Sensitivity after Dental Onlay

[lee2732]

I had an onlay about a month ago.  After the procedure (but not before), I had extreme sensitivity to cold and to the bite.  I am NOT sensitive to hot.  I basically cannot chew on that tooth and water or anything cold (even water without ice) causes immense pain.  I went back to the dentist once already about 2 weeks ago and he said this was all caused by my bite being off so he ground the onlay down a bit.  It's still equally sensitive so I am going back tomorrow.

Is this double fine tuning normal?  Is there something other than an onlay with a better success rate?

Thanks so much for your response.

[Jerome Bogin, D.D.S.]

My feeling is the sensitivity is emanating from the cementation process. It is possible that it will improve but if you can not bite on it in a reasonable period of time I would suggest you have it remade.

[Jordy]

I don't know specifically about onlays, but yes I've had to have multiple reshapings of crowns after having walked away from the office.  As much tweaking as they do, sometimes you still don't notice part of the bite doesn't feel right until hours later as you talk and eat and go about your day (especially if you were numb in the chair while he did the restorative work.)  Even the most microscopic high spot can cause extruciating pain until it's filed down.

[mike1105]

many a time in my experience, patients have sensitivity when restorations are "bonded" to teeth. the technique involves treating the tooth with many different chemicals, inclding an acid etch, which can make the tooth sensitive, especially if the restoration is deep. In these cases, all the adjusting in the world will not do a thing. If you bite down, and do not feel this tooth contact, and if you can not feel it "getting in the way" when you slide your teeth from side to side, it is probably not the bite that is the problem. Sometimes the tooth just needs time to calm down. In other cases, root canal treatment may be needed. the problem i in the nerve in these cases. I always make it a point to explain to patients before we do these types of restorations that a scenario like yours is always possible, and that root canal treatment may be needed.

[lee2732]

Mike,
     Thanks for your response.

     When I bite down with nothing in my mouth or if I slide my teeth from side to side, I do not feel anything odd.  However, if I chew a sandwich or even gum on that tooth, its VERY sensitive.  I mention this to see if your 'nerve theory' is still applicable given that my tooth is sensitive to the bite.

     I really don't care if I have to get a root canal, I surely cannot tolerate this for the rest of my life.  But, if it goes away a large percentage of the time in say 3 months, I would gladly wait that long to see.  

     Thoughts?

[mike1105]

every case is different. to help you specifically, i would need to see a film,  a die of the prepared tooth, and i would need knowledge of the bondig system used etc etc..... unless the bite is truly off, there is no reason to adjust it. a good percentage of the time, this tpe of thing gets better on its own. Root canal treatment ususallu does the job if the problem persists becasue the nerve is removed...... all of these issues shoud be discussed with your dentist.

[lee2732]

Im going to see him in an hour.  I wanted to get a feel for whether he was just not a good dentist based on this (same exact issue occured with my wife).  

Thanks for your feedback.  One final question:  Are Onlays always bonded?  I'm not clear if there is some other way to do them or if bonding is always used.

[mike1105]

these days, onlays are usually bonded becseu they are made of resin or porcelain and therefore need to be. I have only gold restorations in my mouth, whic require no acid etch preparation of the tooth structure beofer they are cemented (not bonded).  always try to have my patients consetn to gold restorations on back teth. true, they are yellow and shiny but there is no better restoration in my opinion. They wear well, can be fitted very accurately, require minimal tooth reduction and they can't break !!!

I do not like bonded back teeth resorations at all. they look nice, but they can cause sensitivity, as you know, and they can break.they also require more tooth reduction (drilling) than gold because the restoration itself needs to be thicker. hope this helps. there aren't many dentists who do gold anymore becasuse it is more difficult to do well (it requires very precise tooth preparation and impression techniques) and also becasue cosmetics is the current trend and is best for "show and tell" practice building.

most men in my practice, when I explain to them their options, risks, and bebfits, opt for gold. it's a little tougher with women for obvious reasons. ME-- i dont care hat it looks like. I just want it to last forever and not bother me. Gold gives you the best shot at that.

[lee2732]

I just got back from the 2nd dentist visit since the onlay.  He told me its cement, is that different than bond?  In any case, he was not able to rectify the biting sensitivity or the cold sensitivity.  He said he wants to redo this onlay altogether.  I asked him what might have gone wrong this time that won't go wrong next time.  He didn't really answer me well but he said something about the possibility of a micro-fracture in the onlay.

What do you think I should do (understanding you cant see my teeth)?  Should I opt for gold?  Would going into another dentist for a 2nd opinion be helpful?  Can anyone 'see' the issue?

[mike1105]

it is not possible to recommend a  certain restoration over another without seeing the tooth. The "microfracture of the onlay" idea seems far fetched to me personally. If you sensd he did not have a good answer then he probably doesn't. it can never hurt to get another opinion--go to someone you are referred to by a friend or family member. and go before it gets redone.

Onlays are difficult to do well. they are very technique sensitive. they require good hands. they are done too often in my opinion---partly becasue they ommand a high fee.

[lee2732]

Yeah, I understand that you can't help diagnose my issue without seeing my teeth.  I was looking for exactly the feedback you are providing.  My dentist seems good and detail oriented, but he is young, is building a new practice and I suspect may be recommending procedures that, while warranted (and approved by my insurance), are possibly not the most popular or effective approach.  

What would another option to the onlay be?  Would this other option be less likely to cause the issues I am having (meaning is it easier to do right)?

[mike1105]

Keep in mind this is not a diagnosis and is only my personal opinion. Zyour dentist is best qualified to answer your specific questions.

if an onlay is truly needed (many times teeth are "onlayed" when more simple and less expensive composite fillings would more than suffice) the alternative to it is to crown the tooth. crowns are easier and less technique sensitive. I am not a fan at all of placing onlays on any tooth other than a molar. If a premolar needs an onlay, then in my practice it usually receives a crown. And then, as you know for molars, I use gold if the patient allows. If the patient does not allow this, I usually crown those teeth. I've seen way too many poorly placed ceramic or composite onlays. I've seen alot of them fall off becasue the tooth preparation is not good-- they are difficult to do well. Many dentists also rely way too much on the chemical bond for these restorations--- in truth, the chemical bnd only works well when the fit is snug and well adapted, and if the tooth is correctly prepared. When I place gold onlays they fit so well (the gold metal can be so well adapted to the tooth) that sometimes I cannot even remove them after I try them in with NO CEMENT !!!!  Once cemented, I personally gurantee them forever. that's how good they are in my opinion.. but again, any dentistry is only as good as the hands that do it.

[sandwiches]

I have an onlay on a molar as well, and it definitely was more sensitive at first. It is better now (5 months later) except that I am getting an intermittant ache. I'm not sure if this means root canal (very possibly) or a problem with the onlay.

Just my two cents: the onlay was very sensitive for the first month or two.