Can a tooth be so heavily filled that it cannot have a successful root canal and crown?

[ToothPatient]

Dentist I attended seemed to think so much of the tooth was filled that a root canal and crown probably wouldn't last too long.

I was under the impression a post and core would support a crown, but perhaps some residual tooth structure is necessary to do so?

This tooth has been worked on heavily.

Inspecting dentist said it's more filling that tooth at this point, most of the front of the tooth is filling.

Tooth 7, so the one that's clearly heavily filled.

I understand whether to get a RCT or extraction is ultimately my own decision in perspective of what my dentist has explained based on an inspection, but perhaps just getting some additional perspective here?

A very heavily filled or damaged tooth, may not in fact be suitable for a root canal and requires extraction?

And presumably an implant thereafter.

 

[ToothPatient]

For perspective, this was the tooth prior to getting it filled a couple months ago:

 

[Dr M]

Based on the x-ray, a root canal, post core and crown is still possible. Get a second opinion from another dentist. Perhaps your dentist is not experienced enough to perform the root canal and do the crown.

 

[dentistgreatneck]

Yes, a tooth can sometimes be so heavily filled or damaged that a successful root canal and crown may not be feasible. When a tooth is extensively filled, it may have insufficient healthy structure left to support a crown or withstand the pressures of daily function. If the remaining tooth structure is too weak, prone to fracture, or has recurrent decay, alternative treatments, such as extraction and replacement options (like implants or bridges), might be recommended. An evaluation by a dentist is essential to determine the best of action.

 

[Dr M]

The extraction of this tooth might also prove difficult. It has long roots, that extend into your sinus. This sometimes leads to additional procedures, such as sinus lift surgery and/or bone augmentation, when you think about replacing it with an implant. Additional procedures = additional costs.
When you design the crown, it can be designed in such a way, that it is taken out of the occlusion or that the load on the crown is minimal at best. This increases longevity.
The main success factor for me here would be the quality of the root canal. Poor root canal treatment would lead to future infection and ultimately tooth loss.

 

[ToothPatient]

Thing with this tooth is, it's hasn't had an infection (no signs of an infection, and I went on anti-biotics for five days with no change).

It just initially developed acute temperature sensitivity after a large cavity was filled two months ago.

A correction was made and that became less severe, more temporary (initially it lingered, I believe as illustrated here, due to a lesion on the buccal side of the tooth that was filled later).

However, like an absolute dumb ass, I went into a different dentist to reduce the height of the filling, and instead of reducing it by the 0.5 mm it was high, he took a massive lump out of the tooth and I needed to get it refilled again cause it weakened it so badly; resulting in pain now upon biting down, as well as the initial heat/cold sensitivity.

SUBSEQUENT to getting it refilled, it seems to have developed a "shadow" on the buccal face........ I have no idea what that represents. Some kind of black'ish shadow line underneath the exterior.
On dental inspection, this apparently exists on the occlusive surface also, this "shadow".

In any case, I said I'll wait as long as I can tolerate to see if the pain/sensitivity diminishes or resolves before committing to the next procedure.

..........

The dentist who suggested an extraction typically refers out for root canals to endodontists, then does the crown himself. But absolutely I'll seek a 2nd and 3rd opinion if necessary to come to the most informed decision possible before deciding on a root canal or extraction.

 

[dental_care]

A heavily filled or damaged tooth might not be suitable for a root canal and crown. Extraction and replacement might be necessary.

 

[ToothPatient]

The extraction of this tooth might also prove difficult. It has long roots, that extend into your sinus. This sometimes leads to additional procedures, such as sinus lift surgery and/or bone augmentation, when you think about replacing it with an implant. Additional procedures = additional costs.
When you design the crown, it can be designed in such a way, that it is taken out of the occlusion or that the load on the crown is minimal at best. This increases longevity.
The main success factor for me here would be the quality of the root canal. Poor root canal treatment would lead to future infection and ultimately tooth loss.

The dentist that gave this opinion did mention he would refer to an oral surgeon for extraction if I chose that route, for the reason you mention, the roots extending into the sinus.

I'm currently doing my homework on endodontists...... they all seem quite qualified, some graduated with "distinctions" apparently, I'm guessing that's good....

I guess what I'm trying to determine at this point is how long I could get out of a RCT and crown based on the current integrity of the tooth (presumably not good?).

I've read a RCT can hold up for many years, a lifetime in some cases.

But then again it comes back to this tooth and its current condition.

Any way to determine that?

Perhaps continue to seek 2nd 3rd and 4th opinions from the most qualified/experienced dentists I can find?

 

[Dr M]

The success rates of root canals vary. There a loads of factors that influence the outcome. I think the tooth should be fine for about 5 years, but I would suggest getting the root canal done by a good endodontist. Maybe look up some reviews on the endodontist you choose.

 

[ToothPatient]

The success rates of root canals vary. There a loads of factors that influence the outcome. I think the tooth should be fine for about 5 years, but I would suggest getting the root canal done by a good endodontist. Maybe look up some reviews on the endodontist you choose.

Curious could a "same day" or "immediate" implant apply in a case like this?

Could that potentially preclude a sinus lift or bone graft being necessary?

Dentist who mentioned extraction did say he would refer to an oral surgeon due to the long roots and presence in the sinus as mentioned.

I'm just curious at this point whether sinus lifting may be more likely if I had to allow the socket to heal as oppose to getting that space filled immediately.

 

[Dr M]

The low sinus wall is more of a concern with the extraction of the tooth. As the roots come out, it leads to an opening that extends from the oral cavity to the maxillary sinus.
An immediate implant would not cancel out this possibility.

 

[ToothPatient]

The low sinus wall is more of a concern with the extraction of the tooth. As the roots come out, it leads to an opening that extends from the oral cavity to the maxillary sinus.
An immediate implant would not cancel out this possibility.

Okay, that definitely sounds like a potential concern.

If that happens, what's the treatment protocol from there?

I mean, by the sounds of things an opening is more than likely to happen; does the socket just get stitched up and I hope the sinus heals and doesn't get infected?

Or could the sinus become perforated with the extraction?

 

[Dr M]

If the sinus opens up with the extraction, you try and close it immediately with a surgical flap. You will then also get some strict instructions to follow, like not blowing your nose for a certain amount of time etc.
If you plan on getting an implant, they can sometimes perform the sinus lift together with the extraction, even if there was an opening.

 

[ToothPatient]

If the sinus opens up with the extraction, you try and close it immediately with a surgical flap. You will then also get some strict instructions to follow, like not blowing your nose for a certain amount of time etc.
If you plan on getting an implant, they can sometimes perform the sinus lift together with the extraction, even if there was an opening.

Based on how far those root extend into the sinus, it seems like a real probability there'd be a perforation of some kind during extraction (if it comes to that).

Which really pushes me more toward a root canal, as unideal as that is.

.......

Worst thing about this situation is, only reason I got this cavity in the first place was cause I had mercury amalgam fillings replaced for composites in 2020, and upon replacing one, the dentist removed a huge part of the lingual side of that tooth.

Then filling that back in, she changed the shape of it such that it started trapping food between it and the molar in front.

I never went for frequent dental check ups cause I never needed them, once every three years or so, and always got a great report.

When I went back this time, huge cavity......... cause it had been trapping food all this time, unbeknownst to myself.

I never imagined it could lead to all of this, in terms of cost, pain, complexity etc.

Nuts.

 

[ToothPatient]

I had a heavily filled tooth (also a front one) and my dentist mentioned that the structure was mostly filling too. They said a root canal might not hold up long-term because there wasn’t enough actual tooth left to anchor the crown properly. Like you, I thought a post and core could save it, but apparently, there’s a limit to how much filling can support a crown.

I understand a "post" is typically undesired also?

Maybe a dentist can clarify that, but it would act as a "wedge" and weaken the tooth overall?

i.e. when it gets to the point a post may be necessary, then perhaps an extraction becomes the most practical option?