Re: Crowned tooth needs root canal?

On Fri, 15 Jul 2005 21:44:35 GMT, W_B <no_one@xxxxxxxxxxx> wrote:

>On Fri, 15 Jul 2005 14:29:28 -0700, "Blocks To Books"
><blocks2books@xxxxxxx> wrote:
>
>>
>>----- Original Message -----
>>From: "Steven Bornfeld" <dentaltwinnonsense@xxxxxxxxxxxxx>
>>Newsgroups: sci.med.dentistry
>>Sent: Friday, July 15, 2005 12:55 PM
>>Subject: Re: Crowned tooth needs root canal?
>>
>>
>>> It is certainly possible that a crack can progress despite the presence of
>>> a crown. In this case however it's unlikely that a root canal is going to
>>> be able to save the tooth. In a situation like this there is often a
>>> vertical root fracture, and if a crown does not prevent its spread the
>>> tooth will sometimes be lost.
>>> The first thing to do is to confirm that the crowned tooth is actually the
>>> tooth responsible for your pain. If it is (and before progressing to root
>>> canal treatment) I would remove the crown and any underlying restorative
>>> material if at all possible and examine the tooth carefully--preferably
>>> with magnification.
>>>
>>> Steve
>>
>>Thanks again. I was just now able to determine the crowned tooth is for
>>sure the one that is the source of the pain by biting on a q-tip - using it
>>almost like a home-made tooth sleuth - which I learned from an original
>>cracked molar where a dentist used a tooth sleuth to diagnose it. I learned
>>about using a q-tip as a type of tooth sleuth from lurking on smd on and off
>>over the years. I tried biting on all the upper molars with the q-tip and
>>the only one that hurt when I bit on the q-tip was the crowned molar but it
>>hurt on the cheek side instead of the tongue side where I thought the pain
>>was originating from. Don't now if a sprained tooth can cause this same
>>type of pain. The bite has been adjusted because it was high in places. I
>>rested the tooth from all chewing for a week but as soon as I began chewing
>>hard foods on that side again, the pain resumed as it was before the bite
>>adjustment on the crown.
>>
>>My dentist - who is a second opinion dentist - thinks there is a possibility
>>the crown might be loose or leaking and the pain could be caused by decay
>>getting inside. I didn't want to destroy the crown or damage my tooth
>>further drilling the crown off only to learn the tooth was actually cracked
>>into the nerve and could be fixed by a root canal and then have to buy a
>>second crown. I thought if it needed a root canal - then I should do that
>>first and then, if the crown survived, see if that solved the problem. If
>>not, get the old crown drilled off the root canalled tooth and replace the
>>crown and pay the big bucks in that order.
>>
>>Unfortunately the crown is fairly new - only three years old. I don't know
>>if that might make it harder to get off without destroying it. It was
>>placed by a prosthodontist who is retired. It's actually the nicest and
>>appears to be the most high quality restoration I have in my mouth. It has
>>a composite build up underneath the crown. I wonder if my endodontist could
>>drill into the biting surface of the crown like he was preparing to do a
>>root canal, remove the build up and get a look at the tooth that way with
>>his microscope.
>>
>>Another thing that really concerns me is that this tooth is an upper first
>>molar with roots almost inside my sinus. The roots have always been that
>>way. I've been told that about the closeness of the roots my entire life
>>when I get x-rays but it's never caused me any pain problems the tooth in
>>the past. Because of the close proximity to the sinus cavity, I don't know
>>if I could have an extraction without causing damage to my sinus bones and I
>>don't think there is even enough bone and space for a replacement tooth
>>implant to ever be screwed in. As far as a sinus lift goes; I don't know if
>>everyone is a candidate or only those people whose sinuses have sagged. I
>>have very small bones and I think the closeness is just part of my body make
>>up. It's compact and everything is close together. Unfortunately the teeth
>>on either side of my molar have no restorations; which makes a bridge a more
>>invasive situation. I've been concerned about anything happening to this
>>particular tooth for all those reasons.
>>
>>I was/am a heavy clencher and they didn't know how to prevent the damage
>>like they do now with NTI's. Because of that, over the years, my teeth have
>>been damaged by abfraction lesions, cracked molars, and gum recession even
>>though I have almost perfect home care and am in good health. I will talk
>>to the endodontist about what you suggested when I go in on Tuesday for his
>>evaluation. Unfortunately from having more than one cracked molar, I pretty
>>much remember what the feelings are with a cracked tooth and that is what
>>this feels like. I truly hope and pray I'm wrong on this. I didn't know it
>>could be a hopeless case that couldn't be salvaged by a root canal. I
>>thought only teeth with root canals were subject to root fracture and
>>couldn't be saved.
>>
>>Thank you very much for responding. The help and education people can get
>>here is vital. Thank you again for trying to help me understand my options
>>and what might be possibly going on. If you get any more ideas on my
>>situation, I would appreciate it. The help you have already given is
>>appreciated very much.
>>
>>> --
>>> Cut the nonsense to reply
>>
>>>
>>
>
>IMO the only way to safely remove a crown is by cutting it off.
>Sometimes a 'Richwill crown remover' can be used sucessfully.
>Those reverse dent puller thingies should remain in the auto
>body shop.
>
>If the crown cannot be removed safely, then have the RCT done
>through the crown and have Fuji 9 placed in the access.
>
>You can get a new crown later after your symptoms subside.
>
>You do have an appointment with the endodontist right ?


The slide hammer is good for tapping off an NTI which became too tight
during adjustment phase.
...
Stephen
Troy, Michigan, USA

I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting.
.

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