Postoperative High Spot After Composite on a Premolar
A 29-year-old patient returns two days after a MOD composite on tooth #14 reporting that the tooth 'hits first' when closing and has mild cold sensitivity. The patient has no history of TMD. Clinical examination shows a heavy articulating-paper mark on the mesiobuccal cusp tip of #14 and a matching mark on the opposing mandibular second premolar, #45. The restoration was placed with a sectional matrix, and the patient's occlusion is group function on the left side. The gingival margins are smooth, and a radiograph shows no overhang. The patient reports the cold sensation is worse after drinking ice water and subsides within seconds. You have 40-micron articulating paper, 8-micron shimstock, and fine diamond finishing burs. The dentist asks you to help identify and adjust the interference.
1. How would you determine whether the heavy mark is a true occlusal interference or a normal contact, and what adjustment sequence would you recommend?
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I would first use 8-micron shimstock to see whether #14 holds the strip in centric and whether the mark is a true interference. A heavy 40-micron mark alone can be a normal contact. I would have the patient tap in centric, then slide left and right, and mark excursive contacts. If #14 holds shimstock in centric or prevents smooth excursion, I would adjust the restoration with a fine diamond, re-mark, and recheck. I would adjust the composite, not the opposing #45 cusp, because the restoration is the new variable and the enamel cusp is likely correct. I would finish and polish the adjusted area. The reasoning is that adjusting the opposing tooth can create a new interference and remove sound enamel.
2. What could explain the cold sensitivity, and how would you differentiate restorative causes from occlusal trauma?
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Cold sensitivity after a composite can come from marginal leakage, contamination during bonding, a deep preparation close to the pulp, or occlusal trauma. I would check the margins with an explorer, inspect for flash or open margins, and review the isolation and bonding steps. If the restoration is high, I would adjust occlusion first; if the margin is open, I would repair it. If the sensitivity is mild and the restoration is intact, I would monitor and recommend a desensitizer or fluoride varnish, but I would not assume it is normal without checking. Differentiating occlusal from pulpal causes matters because the treatments differ: occlusal trauma calls for adjustment, while marginal leakage calls for repair and pulpal symptoms may require further evaluation.