Persistent Amalgam Fillings Despite Severe Bruxism: A Case Analysis

Full Analysis and Diagnosis (Zoom 100%)
Upon close observation, one of the upper front teeth shows visible dark discoloration—a likely indication of pulpal necrosis or internal tooth trauma. This often happens when the tooth’s nerve dies due to deep decay, previous injury, or infection spreading inside the pulp chamber. The surrounding gumline also appears slightly inflamed, which can contribute to pain and pressure sensitivity.

Client Report:

“Need help, it is painful.”

Case Study: Correcting Transposition of Canine and First Premolar

Appliance Used: Self-Ligating Braces (Clear Ceramic) + Transpalatal Arch
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Clinical summary (based on the photo)

• Visible localized gum recession on the lower anterior teeth (root exposure at multiple incisors), with the gingival margin apically displaced from the CEJ.

• Gingiva looks slightly inflamed in some areas (reddish band), but there’s no obvious acute swelling or pus in the image.

• Likely increased root sensitivity risk due to exposed root surfaces.

Quick visual impression

I can’t give a definitive diagnosis from photos alone, but the image shows a large existing restoration (amalgam or metal) on a lower molar with surrounding gum redness. The appearance and your description of “horrible, stinging pain” suggest one of the following is likely:

• failing/restored tooth with recurrent decay reaching the pulp,

• pulpitis (inflamed nerve) possibly progressing to irreversible pulpitis, or