I would very much appreciate advice regarding the following. I had a periodontist extract #19 in June 2015. #19 was badly compromised (apico 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, 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 (hard to get an appointment with).

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? (lingual 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 am also attempting to exclude other causes (neuroma....?, ENT related, saw an ENT MD).

Any hints, ideas on how to pin this down would be much appeciated. Antinflammatories are a hit and miss on this.

Best regards and thanks in advance --jr