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Medical Forum / General / Dentistry / February 2007

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Root Canal imminent....is a crown mandatory?

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madrox99@hotmail.com - 05 Feb 2007 07:48 GMT
Greetings,

How are you all? If you don't mind I thought I'd drop in and get a
feel of what to expect from an upcoming root canal procedure.

I just signed up for both a Dental Plan and Dental Insurance.  I have
piercing pain in my upper left tooth.  I already went for the
preliminary checkup and it looks like I'll need a root canal.

I'm a recent college graduate, and I have no family in the USA so I'm
not exactly rich.

Now the Dental Insurance won't cover the canal because there is a 4
month waiting period.  I'll get some sort of discount on the plan.

My concerns are as follows:

1) I'm nervous of the cost.  Reading up on google archives indicate I
should expect to pay *at least* $2,000 for the total procedure, even
with the plan.

2) Is a crown always necessry, and if so, is it necessary immediatly
after a root canal or can it be held off 6 months or so?

3) Given my financial situation, is a prefabricated crown (stainless
steel) a viable option?

I'm a little nervous, more from the impending financial hit I might
take, as opposed to the drilling and procedure of the canal itself :)

Regards,
Steven Bornfeld - 05 Feb 2007 13:53 GMT
> Greetings,
>
[quoted text clipped - 27 lines]
>
> Regards,

    I don't know what "plan" or "insurance" you have.  Most insurance plans
covering procedures on the basis of UCR (usual, customary and
reasonable) will pay for root canals at 80% of UCR (note that some UCR
schedules seem to have been discovered in a time capsule from the time
of Ramses II)--some will pay less.
    You haven't said what tooth you are dealing with, nor why the tooth
needs root canal.  Around these parts (Brooklyn, NY) the fee for an
endodontist for an average molar tooth is in the $1000-$1200 range.
Less complicated teeth or those done by a generalist will likely be less.
    The majority of teeth requiring root canal need to be crowned, or at
least a restoration that covers the chewing surface.  This is to
minimize the chances of cracking.  Fees for crowns vary widely, but $1K
is a pretty fair guess of an average nationwide.  A post and/or core may
be needed as well.  Given this, a total fee of $2000-$2500 might be
right; out of pocket fees of $2000 indicate you're not getting much help
from your plan, and if you're paying for this I can't see why from this
example.
    It is not unusual for a patient not to be able to crown a tooth
immediately.  In this situation (and esp. if I know the patient can be
trusted to return) I will sometimes restore the tooth with a filling
after shortening the tooth (therefore removing the tooth from most
biting forces) as long as they know the tooth MUST be restored more
definitively within a reasonable period of time (maybe a year).  There
are few common scenarios in my office more disheartening than having a
patient go through a root canal, and next year having to extract the
tooth because it has cracked or rotted.

Steve
madrox99@hotmail.com - 05 Feb 2007 15:50 GMT
On Feb 5, 8:53 am, Steven Bornfeld <dentaltwinm...@earthlink.net>
wrote:

>         I don't know what "plan" or "insurance" you have.  Most insurance plans
> covering procedures on the basis of UCR (usual, customary and
> reasonable) will pay for root canals at 80% of UCR (note that some UCR
> schedules seem to have been discovered in a time capsule from the time
> of Ramses II)--some will pay less.

Well I just got the insurance. In order to get some treatement. There
is a 4-month waiting period for Root Canal type treatements before the
Insurance (Mega) will cover it.  I do have a plan via Cariengton.  I'm
still new to this, so I'm reading the chart and trying to figure out
how much I'll have to pay out of pocket.

I had thought the charge for root canal, was root canal entire
procedure.  After research, I see crown, filling, etc etc each
individual part of the process is a charge in itself.  Is that
correct?

>         You haven't said what tooth you are dealing with, nor why the tooth
> needs root canal.  

Upper Right Molar.  The tooth has a hole in it.  It's been aching for
a while. 1 month or so ago sometimes it'd be so bad I couldnt' sleep.
It's extremely sensitive to heat or cold.  Sometimes I get pain
attacks when driving on the beltway or if I"m on the metro.  It's been
perfectly fine for a few days.  The pain seems to randomly come and
dissapear as it chooses.

Around these parts (Brooklyn, NY) the fee for an
> endodontist for an average molar tooth is in the $1000-$1200 range.
> Less complicated teeth or those done by a generalist will likely be less.

I'm in Washington DC.

>         The majority of teeth requiring root canal need to be crowned, or at
> least a restoration that covers the chewing surface.  This is to
[quoted text clipped - 4 lines]
> from your plan, and if you're paying for this I can't see why from this
> example.

I think the problem is the insurance doesnt' kick in for this yet.
The other option is to wait 4 months after the root canal.  The
Careington plan hopefully will give me a good discount on the Root
Canal.

>         It is not unusual for a patient not to be able to crown a tooth
> immediately.  In this situation (and esp. if I know the patient can be
[quoted text clipped - 5 lines]
> patient go through a root canal, and next year having to extract the
> tooth because it has cracked or rotted.

ODL. Mama mia! Talk about doomed if you do, doomed if you don't :/

Thanks for your reply Steve BTW, some of my friends are just finishing
medical school.  I have respect for you guys and the service you
provide.  I hope no one takes my alarm at dental costs as a knock on
the work you do or on your profession.

It's just that, well, I'm financially shot right now, unemployed too.
I only got the plan and insurance because the pain was becoming too
much to bear.

Cheers,
Mark & Steven Bornfeld - 05 Feb 2007 16:53 GMT
> On Feb 5, 8:53 am, Steven Bornfeld <dentaltwinm...@earthlink.net>
> wrote:
[quoted text clipped - 46 lines]
> Careington plan hopefully will give me a good discount on the Root
> Canal.

    Your dentist's office should be willing, ready and able to guide you
through the details of your insurance policy.  You shouldn't have to
guess about the provisions.

>>        It is not unusual for a patient not to be able to crown a tooth
>>immediately.  In this situation (and esp. if I know the patient can be
[quoted text clipped - 7 lines]
>
> ODL. Mama mia! Talk about doomed if you do, doomed if you don't :/

    Actually, you're usually doomed if you DON'T.

> Thanks for your reply Steve BTW, some of my friends are just finishing
> medical school.  I have respect for you guys and the service you
> provide.  I hope no one takes my alarm at dental costs as a knock on
> the work you do or on your profession.

    Certainly not.  Healthcare delivery is in crisis IMO--dentistry is just
a relatively modest part of that.

> It's just that, well, I'm financially shot right now, unemployed too.
> I only got the plan and insurance because the pain was becoming too
> much to bear.
>
> Cheers,

    If you are reasonably careful, and the tooth well-sealed by a
traditional restoration after the root canal, and the tooth is removed
from the bite, it should be possible in most cases to wait 4 months on
the crown.  Unfortunately, it's a real gamble to wait with the root
canal (not that I haven't seen plenty of folks try).

Good luck,
Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Newbie - 05 Feb 2007 22:05 GMT
>> provide.  I hope no one takes my alarm at dental costs as a knock on
>> the work you do or on your profession.
>
>    Certainly not.  Healthcare delivery is in crisis IMO--dentistry is just
>a relatively modest part of that.

WooHoo...

As opposed to the UK or Canada ?
Mark & Steven Bornfeld - 05 Feb 2007 22:11 GMT
>>>provide.  I hope no one takes my alarm at dental costs as a knock on
>>>the work you do or on your profession.
[quoted text clipped - 5 lines]
>
> As opposed to the UK or Canada ?

    Independent of UK and Canada (last I checked).

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Newbie - 05 Feb 2007 22:25 GMT
>>>>provide.  I hope no one takes my alarm at dental costs as a knock on
>>>>the work you do or on your profession.
[quoted text clipped - 9 lines]
>
>Steve

Sorry dude, I disagree that there is a health care delivery crisis.

Delivery is no problem, paying for it is a problem for some but not
nearly most.
Mark & Steven Bornfeld - 05 Feb 2007 23:00 GMT
>>>>>provide.  I hope no one takes my alarm at dental costs as a knock on
>>>>>the work you do or on your profession.
[quoted text clipped - 14 lines]
> Delivery is no problem, paying for it is a problem for some but not
> nearly most.

    You know what they say--when you lose your job it's a recession; when I
lose MY job it's a depression.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Newbie - 06 Feb 2007 14:22 GMT
>> Sorry dude, I disagree that there is a health care delivery crisis.
>>
[quoted text clipped - 5 lines]
>
>Steve

Luckily few of us in our profession have that problem ;-)
Newbie - 05 Feb 2007 22:00 GMT
>Greetings,
>
[quoted text clipped - 16 lines]
>should expect to pay *at least* $2,000 for the total procedure, even
>with the plan.

Depends largely on your geographic location.
In my area a RCT and Crown on a molar runs
~ $1,400 - 1,800

>2) Is a crown always necessry, and if so, is it necessary immediatly
>after a root canal or can it be held off 6 months or so?

I rarely wait more than a month. It really depends on the tooth
in question.

>3) Given my financial situation, is a prefabricated crown (stainless
>steel) a viable option?

Only as a temporary measure until you can afford a permanent crown.

>I'm a little nervous, more from the impending financial hit I might
>take, as opposed to the drilling and procedure of the canal itself :)
>
>Regards,
Jim - 06 Feb 2007 00:03 GMT
Since it's a molar, what I would do is complete the root canal therapy
(clean, shape, and fill the canal spaces with gutta percha) and
probably restore the tooth with a cusp coverage amalgam core buildup
at the same appointment (if the tooth has been asymptomatic) or soon
thereafter (if the tooth has recent pain symptoms).  The amalgam core
buildup should easily last a year (I've seen them last a LOT longer
than that).  It's very important to complete the root canal therapy
ASAP and restore the crown of the tooth with a durable restoration
quickly so it doesn't fracture.  

On molars I recommend a fully coverage cast crown eventually.  I have
seen endodontically treated teeth with amalgam cores fracture and the
teeth required extraction but that's rare if the amalgam is done well.
Some docs restore endo treated molars with composite resin (plastic)
but unless there has been very conservative endodontic access and
there are low masticatory forces involved (such as with an unopposed
tooth) I use amalgam.

>Greetings,

(snip)
Newbie - 06 Feb 2007 14:23 GMT
>Since it's a molar, what I would do is complete the root canal therapy
>(clean, shape, and fill the canal spaces with gutta percha) and
[quoted text clipped - 17 lines]
>>
>(snip)

Fuji 9 is an excellent alternative.
Routinely use this to seal the access while the RD is still in place.
Dartos - 06 Feb 2007 19:19 GMT
> Fuji 9 is an excellent alternative.
> Routinely use this to seal the access while the RD is still in place.

Agreed.

I definitely prefer something bonded.

D
Newbie - 07 Feb 2007 14:45 GMT
>> Fuji 9 is an excellent alternative.
>> Routinely use this to seal the access while the RD is still in place.
[quoted text clipped - 4 lines]
>
>D

Am considering adding a thin layer of flowable (bonded of course)
over the orficies (sp?) before the fuji 9.

Thoughts ?
Dartos - 07 Feb 2007 18:07 GMT
I can't quote all of the microleakage studies, so I don't
know if that is actually 'better'.

I routinely use a layer of opaque flowable over the gutta-
percha.  But if you are doing that the day of finishing the
endo, you need to alcohol off all of the cement so it will
bond well.

That wouldn't be a problem with Resilon, and makes me consider
switching.

D

> Am considering adding a thin layer of flowable (bonded of course)
> over the orficies (sp?) before the fuji 9.
>
> Thoughts ?
Newbie - 08 Feb 2007 17:09 GMT
>I can't quote all of the microleakage studies, so I don't
>know if that is actually 'better'.
[quoted text clipped - 3 lines]
>endo, you need to alcohol off all of the cement so it will
>bond well.

Am still using Grossman's and use Cavidry to remove any
excess before placing Fuji 9. Also take a surg length round
bur (4 or 6)  to cut the GP flush or slightly into the orfice.
Am just thinking that the flowable would make a better
seal at the orfice since the viscosity is lower.

>That wouldn't be a problem with Resilon, and makes me consider
>switching.

Have been considering Resilon also. Haven't talked to my endo
buddy yet so am reluctant to switch without some input.

>D
>
>> Am considering adding a thin layer of flowable (bonded of course)
>> over the orficies (sp?) before the fuji 9.
>>
>> Thoughts ?
Dartos - 08 Feb 2007 19:21 GMT
A couple of guys on another list have been using it for a year
or two and are quite happy.  The main endo dude is still using
GP & Grossmans.

:-)
D

> Have been considering Resilon also. Haven't talked to my endo
> buddy yet so am reluctant to switch without some input.
Newbie - 08 Feb 2007 21:49 GMT
Gotta stick with the Endos on this until I hear otherwise.

But if they switch, I'm right behind them.

Thought I saw something about the material resorbing.
Have you heard this ?

>A couple of guys on another list have been using it for a year
>or two and are quite happy.  The main endo dude is still using
[quoted text clipped - 5 lines]
>> Have been considering Resilon also. Haven't talked to my endo
>> buddy yet so am reluctant to switch without some input.
Steven Fawks - 09 Feb 2007 00:40 GMT
> Gotta stick with the Endos on this until I hear otherwise.
>
> But if they switch, I'm right behind them.
>
> Thought I saw something about the material resorbing.
> Have you heard this ?

Extruded cement, yes.

D
 
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