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Medical Forum / General / Dentistry / January 2005Choosing the best dentist for my crown?
Last week I posted a question about how to evaluate whether and when I should get a crown for a tooth with a 7-week old root canal that still had sensitivity to touch. Thanks to numerous helpful suggestions from members of this forum I've reached the following point (also cross-posted in the original thread). I went for a second opinion visit Thursday. Dentist used a high-powered microscope (displayed on a screen and printed out) to get a better look at the problem tooth. It showed one area that had been patched (amalgam) on the back surface of the tooth and a small hairline crack on the side of the tooth. This dentist proposed putting in a gold crown, but warned that it is not certain that the tooth will be saved in the long run. He didn't see any evidence in the x-ray that there was a hidden untreated root. Now here's another problem. This dentist has an excellent reputation as judged by a local consumer magazine and a report on dentists that other dentists recommend. He seems top-notch to me as well. However he will cost hundreds more than my regular dentist--who also seems OK, but not with anything like this guy's reputation. And, I think this dentist wants to use a porcelan crown. Is there much of a difference in these treatments? Is the gold crown a better approach with a tooth with one real and one minor crack? I know you don't know these dentists, but, in general, what hints can you give about making this sort of choice? Thanks, again, for your help. > Last week I posted a question about how to evaluate whether and when I > should get a crown for a tooth with a 7-week old root canal that still [quoted text clipped - 24 lines] > > Thanks, again, for your help. Considering the questionable nature of the tooth, its long-term survival has much more to do with the outcome of the root canal and the presence and nature of any root fractures than what material the crown is made out of. In my mouth, I would rather have a gold crown, but many patients would opt for porcelain on purely cosmetic grounds. As a practical matter, if you are going to make the effort to save this tooth and can accept the questionable long-term prognosis, either one will be equally effective. Steve Steve-- I was told that the crown would help strengthen the tooth against fracture and I was assuming that the more malleable gold crown would somehow be more able to get into a better fit. Is that wrong? Fred > Steve-- > I was told that the crown would help strengthen the tooth against > fracture and I was assuming that the more malleable gold crown would > somehow be more able to get into a better fit. Is that wrong? > > Fred You're not going to beat the fit of gold. However, porcelain crowns are almost always bonded into place, so any pre-existing fracture will tend to be supported by either. I am concerned though that if a fracture extends to the level of the bone now, it will not have to spread further to prevent healing of any infection. This is sometimes very difficult to determine visually, and though a fracture can sometimes be inferred by an x-ray, you don't know for sure until you extract the tooth and examine the root. This is sometimes a difficult decision--to crown a tooth that may be lost anyway. I will sometimes grind a tooth to remove it totally from the bite, or sometimes place a temporary plastic crown on the tooth to allow healing. I generally will not proceed with the crown if there is any pain, and certainly not if I have any sign on x-ray that there is a problem with the root canal treatment. Steve Steve-- Regarding the details of the tooth, there isn't evidence one way or the other. The x-ray isn't clear about hidden or untreated roots. There is no temperature sensitivity, if that's important. On the other hand, the endodontist said the roots he worked on were dead, so maybe that wouldn't be expected. Similarly, neither the x-ray nor visual examination revealed the extent of the crack. Since I have already lost the lower wisdom teeth I want to treat this tooth even knowing that it may fail sooner or later. Thanks for your comments. Dr. Bornfeld's advice is excellent. There's a couple of things that can be done to be sure you don't spend so much money on a tooth that could be lost: 1. Have the temporary crown made. This is usually made of acrylic or resin. If there is a crack that can be "fixed" with a crown, your symptoms will disappear. OR 2. Have an orthodontic band cemented on the tooth. This will have the same effect on your cracked tooth symptoms as the temporary crown. If after any one of these two alternatives your symptoms go away, then have a permanent crown made. Either gold (all metal), porcelain (no metal) or porcelain fused to metal can be done. Your dentist is in a better position to say which is best in your case. If the symptoms persist there may be a vertical fracture of one of the roots and there may be no other alternatives but extraction. Dr. Bonilla Thanks for the advice. I'm going for another 2nd opinion tomorrow and I'll make sure that these points are covered. The more I think about how and when the symptoms appear the possibility of a vertical crack (on the back surface of the tooth where there appears to be an amalgam repair) seems great. I'll try and get that anaylzed as well. BTW, would a properly fitted and cemented crown be strong enough to repair the tooth with a crack? > Thanks for the advice. I'm going for another 2nd opinion tomorrow and > I'll make sure that these points are covered. The more I think about [quoted text clipped - 4 lines] > BTW, would a properly fitted and cemented crown be strong enough to > repair the tooth with a crack? I would hesitate to call it "repaired". However, if the fracture does not extend to the pulp or the bone, it will probably prevent the crack from spreading. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Please read the next chapter in this story in the thread "Help--should I get a crown." |
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