Post RCT - Any alternative to crown?

[Lokesh]

Hello,

When I was a kid, I fell and hurt my lateral incisor. I got it checked recently and I was advised to get an RCT done. After RCT, doctor suggested that they would draw blood and grow tissue from it in the lab and reintroduce it into the tooth with RCT.

Every other doctor has asked me to get a crown placed. What should I do?

The 'regrown tissue' procedure sounds close to keeping the tooth 'natural'.

Please suggest.

 

[Busybee]

I've never heard of such a thing. There is a an experimental treatment to regrow dentine with a biomaterial (s Harvard and Nottingham universities research study). This treatment is not available to the public yet. But you have already had the nerve removed and this is experimental work your dentist is suggesting. You need to give signed consent if he is carrying out research & using you as a guinea pig. The study I mention used stem cells from embryos. What your dentist suggests sounds dangerous and you could end up losing the tooth altogether and getting quite ill if it goes wrong. Which country are you in?

 

[MattKW]

I have heard of some technique where the dying tooth can be revascularised, but there's no way of revascularising after you've had an RCT; fairy tale stuff. As for a crown, lateral incisors must be approached with care, as they are quite small teeth, and a crown doesn't always offer an advantage. If you haven't had cavities on the sides of the lateral incisor which would weaken it, I probably wouldn't suggest a crown. Sometimes I don't even do RCTs for lateral incisors, and prefer to extract them - there are sometimes alternatives like implants, cantilever bridges from the adjacent canine, or even cantilever Maryland bridges. And I'd also be interested which country you're in.

 

[Busybee]

Matt I'm horrified to read you'd remove a lateral rather than crown it!

 

[Lokesh]

I've never heard of such a thing. There is a an experimental treatment to regrow dentine with a biomaterial (s Harvard and Nottingham universities research study). This treatment is not available to the public yet. But you have already had the nerve removed and this is experimental work your dentist is suggesting. You need to give signed consent if he is carrying out research & using you as a guinea pig. The study I mention used stem cells from embryos. What your dentist suggests sounds dangerous and you could end up losing the tooth altogether and getting quite ill if it goes wrong. Which country are you in?

Thank you for the reply. I am in India.

Here is the complete story. May be this will give you more context.
The lateral incisor took a hit when I fell. I started seeing abscess above it on the gum. Doctor suggested RCT and for some reason they did RCT to the tooth on the left and to the tooth on the right of the lateral incisor. The lateral incisor has not been touched.
The lateral incisor is structurally very strong. There is discoloration and I need to get it fixed. The two teeth that got RCT also are structurally strong.

Today I went for another opinion and the doctor suggested RCT for the lateral incisor.

I am confused with all that happened.

 

[Lokesh]

I have heard of some technique where the dying tooth can be revascularised, but there's no way of revascularising after you've had an RCT; fairy tale stuff. As for a crown, lateral incisors must be approached with care, as they are quite small teeth, and a crown doesn't always offer an advantage. If you haven't had cavities on the sides of the lateral incisor which would weaken it, I probably wouldn't suggest a crown. Sometimes I don't even do RCTs for lateral incisors, and prefer to extract them - there are sometimes alternatives like implants, cantilever bridges from the adjacent canine, or even cantilever Maryland bridges. And I'd also be interested which country you're in.

Thank you for the reply. I am in India.

Here is the complete story. May be this will give you more context.
The lateral incisor took a hit when I fell. I started seeing abscess above it on the gum. Doctor suggested RCT and for some reason they did RCT to the tooth on the left and to the tooth on the right of the lateral incisor. The lateral incisor has not been touched.
The lateral incisor is structurally very strong. There is discoloration and I need to get it fixed. The two teeth that got RCT also are structurally strong.

Today I went for another opinion and the doctor suggested RCT for the lateral incisor.

I am confused with all that happened.

 

[Busybee]

Well I don't understand how they will do what they are proposing without stem cells. Like I said, it's experimental. If you do go ahead with this make sure they fully explain the risks. If you go for the root canal I hope it goes well.

Let us know how you get on.

 

[MattKW]

Matt I'm horrified to read you'd remove a lateral rather than crown it!

But that's because you don't have experience in the particulars of trying to save compromised teeth. It's akin to trying to save a written off car in some circumstances. Crowns cannot save some teeth, they will actually weaken them - lateral incisors and 1st premolars rare the most risky. Patients don't appreciate it if they've spent a lot of money, time, and discomfort, for an RCT and crown that fails within 2-3 years.

 

[Busybee]

But that's because you don't have experience in the particulars of trying to save compromised teeth. It's akin to trying to save a written off car in some circumstances. Crowns cannot save some teeth, they will actually weaken them - lateral incisors and 1st premolars rare the most risky. Patients don't appreciate it if they've spent a lot of money, time, and discomfort, for an RCT and crown that fails within 2-3 years.

I have my own extensive experience of a crown on a lateral compromised tooth. One that has been that way for decades now and I am very much invested in keeping it in situ. It's stronger with a crown & rct than it was before. It would cost me far more in money & trauma to have a bridge or attempt an implant. It's the most sensible option financially and psychologically to try to save such a tooth with a crown and rct. It's definitely worth trying.

 

[MattKW]

Yes, you have your own individual circumstances that have worked well, and i'm happy for you. It doesn't always work that way, and unless you have unlimited funds, then budgetary concerns and longevity are factors to be considered for any type of treatment.