In case anyone else in the future finds this thread via Google search like I did, I had the exact same symptoms, and it also ended up being a hole in a piston, #1 in my case. My truck is a 2017 5500, had 197,000 miles, and ran about 100,000 miles of that deleted. I was towing 15,000 pounds of trailer and skidsteer up up a grade and all of a sudden had a major loss of power and shaking and smoke. Pulled the head and found the obvious hole in #1
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After closer inspection, I also found the formation of cracks of varying sizes in pistons 2, 3, 4, and 6.
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Everything else in the rotating assembly and the bottom end appears to be in great condition. Plastigage on the bearings is good, pins look great, bores mic out well and have good crosshatch, no issues with head or head gasket other than obviously needing to replace it now that the head is off. Ive rebuilt multiple diesels before, but in this case, my thoughts are to replace the pistons and reuse the stock rings since they are already mated to the cylinders so to speak. I figured I’d go back with stock pistons, but at $500 a piece, I can’t make that make sense. Are there any other pistons out there that use the stock ring dimensions and are of decent quality? I’m having trouble finding that information.