Post-Operative Hyperocclusion

Dental diagnosis
Overview
Post-operative hyperocclusion after placement of fillings in the posterior teeth.

Red marks produced by occlusal marking ribbon are used to help the dentist identify high spots in the patient’s bite after fillings and other new dental restorations are placed. The goal is an evenly balanced bite (occlusion).

Teeth which have recently undergone restorative dental procedures (crown, filling, etc.) may develop bite sensitivity afterwards. If the restoration was made in a lab, the problem may be that it is too large or does not fit quite right. Sometimes the problem may be caused by not adjusting the bite completely following the procedure, in which case the new restoration may be left with abnormally heavy bite forces on it. Localized numbness (anesthesia) can complicate the dentist’s ability to verify a proper bite relationship between the upper and lower teeth (occlusion), because a numb patient may not be able to provide reliable feedback.

Teeth are living tissue, and dental procedures are surgical in nature. So it’s also possible for fluid to accumulate in the periodontal ligament due to inflammation that may develop following procedures on the tooth. In these cases, the bite appears normal immediately following the procedure, but over the course of a few days following the procedure, the tooth begins to develop bite tenderness and may contact first when the patient closes together.

How is this dental diagnosis established?

There is a history of recent filling, crown, or other restoration on the affected tooth. The patient may report the bite feeling irregular immediately after local anesthetic “wore off”, or the bite may begin to feel irregular over the course of a few days post-operatively. The patient reports tenderness to bite, and frequently to temperature changes (especially cold).

An evaluation of the patient’s bite relationship (occlusion) demonstrates heavy forces and/or premature contact on the affected tooth (i.e. it contacts before the others). This is usually done with an occlusal marking ribbon and a piece of mylar shim stock. Vaseline may be applied to the marking ribbon to help it mark wet teeth. Some dentists use electronic measuring devices to assess occlusal forces.

Generally, there will be no findings on X-rays within a few weeks of the procedure (changes take longer than that to appear on radiographs). However, your dentist may recommend exposing a “baseline” X-ray image, against which future changes may be compared.

Treatment options

If the bite tenderness is solely due to post-operative hyperocclusion, simply adjusting the bite with a dental handpiece (occlusal adjustment) will generally resolve the problem. Adjusting a new restoration should not require a large amount of material to be removed. Heavy reduction of a new restoration may compromise its structural durability and shorten its life. New restorations which are made in a laboratory should not need significant adjustment. Those that do are usually returned to the lab for refinishing before they are cemented to place. Your dentist will determine how much structure can safely be removed to eliminate symptoms without compromising the restoration.

Related diagnoses

Post-operative sensitivity results from the normal inflammatory response which follows restorative work on a tooth. Depending on how involved the procedure was, the age of the patient, and the patient’s immune status, post-operative sensitivity can range from mild to severe. Most often, it does resolve without further treatment, but post-operative hyperocclusion should be ruled out, and the tooth’s status should be closely monitored.

Prolonged post-operative hyperocclusion can result in pulpitis (inflammation of the tooth pulp), which may or may not be reversible, so you should report an irregular bite to your dentist as soon as you notice it. Don’t wait to see if you “get used to it”. Adjusting the bite will generally resolve reversible pulpitis, but not irreversible pulpitis. Resolving irreversible pulpitis generally requires endodontic treatment, and that may lead to additional restorative procedures.

Author: Thomas J. Greany, D.D.S.
Editor: Ken Lambrecht
This page was reviewed by members of our review board.

This page was last updated on June 1, 2016.

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Background information

Tooth sensitivity related to Class I and II restorations
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
1996 127 (4): 497-498

Information you may wish to read before making a decision on treatment

Reduction of post-operative pain: A double-blind, randomized clinical trial
Browning, William D., DDS, MS, et al.
The Journal of the American Dental Association
1997 128 (12): 1661-1667