Mild gum pain or discomfort after implant crown placement is normal and should self-resolve over the next 2-3 days. Generally, it has to do with the fact that you now have a brand new prosthesis in your mouth which you've never had before.
However, moderate to severe pain the gum is abnormal, especially if the symptoms persist for more than a few days. Albeit rare, it is an indication of a potential post-restorative complication. This will require treatment by your dentist and should not be left as a "let's wait and see if it gets better."
Causes of gum pain
The cause of the gum pain after implant crown placement will depend on the severity of the discomfort. Mild discomfort is normal and not alarming but moderate-severe pain can be indicative of a restorative complication.
Gum pain severity
Prosthetic size discrepancy
Infection; Residual cement; Broken implant; Wrong crown size
Mild gum pain
We expect our patients to experience mild discomfort around the gums of their new dental implant crown for the first few days.
Signs & Symptoms:
Mild pain. Discomfort but it isn't anything that would require taking painkillers.
Gum blanching. The gingiva around the new crown looks white in color.
Gum soreness or tenderness. Mildly uncomfortable pressure pushing on the gums.
These symptoms are self-explanatory if you compare the status of your implant before the tooth cap was placed on it and what it looks like afterwards.
Prior to crown placement: Your gums were used to having a very small sized healing abutment in it.
After crown placement: Your gums now have to adjust to a new object that is much bigger than the healing cap, approximately the size of your tooth.
Ultimately, the mild "gum pain" which you're feeling once the implant tooth cap has been inserted is due to the pressure of the crown squeezing into the gums. The size of the healing abutment was significantly smaller than the size of your new crown.
In summary, the size discrepancy between the two prosthetic pieces is cause of the gum discomfort that you're feeling.
Moderate to severe pain
Any type of gingival pain that is more than mild can be indicative of a complication that may be brewing with your implant. It may not necessarily be due to the crown because it can be from the implant fixture in the bone.
Infection. It is possible to develop an infection around the implant fixture or around the gums. This can lead to a dental abscess where you see pus oozing out of the soft tissue.
Residual cement. A major disadvantage to cement retained implant crowns is the need to clean up residual cement. When it is not removed, the glue can induce gum irritation in the short term and potential bone loss in the long term. The latter will lead to implant failure.
Broken implant. Perhaps your fixture screw cracked? Well, that's not good.
Wrong crown size. Rare but possible, perhaps your dentist used the wrong sized implant part and the crown ended up coming back too large for your gum hole. This would cause a lot of pressure in the gums.
If the pain is due to any of the above reasons, you will need it treated meaning you should return to your dentist for a follow up appointment. Unfortunately, none of them are things which you can fix at home.
Treatment for gum pain after implant crown placement is dependent upon what the exact cause for the discomfort is.
Cause for implant gum pain
Debridement and drainage
Remove residual cement
Broken implant fixture
Remove and replace implant
Bulky implant crown
Replace with smaller crown
Mild gum pain
No treatment, self resolving
Debride infection. If there is an infection around the implant, it will need to be cleaned out. This may include opening a gum flap to visualize the site and drain the abscess.
Removal residual cement. Extra implant glue that is causing inflammation can simply be removed with hand scalers and then have the site disinfected.
Extract the implant. A cracked or fractured implant fixture is non-restorable. These will need to be surgically removed and then another implant placed after it heals.
Replace the crown. An implant crown that is too big can be replaced with a smaller one. Hopefully this one is the correct size so it won't create the same problem.
When treatment is unnecessary
Last but not least, the mild gum pain due to unfamiliarity with the new implant crown does not require any treatment. Yes, most of our patients do make a comment about the gum discomfort and pressure on the day they receive the implant cap.
However, what we find with our patients is that the discomfort will self dissipate after 2-3 days on their own. They will get used to the new crown in their mouth after that time and won't even notice it anymore after those 48-72 hours.
In other words, the gum irritation is transient and will go away without any intervention.
Typically mild discomfort is expected in the gums around the implant crown immediately after it has been placed. Although that uncomfortable sensation should go away after 2-3 days once you get use to it.
However, moderate or severe pain around the gums may be indicative of something more serious. Perhaps an infection or other complication may have arisen during the implant process. These will warrant a trip to the dentist in order to get a diagnosis and have it treated.