Why does my dental implant hurt months later?

The six things it usually turns out to be

Implants have no nerve inside them, so pain is coming from the tissue around them, from the hardware moving, or from somewhere nearby. What you feel gives useful clues, but only an examination and an x ray can separate these.

• Peri-implantitis: inflammation with bone loss around the implant. Usually comes with red, tender or bleeding gum, sometimes pus, and a dull ache. The American Academy of Periodontology lists poor plaque control, smoking, diabetes and previous gum disease as the risk factors.
• A loose abutment or crown screw: often felt as a dull ache after chewing, sometimes clicking or slight rocking. Common and fixable, but a loose screw left in place can fracture.
• Occlusal overload: the crown is high or takes too much force, especially if you clench or grind. An implant has no periodontal ligament to cushion the load, so a small high spot puts unbuffered force into bone.
• A problem in the neighbouring tooth: decay, a cracked tooth or an abscess next door is often felt as implant pain because the brain localises dental pain poorly.
• Nerve irritation: an implant placed near the inferior alveolar nerve in the lower jaw can produce tingling, burning or shooting pain. This is uncommon but needs prompt assessment.
• Food impaction: an open contact or a gap under the crown lets food pack in, inflaming the gum. Feels like pressure and soreness after meals.

Peri-implantitis is the one to catch early

The American Academy of Periodontology divides peri-implant disease into peri-implant mucositis, which is soft tissue inflammation with no bone loss and may be reversible if treated early, and peri-implantitis, where the bone supporting the implant is deteriorating and surgical treatment is typically needed.

The catch is that peri-implantitis is often painless in its early stages. By the time it hurts, meaningful bone can already have been lost. That is why bleeding when you brush around an implant, which most people ignore, is the sign worth acting on, and why implants need monitoring at regular check ups even when they feel fine.

What your dentist will do

Expect an examination that checks whether anything moves, probing around the implant to measure pocket depths and see whether it bleeds, a bite check with articulating paper, and an x ray to compare bone levels against what they were when the crown went on.

That comparison is the key piece of information. Stable bone with inflamed gum points toward mucositis. Bone loss points toward peri-implantitis. Perfect bone with a sore implant that clicks points toward hardware, and perfect everything points toward looking at the neighbouring tooth.

What you can do before the appointment

Do not wait to see if it settles. Every one of the likely causes gets more expensive with time: screws fracture, bone is lost, cracked neighbouring teeth split further.

• Stop chewing on that side
• Keep the area very clean, gently, including cleaning between the implant and its neighbours
• Warm salt water rinses if the gum is sore
• Note when it hurts: on biting, after meals, spontaneously, or at night
• Note whether the gum bleeds when you clean there
• Mention if you grind or clench, and whether you have a night guard
• Stop smoking, which is a listed risk factor for peri-implant disease

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