I saw a PT, who had a larged 2 pined GIC MODL restoration.
The student that saw her before had left the restoration slightly high, and
she subsequently came back to see her. The student reduced the height of the
restoration.
The PT came back, and I saw her. I took a pain Hx. I then checked the
occlusion. The tooth was out of occlusion. I asked her if there was a sharp
short acute pain that occurs when biting down in a certain position She said
yes. Trying to get the same response with percussion is a lot harder!
My diagnosis was cracked cusp, although I couldnt really see it. I used the
cotton wool test. A Periapical revealed nothing untoward the pulp. The pain
wasnt that of pulpitis.

I was discussing the case with my tutor, and she told me that it probably
needs RCT. But I couldnt help but get the feeling that there may be a chance
that even after doing the RCT, movement by part of the tooth will stimulate
nocicoceptors in the PDL giving rise to that sharp short acute pain that
occurs when biting down in a certain position.

Your opinions please?

cheers