Vertical root fracture symptoms after 4 months

[iartemch]

Hello,

I’ve had pain and pressure in the gum and in my #9 tooth with root canal for the last 4 months. The tooth is covered by a veneer. The root canal was done because of pain after veneer replacement - It was done 6 months before my current symptoms began.
Nothing showed up on the X-ray taken 3.5 months ago. 2 dentists and 1 endodontist say root canal looks good. I have had 4 bite adjustments with some relief after that. The dentist who replaced my veneers and did crown lengthening said I needed to come for another adjustment. She also suggested it might be vertical root fracture. Another dentist suggested to see ENT since my sinus infection might be causing it ( I also developed pain and pressure in gums in teeth #10, 11 and even 12).
I have no pain in tooth #9 when biting. In fact, pain and pressure disappear when I bite while eating. Also, no pain or pressure while wearing a night guard.

Given the fact that it has been 4 months since my symptoms started, shouldn’t I have developed a periodontal pocket or bone loss visible on the X-ray ? Since my veneer felt weird from the beginning (no problems with temporaries), is it possible that it did not fit right to the tooth under it? Can my sinus infection mess up my tooth since I am congested and feel pressure and pain in maxillary sinus mostly on that side?

Please, any advice is greatly appreciated. I don’t want to extract my upper front tooth if there is no need for it. Thank you!

 

[MattKW]

1. I would've expected a periodontal swelling to have developed as you say. Bone loss may not be visible on a standard dental Xray. You might see a fracture on a CBCT, but I would've expected the perio to be the first sign. Also, there should be pain on biting with a fracture.
2, Can't see why a veneer would've caused much change in your bite unless there was significant incisal adjustment. Normally you still have to keep the length of a single veneer within the movement envelope consistent with adjacent teeth, unless you do a lot at the same time.
3. Nothing to do with sinus issues. Maxillary sinus issues only affect back teeth, say 2nd premolar and backwards and would manifest as a dull ache, exacerbated when chewing, and not easily located to a single tooth.

Yeah, can't say for sure. A crack seems the most likely out a poor choice of possibilities. Maybe consider a simple ortho retainer for a few months rather than risk something more aggressive. Pls write back here when you find a diagnosis and effective solution.

 

[iartemch]

Thank you for your reply. I am planning to get CBCT to see what goes on with the tooth and the bone.
I will write if/when I get a diagnosis.