time?)

Thanks in advance for any advice! (I'll be at spear center this weekend if you want to talk in person!)

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