High restoration causing occlusal trauma — ORE Part 1 MCQ

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ModerateRestorative DentistryHigh restoration causing occlusal traumaORE Part 1

A 35-year-old patient returns two days after a deep composite restoration in a lower molar. He reports tenderness when biting, especially in the morning, but no spontaneous pain. Cold testing is normal and the tooth is tender when checked in maximum intercuspation with articulating paper showing a heavy contact on the new restoration. What is the most likely cause?

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Correct answer: E — Occlusal prematurity on the restoration

Explanation lettering: E = shown as C · C = shown as E

The correct answer is C. The key diagnostic features point to occlusal prematurity: bite-related tenderness (especially in the morning when clenching), absence of spontaneous pain, normal cold response (ruling out pulpal inflammation), and heavy contact visible on articulating paper in maximum intercuspation. Occlusal prematurity is a mechanical problem—not an endodontic or infectious one—arising from the restoration being higher than the natural occlusal plane, causing excessive loading of the periodontal ligament and supporting structures. Irreversible pulpitis (A) and acute apical abscess (B) would present with spontaneous pain and abnormal cold response, which are absent here. Vertical root fracture (D) typically presents with delayed symptoms and percussion sensitivity. Allergic reaction (E) manifests with tissue inflammation rather than mechanical bite trauma. Post-restoration occlusal adjustment is standard UK general dental practice and resolves this problem.

Reference: Occlusion and Its Role in the Long-Term Success of Dental Restorations: A Literature Review. PMC 11624512 (2024). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624512/; NHS England Dental Record-Keeping Standards (2019), supported by practitioner survey in PMC 9546105 (2022).