u/rafa0794

I had veneers placed on #4–#13 about 3 months ago (minimal prep ~0.6 mm). During treatment, I required RCT on #12. Pre-op CBCT reportedly showed large pulp chambers with close proximity to the external surface (see attached images).

I was given a night guard for bruxism, which I initially wore consistently but noticed it seemed to increase clenching.

Since placement, I’ve needed multiple occlusal adjustments for persistent “pressure-like” discomfort, which evolved into diffuse, intermittent pain across multiple teeth, including non-veneered teeth. The pain is migratory, shifting between incisors, canines, and molars, often localizing to one region at a time before resolving. It’s sometimes distracting, associated with headaches, and has caused significant hyperawareness of my teeth.

While wearing the night guard, symptoms were worse at night, sometimes waking me from sleep. After stopping it about a week ago, I’ve had marked improvement, including no more nocturnal awakenings, though intermittent discomfort persists.

I’ve seen three dentists, two found no clear issue, one suggested PDL inflammation/occlusal trauma.

Tooth #13 has pulpal irritation, treated with GLUMA and 5% potassium nitrate toothpaste, which helped. However, I still get occasional focal, throbbing pain similar to what I had with #12 pre-RCT. Sensitivity is to cold only, not warm. Endo Ice produced a strong but non-lingering response, and RCT was not recommended.

Questions:

• Could this be explained by PDL inflammation/occlusal trauma from repeated adjustments or altered occlusion?
• Does improvement after stopping the night guard suggest it was worsening parafunction or occlusion?
• How should I interpret #13, strong but non-lingering cold response with intermittent throbbing, in terms of reversible vs irreversible pulpitis?
• Does the migratory nature of pain favor occlusal/PDL issues over pulpal pathology?
• At 3 months out, what else should be considered, e.g., persistent occlusal instability, pulpitis in other teeth, or central sensitization?

Any guidance on distinguishing these clinically would be helpful. I am a non-smoker and drink 1 alcoholic drink maybe once every 2-3 months.

Oral endoscope

CBCT of #12

Images (including XR)