Tooth hurting after crown placement

[jacoru]

Hi,
I have a 73 yo pt who had a fractured #30 PFM crown, which I replaced with a zirconia (Katana) crown on 8//5/21 (Cerec, delivered same day). The tooth was asymptomatic prior to crown replacement. Pt has come twice because he experiences discomfort and cold sensitivity when he chews food on that side. He describes the discomfort as dull ache "deep in the tooth" and points to tooth's roots; sharp pain when something cold hits the tooth. The prep was not close to the pulp chamber at all (didn't even need a core buid-up) and pt's bite feels fine to him. I took a PA and checked for excess cement. PA is WNL and no clinical or radiographic signs of excess cement. Probing depths are also WNL. I checked/adjusted the occlusion on the distal marginal ridge, which is the area the pt says bothers him the most when he's eating. I replicated the patient's symptoms by having him bite on a cotton roll and eliminated any possible excursive interferences. Pt is still experiencing discomfort and it's been almost 2 months since I cemented the crown. Any thoughts on what could be causing his symptoms?

 

[honestdoc]

Most likely pulpal due to your descriptions. Usually a 73 y/o will have more calcified (insulated) pulp that would minimize cold sensitivity. Another likely scenario would be fracture. When did you probe? Sometimes vertical root fracture may manifest into abnormal probings after a few weeks. If symptoms don't improve soon, the tooth may need a root canal (best case) or extraction if fracture is detected.