Question

An MOD inlay is placed in a maxillary left first premolar. A month later, the patient returns complaining of pain on mastication since placement of the restoration. The pain is sharp and stabbing and occurs only when the patient is eating. Radiographs and occlusion are normal; percussion and pulp tests are also normal. When biting with an applicator stick on the cusps of the tooth, pain is produced on the facial cusp but not on the lingual cusp. The most probable diagnosis is

A. sinusitis.
B. a fractured cusp.
C. hypersensitivity.
D. irreversible pulpitis.
E. acute apical periodontitis.

Answer 1

The most probable diagnosis for the patient's symptoms after getting an MOD inlay on a maxillary left first premolar is a fractured cusp, considering the localized pain during mastication and normal findings in radiographs, occlusion, and pulp tests.

Step-by-step explanation:

Based on the description provided, the patient experiencing sharp and stabbing pain that occurs only during mastication and is localized to the facial cusp of a maxillary left first premolar with an MOD inlay, with normal radiographs and occlusion, and normal percussion and pulp tests, the most probable diagnosis is a fractured cusp. The absence of symptoms in non-chewing situations and the provocation of pain upon biting with an applicator stick on the facial cusp specifically point towards a mechanical issue such as a fracture, rather than a problem with the tooth's pulp or periodontal infection. Conditions like irreversible pulpitis or acute apical periodontitis typically present with broader symptoms, including spontaneous pain and sensitivity to temperature, which are not described in this case.