Doctor – I still can’t chew on my new dental restoration! Those are some of the most frustrating words for any clinician to hear, as it usually means an unhappy patient, along with another adjustment, then hoping it will get better.
I won’t review all the possibilities for the symptoms of discomfort while chewing following a restoration, but I will offer one thing I think every clinician should check. If your patient presents complaining that they can’t chew on a newly placed restoration, even after a few days or weeks have passed.
A male presented with the complaint that he can’t chew on the upper right second molar without discomfort, which was placed almost a year ago by his dentist, (Fig. 1). He has been back to the dentist numerous times and had his bite on the restoration checked and adjusted, but it hasn’t helped, and here is where my suggestion comes to play.
When I asked him what the dentist had done, he told he was asked to bite, and then grind forward, left and right while the dentist marked the tooth with ribbon, similar to what almost all of us would do. The problem with that approach is that it doesn’t take into account that most patients have another direction their mandible can move, a retrusive direction.
While it is hard to ask a patient to move there, it is easy with a leaf gauge to allow the condyles to seat, then simply remove leaves until you see what teeth touch when the mandible is in the retruded position. In his case the distobuccal cusp of the gold restoration had significantly harder contact then any other teeth, (Fig. 2)
It is this same kind of distalizing contact that can also open up contacts on new restorations with the patients now complaining of food impaction.
In his case I removed the premature contact in the retruded position as well as any contacts in lateral excursions. Two weeks later he had no chewing discomfort on the tooth of any kind (Fig. 3).
Any time we believe there may be an occlusal problem creating dental symptoms, it is always helpful to evaluate the occlusal contacts in the unseen retruded position.