Hello Bryanna,

Perhaps you would be so kind to comment on this (I have posted before but have had no success in getting a reply).

I had a periodontist extract #19 in June 2015. #19 was badly compromised (apicoectomy in 1991, May 2015 fistulous tract.) Equimatrix bone graft with optimatrix barrier membrane placed over BG and undel F/L mucogingival flaps.

Eventful recovery with sutures falling out 3-4 days post-op, and loss of some BG material. Ultimately, the site healed over a period of 5 weeks but with numerous complaints about deep seated, gripping pain (not acute) in the LL area, as if a stake had been placed in the area.

Checked for bone regeneration with an OMFS (periodontist retired) in Novermber. The extraction site was well healed with a broad alveolar ridge. A Noble implant with a healing abutment was placed in #19, slighlty more mesial than septal area. Site healed nicely but after 3 weeks, the deep seated, gripping ache that builds up during the day and subsides at night, started again. OMFS checked the site 2 and 4 weeks post-op. There is no pathology, edema, exudate, etc. Referred to a TMJ specialist who thinks it's peripheral neuralgia and suggests anti-convulsants.

I am at a loss, speculating on the following:

#18 (RTC in 2008) is failing..but no tenderness, or pain on biting...fractured root, 3rd root not seen on saggital x-ray view...?

#20 vital tooth, but with a crown, with some biologic width violation..and a ledge on DL side...?

IAN or lingual nerve injury duing the blocks? (left side of tounge is affected, a bit sensitive but not numb, etc...hard to tell if this is referred pain from around 18-19 area..?

I have excluded other causes (ENT related, acoustic neromas, etc.).

Any hints, ideas on how to pin this down would be much appeciated. Antinflammatories are a hit and miss on this. Would a cone beam CT reveal any issues, residual infection, etc?

Best regards and thanks in advance --jr