Tooth rejection after implantation, symptoms and causes

Chief editor of the site:

Snitkovsky Arkady Alexandrovich

Chief physician of the professorial dentistry “22 Century”, dentist, orthopedic dentist

Author of the article:

Scientific team of dentistry “22 Century”

Dentists, candidates and doctors of medical sciences, professors

Pain after dental prosthetics can occur both during the period of adaptation to a new design and be the norm, or be a symptom of the development of an inflammatory process in the oral cavity. In the first case, the unpleasant sensations disappear on their own after some time or after correction of the dental structure. In the second case, it is necessary to determine and eliminate the cause; this could be an incorrectly manufactured prosthesis, poorly treated supports under the structure and the further development of complications - pulpitis, periodontitis, periostitis, exacerbation of chronic processes such as periodontitis, the formation of periodontal abscess, and so on. To receive qualified assistance, the patient must go to a dental clinic. Self-medication is strictly prohibited.

When to install a crown

A crown is a certain type of orthopedic structure that covers the main part of the tooth. The main function of this kind of dome is protection. Crown installation is recommended in the following cases:

• Significant tooth destruction, impossibility of restoration with filling material or repetition of the natural structure through restoration.
• To eliminate dentition defects expressed in irregular tooth shape.
• When installing a fixed dental prosthesis (bridge), when several teeth are missing in a row. In this case, it is necessary to install crowns on the supporting teeth even if they are destroyed.

A crown is placed exclusively on a tooth that has an intact root, pulp chamber and nerves. In case of total destruction and spread of caries in the pulp, preliminary depulpation and filling of the space inside the tooth root is required.

We do not recommend the installation of bridges to our patients if they have healthy supporting teeth. Installing a crown involves grinding (removing enamel) from the teeth. Thus, even being protected by a crown, the tooth is quite vulnerable and can be destroyed. Installation of such a structure is acceptable only in case of loss of vitality of the pulp and nerve endings.

If the pin falls out

There are situations when the pin, together with the crown or filling made for it, falls out of the tooth cavity. In most cases, this situation is a consequence of medical errors at the stage of diagnosis or treatment. Reasons for unfixing may be:

• Incorrect determination of indications for pin installation;
• Poor quality fixation;
• Incorrect ratio of the length of the pin and the crown of the tooth;
• Incorrectly adjusted occlusal contacts.

Unfortunately, it is under no circumstances possible to fix the fallen structure back. In such cases, the tooth requires re-treatment, possibly using other methods of restoring the coronal part.

Restoring a tooth using a pin is an inexpensive and relatively quick option for prosthetics of a damaged tooth crown. It allows you to completely restore the lost function of the tooth, as well as achieve high aesthetic values. Since this is not only medical, but also aesthetic dentistry.

Types of materials used to make crowns

Modern prosthetics offers the manufacture of crowns from the following materials:

• Metal. Not exactly a modern type of prosthetics, but the cheapest and most accessible.
• Metal ceramics. Refers to budget options. Disadvantages - the inability to achieve the natural whiteness of an artificial tooth due to the presence of a metal base.
• Ceramics. Crowns are not as durable as metal-ceramic crowns, but they look more attractive and aesthetically pleasing. Usually installed on the front teeth.
• Porcelain. They look very natural, such teeth are very difficult to distinguish from natural ones. Ideal for installation on front teeth.
• Zirconium. The crown is based on a zirconium dioxide structure with a ceramic coating. Can be installed on any tooth, regardless of its condition. The main disadvantage is the high cost.

Tooth pain under a crown does not arise due to any specific material used in its manufacture, as many people think. If discomfort and pain occur, we can talk about inflammation of the mucous membrane and gums caused by an allergic reaction to the metal of the crown. Ceramics and zirconium are hypoallergenic and do not cause problems such as allergies.

Pin installation process

Since such structures are installed at the root of a tooth, the root canal must be hermetically sealed over its entire length, and not have any curvatures, too thin walls, or perforations.

How to insert a pin into a tooth:

1. Passing the canal two-thirds of its length using a special tool - a root reamer with expansion of its cavity to the selected pin diameter. The length of the root part of the pin must be at least twice as long as the planned tooth stump.
2. Antiseptic treatment of the canal (rinsing with antiseptic solutions, most often chlorhexidine), drying.
3. Immersion of the pin into the formed canal and fixation with glass ionomer cement or dual-curing cement.
4. Removing excess material.
5. Modeling of a filling or tooth stump depending on the drawn up treatment plan.

Why inflammation may occur

The occurrence of an inflammatory process after crown installation can be triggered by:

• Incomplete and unsatisfactory filling of the canal with material for replacing dental tissue. In the remaining voids, pathogens quickly appear, whose rapid growth and reproduction provoke inflammation. Pain can make itself felt even months or even years after the crown is installed.
• Punching the walls of the dental canal. Often, a similar phenomenon occurs when a canal that has an uneven axis expands (a curved, bent root). This may be due to insufficient competence or experience of the dentist. Perforation of the wall may occur during pin installation. Taking immediate action in the form of filling the hole reduces the negative consequences to a minimum. If the damaged wall is not closed and the doctor limited himself to filling the canal, a granuloma or cyst may subsequently form. This is explained by the fact that the filling material, going beyond the boundaries of the perforated hole, causes inflammation of the periodontium, due to its incomplete compatibility.
• Leaving debris behind. Unfortunately, such phenomena occur quite often. The instrument may break off due to the use of incorrect technique due to the incompetence of the doctor or due to the physiological characteristics of the root structure (difficult to pass, significantly curved). Removing fragments is not an easy task, and sometimes has no solutions. The remaining foreign body is an almost 100% guarantee of the occurrence of an inflammatory process, even if the canal is carefully and efficiently sealed.
• Pulp burn. This very often occurs when installing a crown on a non-pulpless tooth. Violation of the manipulation technique can lead to tissue hyperthermia and burn of the alveolar fascicle. The consequences may be a painful reaction to cold, hot, sour, sweet, and the appearance of aching and acute pain.
• Poor fit of the prosthesis. In such cases, a gap remains between the crown and the tooth, which will inevitably lead to inflammation. A similar situation can arise if the ledge for landing the structure is too low. This puts pressure on the gums and leads to inflammation, and the patient begins to feel as if his tooth under the crown hurts.

Pain on pressure

Sometimes, with external mechanical influence (chewing, pressure), a feeling of pain may occur. This happens quite often, since the treatment process is quite complex, an artificial crown is installed. After some time, the pain goes away.

Another reason that causes pain when pressure is placed on a tooth is when the filling is placed too high. As a result, the jaw stops closing normally. Most often, pain of this nature occurs when chewing food. For prevention, it is recommended to remain under observation in the hospital for some time to understand whether there are any new unpleasant sensations after the intervention.

Sometimes after installing the pin, if you put pressure on the tooth, you can feel pain

Methods of treating a tooth under a crown

Treatment of a tooth with a crown installed is a rather complex procedure and is quite expensive. Pain can only be eliminated by eliminating the cause that caused it. To do this, the canal is unsealed, appropriate long-term therapy is carried out (may take about 2-3 months), and re-sealing is carried out.

The patient is forced not only to endure unpleasant and sometimes quite painful sensations, but also to incur additional financial costs for the manufacture of a new prosthesis. It is possible to reseal the canals without removing the prosthesis, but it is very difficult. To do this, it is necessary to drill a hole in the crown and carry out treatment through it. Not every dentist will undertake the treatment of a tooth under a crown: this is a rather labor-intensive process that does not guarantee the preservation of the tooth.

Most dentists in such situations refer the patient for tooth extraction. The specialists of our clinic can cope with even the most complex and advanced cases, taking all necessary measures to preserve the tooth.

If the cause of inflammation is underfilling of the canal and conservative treatment is not possible, surgical intervention may be offered as an alternative - resection of the apex of the tooth root. Through a neat incision in the gum, the unfilled area is removed along with the granuloma or cyst. The manipulation involves the use of local anesthesia, the operation time is from half an hour to an hour.

The appropriate method of therapy is determined individually in each specific case. The cause of inflammation, stage, and neglect are assessed. In extremely advanced cases, the only correct solution is tooth extraction followed by prosthetics.

Let's sum it up

Pain after insertion of a pin occurs for various reasons, but moderate pain is normal. The maximum time through which they must pass is up to five days. If the pain lingers for a longer period of time, it is necessary to consult a doctor who will find out what caused the pain.

However, if erroneous and unprofessional actions of the dentist were noticed, which include installing the rod too deeply, non-compliance with the rules for filling the root canals, damage to them with dental instruments, an incorrectly fixed pin and pieces of dental instruments accidentally left in the canal, then the pain is usually very intense and you need to get rid of it only after consulting a doctor.

What does pain depend on during rehabilitation, on what days what sensations should be felt?

Pain after implantation begins when the anesthetic effect of the anesthetic drug ends. After 1.5-2 hours

.
Some tissue numbness may also be present. After 5-7 hours
, if normal sensitivity does not appear, you should consult a doctor, because There is a risk of damage to the facial nerve. Severe pain after dental implantation in the lower jaw can also be caused by trauma to the trigeminal nerve, because it is in close proximity to the roots.

The severity and degree of pain depends on:

• depending on the number of implants installed: one or several;
• depending on the type of operation: for implantation, the gum tissue was cut, followed by sutures - patchwork method (in rare cases) or a puncture was made (transgingival method);
• on the individual characteristics of the patient’s body, his pain threshold;
• from additional surgical interventions: sinus lifting, bone tissue augmentation, etc.

Symptoms of complications

If a tooth with a pin hurts when pressed, most often this means that the rod is installed quite deeply. It rests on the jaw bone and causes discomfort. With the development of serious complications, patients complain of:

• the appearance of edema;
• severe itching;
• tissue redness;
• increased body temperature;
• headaches with the development of osteomyelitis;
• feeling of fullness with granulum;
• severe pain when the root splits;

When a tooth without a nerve with a pin hurts, soft tissue may be affected. They become inflamed, swollen, and red. Patients experience itchy, aching pain that bothers them for a long time, even though the nerve has been removed and the masticatory organ has lost connection with the central nervous system. If discomfort appears immediately after surgery, this is a natural process. After a few days the pain will subside and then go away completely. If discomfort increases, you should consult a dentist.

Advantages and disadvantages

Positive aspects of the installation:

• a decaying tooth retains its shape;
• in the future, you can build up the tooth stump to install ceramic crowns;
• it becomes possible to restore the enamel;
• This way you can prevent tooth extraction;
• The pins are durable and should be replaced no earlier than every ten years.

The disadvantages of this design include the following:

• the pin can become one of the causes of tooth decay;
• if the rod is installed incorrectly, it can cause caries;
• metal pins are susceptible to corrosion from external factors;
• allergies and pin rejection may occur;
• over time, the walls of the tooth become thinner, which leads to the subsequent removal of damaged teeth;
• installing a pin is a fairly expensive procedure, especially when using modern materials.

How to prevent pain?

Prevention of toothache under a crown includes following your doctor’s recommendations: crowns should be brushed just like your own teeth - at least 2 times a day. It is worth paying special attention to cleaning the spaces between the teeth and around the gums - this is where the largest amount of food debris and plaque accumulates. It is recommended to use not only a toothbrush and toothpaste, but also dental floss and, if possible, an irrigator.

You will have to refrain from eating solid foods - seeds, nuts, in order to avoid damage to the crown.

Visit your dentist at least once a year to monitor the quality of your dentures.

Features of nerve removal

Experienced doctors perform depulpation only as a last resort. But sometimes it is impossible to do without it. What is the procedure? First, an x-ray is taken, from which the dentist draws conclusions about the condition of the pulp (nerve tissue), areas around the root and gets an idea of ​​how deep the inflammation has spread. The specialist assesses the length of the nerve and the features of its location, then gets to work and acts in several stages:

• anesthesia: local anesthesia to relieve the patient of inevitable discomfort. Modern drugs make it possible to carry out all manipulations absolutely painlessly,
• caries removal: the dentist drills out the affected areas of enamel and dentin using a drill,
• nerve removal: using a special tool called a pulp extractor, which is screwed into the canal, the dentist removes the neurovascular bundle in several stages,
• expansion and cleaning of the canals: carried out so that the doctor can efficiently clean the canals from remnants of nervous tissue and prepare them for filling. The channels are expanded with thin burs, which help to level and smooth the inner surface of the walls,
• filling: a material specially designed for filling (for example, gutta-percha) is injected to the entire depth of the root. The consistency of this substance allows you to fill the cavity entirely so that there are no empty areas left there. The upper part is covered with composite material. In some cases, a large inlay is placed or a crown is installed over the filling.

A tooth left without a nerve is called “dead.” It becomes insensitive to irritants, and enamel mineralization stops. It loses its whiteness and acquires a dark shade. To restore an aesthetic appearance, the dentist may suggest performing intra-canal whitening, installing a veneer or an aesthetic ceramic (or metal-ceramic) crown.

Clinical researches

ASEPTA® mouth rinses are designed to protect gums from inflammation and improve oral hygiene. The main indications for their use are:

• acute and chronic gingivitis;
• acute and chronic periodontitis;
• stomatitis;
• post-extraction alveolitis;
• toothache of infectious origin.

Clinical trials conducted in laboratories have shown that after 3 weeks of using ASEPTA® rinse, gum bleeding is reduced by 28.3%, inflammation is reduced by 32.3% and the hygienic condition of the oral cavity is improved by 33.5%*.

Sources:

1. Clinical and laboratory assessment of the influence of domestic therapeutic and prophylactic toothpaste based on plant extracts on the condition of the oral cavity in patients with simple marginal gingivitis. Doctor of Medical Sciences, Professor Elovikova T.M.1, Candidate of Chemical Sciences, Associate Professor Ermishina E.Yu. 2, Doctor of Technical Sciences Associate Professor Belokonova N.A. 2 Department of Therapeutic Dentistry USMU1, Department of General Chemistry USMU2
2. Clinical experience in using the Asepta series of products Fuchs Elena Ivanovna Assistant of the Department of Therapeutic and Pediatric Dentistry State Budgetary Educational Institution of Higher Professional Education Ryazan State Medical University named after Academician I.P. Pavlova of the Ministry of Health and Social Development of the Russian Federation (GBOU VPO RyazSMU Ministry of Health and Social Development of Russia)
3. Report on clinical trials to determine/confirm the preventive properties of commercially produced personal oral hygiene products: mouth rinse "ASEPTA PARODONTAL" - Solution for irrigator." Doctor of Medical Sciences Professor, Honored Doctor of the Russian Federation, Head. Department of Preventive Dentistry S.B. Ulitovsky, doctor-researcher A.A. Leontiev First St. Petersburg State Medical University named after academician I.P. Pavlova, Department of Preventive Dentistry.