Q. I get throbbing pain in the implant after a bone graft. Shall I go with Maryland bridge?

Answered by
Dr. Naveen Thomas
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 10, 2020

Hello doctor,

I recently had a dental implant to replace one of my lower front teeth. At the time of the surgery, I was informed that I had bone loss, so they did a bone graft on the spot and placed the implant. The abutment was left out so that I could put a temporary tooth on the top of it (instead of wearing a flipper for months).

I was fine for the first few days, but after a week or so, I develop intense, throbbing pain. It was at the implant site and the tooth next to it. It is radiating (off and on) through my whole lower right jaw.

I was advised to come in. They removed the implant, did a bone graft again, and closed me up. I was told that the implant did not take and that we would have to wait a few months for the bone to grow and get stronger. After a good while, we could likely try again. I was also told there were no signs of infection or any obvious reason for my pain. They seemed a bit stumped about the pain aspect but said when they pulled on the temporary tooth. The implant easily came right out with it (this was about the 10-day mark after the initial implant surgery).

I want to try this procedure again in several months, but I am worried it will fail again. And a bit nervous about returning to the same surgeon because they could not give me a reason for the pain I experienced. They only said that we would close the implant site next time and let it heal while I will wear a flipper or Maryland bridge instead of a temporary tooth-like last time. I did not put any load on the temporary when I had it, but I did accidentally clink it on my other teeth quite a bit while trying to speak. It felt like the teeth next to it were getting sore, or even the area below the tooth directly to the right of it. I have had an abscess before, and this was a similar pain. However, when they removed the implant, the pain was gone.

I would like to know if what my surgeon and dentist are telling me makes sense or anything suspect here.



Welcome to

The temporary should never have been placed along with the placement of the implant. The implant space should have been closed using sutures and waited for four to six months before giving any load over it.

The implant mostly failed due to the load on it and possible infection, which resulted in the easy removal of the implant. Severe pain mostly results due to infection.

Which tooth was replaced by the implant? Please attach pre and post-x-rays for better assessment of your problem.

Thank you doctor,

I do not have x-rays with me. It is the lower front, just right of center. Is it safe to try again with a Maryland bridge during the implant healing process?



Welcome back to

Yes, Maryland bridge can be given, but the adjacent teeth will be ground down slightly at the back. Later on, when we go for an implant, we have to restore adjacent teeth original shape.

Still be sure not to bite anything with front teeth at all to help in bone healing.

Thank you doctor,

I was hoping the Maryland bridge would be an option that would not load the site. But I will be careful not to bite anything with my front teeth. One other thing so that I will get the implant again in six months, and they will close it up to heal, and I will have a Maryland bridge on during that process.

After I do that for six or so months, do I get the final surgery (with the fabricated tooth and all), or do I have another interim stage with a healing cap? I keep reading about a healing cap. And if I need one, can I have a Maryland bridge on while I have that healing cap?



Welcome back to

If you are doing the Maryland bridge and wait for six months, you do not have to wait for more for the healing cap. The healing cap needs only a week to heal, to surgically open the implant space, and to fix the lid. Then after a week, we directly fix the ceramic crown.

Thank you doctor,

So do you always do a healing cap, or is it sometimes not necessary? Meaning, I would go from the six-month healed implant with Maryland bridge on it directly to the final stage? I wonder if that will have to be two separate appointments one week apart or if we skip the healing cap?



Welcome back to

When we open up the implant, there will be some bleeding. It is better we can wait for a few days first to let the opening borders heal so that we can get a good impression to place the ceramic crown.

Else we can directly open and place the abutment with crown and wait for the wound to heal later.

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