Dental crown and open margin


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Hi, so I have a problem that started the day of temporary crown placement and lasted up till today which is 2 weeks after permanent placement. Sensitivity to cold, heat, slight pain when eating, I can feel lukewarm water if I swish it around. I had a second opinion and they blew air around one side, and caused pain. I had them take x-rays, and I can't see an opening. I had zero issues with this tooth before the crown, none.

Second opinion appears to be a possible open margin. Will an open margin always be visible on bite wing x-rays? If not, what other x-rays will show one? I'm going back to the dentist who did the crown this week and really need them to explore this.
 
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Dr M

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Good day
Unfortunately it is not always possible to see an open margin on a bite-wing, since it gives a 2D image. Sometimes the open margin can be probed.
Another possibility might be pulpitis due to a crown prep on a vital tooth. This is always a risk when prepping a crown on a vital tooth. The prep might have been too close to the nerve. If the pain worsens, it might be an indication for a root canal treatment.
 

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Good day
Unfortunately it is not always possible to see an open margin on a bite-wing, since it gives a 2D image. Sometimes the open margin can be probed.
Another possibility might be pulpitis due to a crown prep on a vital tooth. This is always a risk when prepping a crown on a vital tooth. The prep might have been too close to the nerve. If the pain worsens, it might be an indication for a root canal treatment.
Thank you for the response. I'm going back to the dentist soon. If they suggest a root canal without checking for an open margin, what should I do? I don't believe it's pulpitis, but how would I know for sure? I don't want to get a root canal if nit needed.

BTW, I can floss at an angle and feel it catching on the edge of the crown close to the gum. Also blowing air around that spot irritates it, wouldn't those be signs of a crown not seated?
 

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Dr M

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Those all could be signs of an open margin, but it could also be hooking onto a piece of excess cement. This area should be thoroughly investigated. I would wait for the symptoms to become more severe before considering a root canal. For example, episodes of lingering pain or spontaneous pain throughout the night.
Also be aware that any root canal treatment performed through a crown, has a risk of crown fracture meaning the crown might need to be re-done. But if the margins are not correct, this could be the case anyways.
 

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Those all could be signs of an open margin, but it could also be hooking onto a piece of excess cement. This area should be thoroughly investigated. I would wait for the symptoms to become more severe before considering a root canal. For example, episodes of lingering pain or spontaneous pain throughout the night.
Also be aware that any root canal treatment performed through a crown, has a risk of crown fracture meaning the crown might need to be re-done. But if the margins are not correct, this could be the case anyways.
I have a follow up appointment today at 3 pm with the dentist. Based on her comment at the permanent crown placement, I don't see her taking responsibility for a possible error.

I really appreciate the help. I will follow up with you on how it goes. I don't know what to do if she doesn't want to redo the crown. The pain isn't excruciating, but the pain when eating is concerning. It's not from the entire tooth, seems like one side. Thanks again and I'll be in touch.
 

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Those all could be signs of an open margin, but it could also be hooking onto a piece of excess cement. This area should be thoroughly investigated. I would wait for the symptoms to become more severe before considering a root canal. For example, episodes of lingering pain or spontaneous pain throughout the night.
Also be aware that any root canal treatment performed through a crown, has a risk of crown fracture meaning the crown might need to be re-done. But if the margins are not correct, this could be the case anyways.
Well, the dentist was very concerned, asked questions, and took my complaints seriously at the follow up today. She looked around, adjusted my Bite, and took a few x-rays. Not once did she Mention root canal at all.

She Said everything looked good from what she could see. She wants me to try and give it a month before exploring further. She feels this tooth is just experiencing sensitivity from the procedure and the crown and should go away. While I have a hard time understanding that, I looked at the x-rays too. I don't see an open margin. She painted some stuff on the base of the tooth and ground down high spots. Gave me sensodyne to rub around the tooth.

She said she doesn't want to do something I may not need, which I agree. The last thing I want is to get a root canal and not need it. Idk, I don't see this just going away. Will give it as long as I can, will probably go elsewhere if it doesn't improve.

In your expert opinion, is this diagnosis even possible or is there a problem with the crown? Is it possible a molar could experience sensitivity and pain after a crown? Thank you so much for your help, I don't know who else to reach out to.
 

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Dr M

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Sensitivity is possible after the crown prep yes. Depending on how conservative the dentist was during the initial visit, a lot of times, dentine gets exposed. This exposed dentine can lead to post operative sensitivity and it can take some time to settle. I would also give it a month, especially after occlusal adjustments.
A root canal should be a last resort yes. But like mentioned previously, only if the tooth becomes more symptomatic, with lingering or spontaneous pain.
 

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Sensitivity is possible after the crown prep yes. Depending on how conservative the dentist was during the initial visit, a lot of times, dentine gets exposed. This exposed dentine can lead to post operative sensitivity and it can take some time to settle. I would also give it a month, especially after occlusal adjustments.
A root canal should be a last resort yes. But like mentioned previously, only if the tooth becomes more symptomatic, with lingering or spontaneous pain.
Thank you so much!
 

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Sensitivity is possible after the crown prep yes. Depending on how conservative the dentist was during the initial visit, a lot of times, dentine gets exposed. This exposed dentine can lead to post operative sensitivity and it can take some time to settle. I would also give it a month, especially after occlusal adjustments.
A root canal should be a last resort yes. But like mentioned previously, only if the tooth becomes more symptomatic, with lingering or spontaneous pain.
Well they painted some strong stuff around the tooth at the last appointment, has helped. I've been noticing more sensitivity the last day or so.

As stated, I'm going to give it up to a month before going back. If it gets worse or closer to the day, I may reach back out to you for your recommendation based on everything I've said so far. I'm willing to give it time but if I don't see any improvement in next few weeks, I'm not sure time is the answer. I'll be in touch soon, thanks again.
 

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Sensitivity is possible after the crown prep yes. Depending on how conservative the dentist was during the initial visit, a lot of times, dentine gets exposed. This exposed dentine can lead to post operative sensitivity and it can take some time to settle. I would also give it a month, especially after occlusal adjustments.
A root canal should be a last resort yes. But like mentioned previously, only if the tooth becomes more symptomatic, with lingering or spontaneous pain.
Update. Been 8 weeks since temp crown and 5 weeks with permanent. Symptoms the exact same, but now after eating on that side I have a burning pain for 1 minute that goes away. It seems like biting on that tooth causing pain inflames the nerve for a little bit?

Went back to dentist who referred me to endodontist who strictly does root canals for examination. He took x-rays, looked around, and believes the nerve is inflamed simply from the procedure of the crown. He said since the Symptoms started even with temporary crown, he doesn't believe a replacement crown will fix the problem. He said the heat cold problem will get fixed with root canal, and believes the pain will as well. He talked about it like he's just trying to sell it.

Here I am, wondering whether another crown willfix it. The exam was $100, and root canal $1,400. Since the doctor didn't believe my dentist messed up, I can't go to them to ask to cover part of this. I don't want to get a root canal and still be in pain, or not need it. I have no Symptoms outside of eating or drinking cold liquid.

Should I not pursue a root canal until Symptoms start worse, request my crown under warranty be replaced, or just give it more time? Should I ask my dentist office to cover part of the bill? I'm sorry, but I don't believe a tooth with zero problem before will somehow need a root canal right after a crown unless the dentist messed up. See this newest x-ray. Please help.
Screenshot_20220825-163104_Gmail.jpg
 

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