Would you consider a crown so long after a root canal to be advisable?

Discussion in 'Endodontics' started by el_ronnoco, Sep 17, 2018.

  1. el_ronnoco

    el_ronnoco

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    I had a root canal on one of my pre-molars (Upper Left 4) in 2012. This has, as far as I can tell, been successful. I have no pain or damage. The specialist who performed it (who only did root canals) did not crown the tooth. I can't remember if he suggested it as a possibility.

    My new dentist on our first (quite brief) consultation wants to crown the tooth. I am somewhat reluctant to have this procedure as I have no problem with this tooth, it has lasted this long, and I feel that interfering with the "seal" of the filling etc sounds like a bad idea.

    I'm in the UK and this is an NHS procedure so isn't likely to financially benefit the dentist a great deal (I don't think..) - I think the maximum I can be charged is £219.

    Can someone advise?
     
    el_ronnoco, Sep 17, 2018
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  2. el_ronnoco

    MattKW Verified Dentist

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    1st premolars are difficult teeth to crown after an RCT, and much depends upon the amount of remaining natural tooth structure, and whether the tooth has been reinforced with post(s). An X-ray posted here would give us a better idea of what you have remaining. Just because it hasn't fractured yet, doesn't mean it won't fracture as soon as you read this! RCTd teeth tend to fracture catastrophically below the gum level, unlike live teeth which fracture at or above gum level.
     
    MattKW, Sep 17, 2018
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  3. el_ronnoco

    el_ronnoco

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    Thank you for your reply Matt. I'm afraid I don't have any x-rays I can share. I don't think the tooth has been reinforced with posts. I do remember him sticking some long thin things in there which he left in for a while but I really have no idea what they were or if they stayed!

    The only thing I do know is that the root was particularly long (35mm I think he said) and my NHS dentists (my old one) didn't have a file long enough to deal with it which is why I went to a specialist.

    So if a 1st pre-molar is difficult to crown is it worth doing? Will crowning the tooth even help mitigate the sub-gum-level fracture you refer to?

    (Just as an update- My appt has been cancelled because this dentist has left the practice due to "personal circumstances" - don't know what that might mean. I might try to get seen by my old one had see if he agrees with the treatment).
     
    el_ronnoco, Sep 17, 2018
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  4. el_ronnoco

    MattKW Verified Dentist

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    25mm would be long, 35mm would be extraordinary for a 1st premolar. Anyway, this is one of those difficult problems we face sometimes. trying to gauge the best risk/benefit ratio for certain situations. Without an Xray I couldn't give any more meaningful advice, except to be careful when chewing with this tooth - nothing stupidly hard like lollies, pork crackling, seeds,... 1st premolars have 2 roots with a slight groove down the front which makes them particularly susceptible to fracture, even without an RCT.
     
    MattKW, Sep 17, 2018
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  5. el_ronnoco

    el_ronnoco

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    Thanks for your replies again Matt. It definitely was 30+mm, I think 33 or 35. Either way he did say it was unusually long. I'll be seeing my old dentist for his advice about this anyway.

    Thanks you :)
     
    el_ronnoco, Sep 18, 2018
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