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Medical Forum / General / Dentistry / October 2006redo root canal on 30 without new crow? (and more)
I recently had a crown and root canal done on #30 but the root canal did not go deep enough and is sore. New dentist is saying the crown is not fit properly (gap at the base) but apart from that is it necessary to replace this crown or possible to drill through the crown & only do the root canal. That's what they are proposing for #6 on top but maybe it's different for a molar with a 2-forked crown compared to an upper canine where they plan to just drill through the crown. PS I had a boatload of work done in Mexico from a well recommended, US trained office & figure I saved $12,000 on 10 crowns & 2 roots but damn I'm not happy about having to redo both root canals!!! And another misfitted crown... some cement left between teeth or maybe just not thorougly cleaned... and a couple more smaller fillings they didn't get to. Pricing question... no insurance... I got an estimate from Western Dental, San Francisco, a pretty cheap place for $3457. They have this $85 'plan' which claims I'm saving $2800 or 44% and I checked a couple dental schools, one says 35-50% savings over a private dentist. I don't know whether it's even worth an appt with the schools to get another estimate, I suppose they don't even offer nitrous and it takes longer so sounds awful. I'm guessing I might save a few hundred, this is the bare bones part of the estimate: $422 #6 root canal $125 #6 resin 1 surf $547 subtotal $650 #30 root canal $225 #30 pre-fab dowel post $744 #30 crown $1619 subtotal $2166 total bare bones $75/visit for nitrous ($1291 cleaning, 2 more fillings & 1 more crown replacement) > I recently had a crown and root canal done on #30 but the root canal did > not go deep enough and is sore. New dentist is saying the crown is not [quoted text clipped - 32 lines] > > ($1291 cleaning, 2 more fillings & 1 more crown replacement) There are a couple of issues here. If you have an open margin it can be watched, but depending on degree it may be more than reason enough to redo the crown. If the margin were OK, it is still possible that the crown could require redo if in accessing the root canal system the remaining tooth structure is sufficiently hollowed out. The dentist will surely need to open a large access cavity for the sake of visibility. Given this, and although I frequently will do a root canal through an existing crown and attempt to retain the crown, I always tell the patient that it may not work out; specifically the crown may break off for insufficient remaining tooth structure to hold it. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> I recently had a crown and root canal done on #30 but the root canal >> did not go deep enough and is sore. New dentist is saying the crown is [quoted text clipped - 21 lines] > the patient that it may not work out; specifically the crown may break > off for insufficient remaining tooth structure to hold it. Yes, I suppose 'open margin' is the term, a spot between teeth where stuff can get stuck under the overhanging crown... though I wonder if they couldn't just caulk that up (ha) since there's 2 crowns with the problem. Also I noticed in the estimate they planned on using a dowel though I'm pretty sure the current crown is done on a stump of tooth. If this is so ambiguous as to approach, maybe I should get 1 or 2 dental schools to look at it for a second opinion. I'm hoping I'll have insurance at some point & can replace the crowns then. Another option is get the guy in Mexico to re-do them as the xrays clearly show more root below the drilled part. They did a hell of a lot of work in just a few visits for very cheap so not surprising they got rushed & made some mistakes but not going deep enough on the roots seems a major error. > Yes, I suppose 'open margin' is the term, a spot between teeth where > stuff can get stuck under the overhanging crown... though I wonder if > they couldn't just caulk that up (ha) since there's 2 crowns with the > problem. Depending on just where the opening is, that is sometimes possible. A filling can be placed in the opening--if it is accessible. However, this is seldom the case in between the teeth. And even then, with the root canal having been done through it, this crown will have 2 strikes against it. So even if it is possible, it should be done mindful of the possibility that it will need to be replaced in the not-too-distant future. Also I noticed in the estimate they planned on using a dowel > though I'm pretty sure the current crown is done on a stump of tooth. If > this is so ambiguous as to approach, maybe I should get 1 or 2 dental > schools to look at it for a second opinion. I'm hoping I'll have > insurance at some point & can replace the crowns then. It's always a good idea to get a second opinion, though it can be cumbersome working through the process to be treated at a dental school. The quality of treatment at dental schools in general is very high. > Another option is get the guy in Mexico to re-do them as the xrays > clearly show more root below the drilled part. They did a hell of a lot > of work in just a few visits for very cheap so not surprising they got > rushed & made some mistakes but not going deep enough on the roots seems > a major error. Or maybe not. Sometimes canals are calcified or otherwise blocked. This is not always evident until you are inside the tooth. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Yes, I suppose 'open margin' is the term, a spot between teeth where > stuff can get stuck under the overhanging crown... though I wonder if [quoted text clipped - 10 lines] > rushed & made some mistakes but not going deep enough on the roots seems > a major error. ________________________ My dental practice is in an area close enough to the border where we see a lot of Mexican dentistry practiced on Americans. Much of the treatment does not meet American standards. A lot of it has to be redone -- not only does this mean the original money has been totally lost, but that the cost to re-treat is higher than it would have been to do it right in the first place. When a large amount of dental treatment is contemplated, and if money is an issue, it is usually easier on the wallet to perform treatment in stages. Only the most important treatment is done first. That spreads the costs out over time, making it more affordable. When ten crowns and two root canals are done quickly, it's possible that many of those crowns could have been postponed to a later date. If dental treatment is done in phases, instead of all at once, that also allows more time for each root canal and each crown to be done properly. Any attempt to rush dental treatment (which should be done with extreme attention to detail, which takes time) can result in sloppy treatment. I hope that a good endodontist can bring your root canals up to decent quality, and that the ill-fitting crowns can be replaced with crowns that fit, before they leak and cause damage. Best regards, - dentaldoc >>Yes, I suppose 'open margin' is the term, a spot between teeth where >>stuff can get stuck under the overhanging crown... though I wonder if [quoted text clipped - 41 lines] > Best regards, > - dentaldoc Bill-- The only thing that puzzles me about these Tijuana dental clinics-- Those praising them often say that the dentists are American-trained. They also imply that somehow American dentists are able to gouge patients (relatively speaking), and assume that the treatment rendered in some of these clinics is of high quality. That may be--unlike you, I've seen little Mexican dentistry (but if you want to hear about old eastern-block dentistry, I could tell you quite a bit). But considering the number of people coming here from Mexico to make a better living, you kinda have to wonder why these American-trained Mexican dentists wouldn't come over here, where they can make such a superior living! I would think that highly-skilled dentists would go right to the head of those looking to immigrate legally, and obtaining a license in the U.S. would seem a very manageable task for dentists so well-trained. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |
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