Removing 10 Titanium Dental Implants and Placing Ceramic Dental Implants

From Chronic Facial Pain to a Pain-Free Bite: A Biological Implant Rehabilitation Journey

When a patient has been living with facial pain for decades, dentistry becomes far more than replacing teeth — it becomes about restoring quality of life.

This was the case for a Caucasian gentleman in his 60s who presented to Nuffield Dental for a consultation while residing in Thailand. His story was long, complex, and emotionally draining. Titanium dental implants had been placed for him as far back as the late 1990s, and over the years, he developed recurrent facial pain and symptoms consistent with atypical odontalgia / atypical dental pain (ADP).

Despite multiple consultations elsewhere, the pain persisted.

After extensive personal research, the patient became increasingly concerned about the presence of metal in his body and its potential role in chronic inflammation, neurological pain, and immune dysregulation. He specifically sought out a biological dentist — someone who could look beyond conventional protocols and address his problem holistically.

Why He Sought a Biological Approach

Biological dentistry focuses on understanding the interaction between dental materials, the immune system, and the nervous system. In patients with unexplained facial pain, long-standing implants, or chronic inflammation, titanium — while safe for many — can sometimes act as a trigger.

In this patient’s case:

• He had a long history of facial pain following implant placement

• Symptoms persisted despite implant removal attempts elsewhere

• He expressed strong concerns about metal biocompatibility

• He specifically requested a metal-free, ceramic-based rehabilitation

Importantly, he did not rush into treatment. He visited our centre twice for consultations, asked detailed questions, reviewed imaging together with us, and wanted absolute clarity on the process before committing.

The Surgical Phase: Removing 10 Titanium Implants Safely

The treatment plan was meticulous and conservative.

We proceeded with:

• Removal of 10 titanium dental implants

• Careful degranulation of all implant sites to remove inflammatory tissue

• Thorough inspection to ensure no residual foreign material remained

Given his pain history, this step was critical. Inadequate debridement can leave behind inflammatory triggers that continue to irritate surrounding bone and neural structures.

To support healing:

• Ozone therapy was applied to reduce microbial load and inflammation

• PRF (Platelet-Rich Fibrin) was placed to enhance soft-tissue and bone regeneration

The goal was not speed — it was biological stability.

Preparing for Ceramic Implants

Rather than immediate re-implantation, the sites were optimised biologically to allow:

• Reduction of chronic inflammation

• Improved bone quality

• A healthier foundation for future implants

The next phase will involve ceramic (zirconia) dental implants, chosen for their:

• Excellent biocompatibility

• Metal-free composition

• Reduced inflammatory response in sensitive patients

The patient’s ultimate goal is simple but profound:

a normal bite and a pain-free life.

Why the Patient Chose Us

The patient shared several reasons for his decision:

1. A biological, not purely mechanical, philosophy

   We addressed pain, inflammation, immune response, and materials — not just teeth.

2. Transparency and education

   Every step was explained. No shortcuts. No pressure.

3. Experience with complex implant removal cases

   Long-standing implants from the 1990s require a very different approach from modern cases.

4. Confidence in Singapore’s healthcare system

   Despite living in Thailand, he trusted Singapore’s regulatory standards, clinical governance, and infection control protocols.

5. Respect for patient autonomy

   His research, concerns, and preferences — including his desire for a ceramic solution — were taken seriously.

A New Chapter Forward

This case is a reminder that dentistry is not just about restoring teeth — it is about restoring comfort, confidence, and well-being.

For patients with chronic facial pain, unexplained symptoms, or concerns about metal implants, a biological approach may offer answers where conventional pathways have failed.

For this patient, the journey has been long — but for the first time in decades, it is finally moving in the right direction.