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Medical Forum / General / Dentistry / March 2007What to do? Root canal or not?
I'm 48 yr old male have a crown on left lower molar that I can't chew on. Is pressure sensitive. Does not bother at any other time except when applying pressure to it. My dentist couldn't find anything wrong so sent me to an endodontist where he did some tests and decide the root is healthy and probably does NOT need a root canal. So..... starting wearing my NTI religiously for several months now upon advice on both dentists thinking that I'm clenching teeth severely at night (which I am). However after several months I still can NOT chew on the tooth with discomfort from pressure. The crown that is on the tooth now needs replaced as its fractured. Should I go ahead and get a root canal before having crown replaced even tho both dentists are unclear if really needing root canal? the root appears healthy but obviously something is wrong! I hate the idea of putting a new crown on...... only to have a root canal months later if problem persists and then drilling thru this gold crown! > I'm 48 yr old male > [quoted text clipped - 25 lines] > have a root canal months later if problem persists and > then drilling thru this gold crown! This is a judgement call. I don't think I'd do a root canal on a wing and a prayer. When the old crown is off, I'd have the endodontist look at it again if there is any doubt. If it still tests normal I'd make a carefully-constructed temporary crown and wear it for a few weeks, and see if there are any change in symptoms. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Mark & Steven Bornfeld <bornfeldmung@dentaltwins.com> wrote: >This is a judgement call. I don't think I'd do a root canal on a wing >and a prayer. When the old crown is off, I'd have the endodontist look >at it again if there is any doubt. If it still tests normal I'd make a >carefully-constructed temporary crown and wear it for a few weeks, and >see if there are any change in symptoms. Yep I agree a judgment call....and one I'm having hard time deciding what to do. <g> can the enodontist make a better judgment with crown off? Will it be more clear to him? I am def clenching teeth in sleep and have been for years (probably). However I am now wearing NTI device very religiously as I've learned my lesson. Both dentists think I have been clenching so hard that the root 9altho not dead)..... is trying to build up additional structure at its point. The explanation given to me was that a root is shaped like the pointed end of a nail.....and my clenching has been DRIVING the root down into my jaw bone. as a result the root is trying to build up additional support structure at its tip. a name was given..... I wish I could remember it.... condensing something or other. My primary dentists thinks should go ahead and do a root canal and install gold crown on top > Mark & Steven Bornfeld <bornfeldmung@dentaltwins.com> > wrote: [quoted text clipped - 24 lines] > tip. a name was given..... I wish I could remember > it.... condensing something or other. Condensing osteitis? This is generally considered a sign of a degenerating pulp. If this is in fact the case, root canal may in fact be needed, esp. in the presence of pain. It doesn't seem likely that such a tooth would react normally to an electronic pulp test, though I couldn't rule that out. Certainly it would be easier to evaluate the tooth with the crown removed. If this is just from grinding and clenching and if you are wearing your NTI religiously as you say, I would hope we could eliminate current parafunction as a cause of the problem. It is possible though that damage had already been done. Steve > My primary dentists thinks should go ahead and do a > root canal and install gold crown on top SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Mark & Steven Bornfeld <bornfeldmung@dentaltwins.com> wrote: >Condensing osteitis? This is generally considered a sign of a >degenerating pulp. If this is in fact the case, root canal may in fact >be needed, esp. in the presence of pain. It doesn't seem likely that >such a tooth would react normally to an electronic pulp test, though I >couldn't rule that out. yep that's it I believe! again..... most likely caused by my stupidity in NOT wearing the NTO device for years <sigh> I think my dentist was hoping that by starting to were the NTI that the tooth may heal? But the endodontist said the root was NOT dead yet.....and again he said he didn't think it needed a root canal..... but did STRESS HEAVILY to wear the NTI device at any rate..... the tooth is STILL pressure sensitive and since I need a new crown on it anyway......would it be wise to just go ahead and get the root canal BEFORE having the new gold crown put on? I know I'm asking a lot here.... especially since you cant se me in person..... but I am at a loss what to do >Mark & Steven Bornfeld <bornfeldmung@dentaltwins.com> >wrote: [quoted text clipped - 22 lines] >be wise to just go ahead and get the root canal BEFORE >having the new gold crown put on? If it were my tooth that's what I'd do. A multi-rooted tooth can have one dead canal and the others alive. I see this quite often. >I know I'm asking a lot here.... especially since you >cant se me in person..... but I am at a loss what to do >If it were my tooth that's what I'd do. >A multi-rooted tooth can have one dead canal >and the others alive. I see this quite often. OK thanks!! >>If it were my tooth that's what I'd do. >>A multi-rooted tooth can have one dead canal >>and the others alive. I see this quite often. > >OK thanks!! Good luck and best wishes, Mark & Steven Bornfeld <bornfeldmung@dentaltwins.com> wrote: >Certainly it would be easier to evaluate the tooth with the crown removed. > If this is just from grinding and clenching and if you are wearing your >NTI religiously as you say, I would hope we could eliminate current >parafunction as a cause of the problem. It is possible though that >damage had already been done. OK...maybe having a temp crown on there is way to go for awhile then? then make appt for endodontsit again? > The crown that is on the tooth now needs replaced as > its fractured. What is broken now. Signature/ Amatus / > I'm 48 yr old male > [quoted text clipped - 25 lines] > have a root canal months later if problem persists and > then drilling thru this gold crown! >What is broken now. Basically the side of the porcelain crown fractured off. It was an old crown tho...abt 8 years My primary dentist just smoothed it off and said it was still functional. Said it would give me some time to decide what I want to do he DID recommend a gold crown this time tho. Said it is easier to drill thru if I decide to get root canal later down the road BUT.....I'm thinking I should just get a rot canal now.....and then put gold crown on However....endodontist says root is still alive.... not dead what to do? what to do? One thing.....I'm a DEFINITE believer in NTI device now! Condensing osteitis on a tooth with symptoms? I would normally offer RCT immediately to such a patient. I personally do not do metal crowns anymore. So, my opinion about how to restore it after the RCT is different from some of the regulars here. Just remember that with your last crown, it broke at the weakest point. If you put a full gold crown over it, what will be the weakest point then? Signature/ Amatus / > >>What is broken now. [quoted text clipped - 20 lines] > One thing.....I'm a DEFINITE believer in NTI device > now! >Just remember that with your last crown, it broke at the weakest point. If >you put a full gold crown over it, what will be the weakest point then? unsure Wont a god crown be less hard than porcelain? Surface hardness of gold will be less than laboratory fired porcelain, but the elasticity will be different. The gold is less likely to chip if you overpower it with heavy clenching. Generally, the gold is made thick enough that it will not bend. Since there is usually very little actual tooth structure left under a metal crown or PFM, excessive force builds up stresses which are then relieved at the base of the crown. Often by the crown snapping off taking all the residual tooth structure with it. If the pressures are slightly more moderate, you end up with "ditching" of the tooth at the gum-line (abfractions). If the material covering the tooth chips with excessive force, you reduce the urgency of any damage from clenching forcibly. A patient who clenches needs to have his teeth restored in a fashion that there is still something there to fix if he overpowers the teeth. You need to plan how it will fail, the next time it fails. Remember that all dental work will fail eventually. Signature/ Amatus / > >>Just remember that with your last crown, it broke at the weakest point. [quoted text clipped - 4 lines] > > Wont a god crown be less hard than porcelain? > A patient who clenches needs to have his teeth restored >in a fashion that there is still something there to fix if he overpowers the >teeth. You need to plan how it will fail, the next time it fails. Remember >that all dental work will fail eventually. OK But cant I prevent this by RELIGIOULSY wearing the NTI device at night Buy a new car and drive it off of the lot. Then put 50K miles on it in city traffic every year, rarely change the oil, ride the brakes, and generally drive like a maniac, and your car will have early mechanical troubles plus cost a lot to keep running. Take the same car, only put 10K miles on it with mainly highway driving, drive sensibly, and provide all maintenance, and the car is likely to last years and years with few problem. However, it still won't last forever. Same with your teeth and any restoration placed by any dentist. The better maintenance, higher quality repairs, less abuse, and proper diet, the longer your teeth and restorations will last. The NTI is kind of like a governer on an auto. It doesn't prevent all wear and stress. It just helps reduce abusive forces that lead to early failures. JMO, D >>A patient who clenches needs to have his teeth restored >>in a fashion that there is still something there to fix if he overpowers the [quoted text clipped - 5 lines] > But cant I prevent this by RELIGIOULSY wearing the NTI > device at night > Buy a new car and drive it off of the lot. Then put 50K miles on > it in city traffic every year, rarely change the oil, ride the [quoted text clipped - 18 lines] > JMO, > D Steve-- If an NTI is a governor, what is the dental equivalent of STP? Steve >>> A patient who clenches needs to have his teeth restored in a fashion >>> that there is still something there to fix if he overpowers the [quoted text clipped - 5 lines] >> But cant I prevent this by RELIGIOULSY wearing the NTI >> device at night SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Buy a new car and drive it off of the lot. Then put 50K miles on >> it in city traffic every year, rarely change the oil, ride the [quoted text clipped - 18 lines] >> JMO, >> D >Steve-- > > If an NTI is a governor, what is the dental equivalent of STP? > >Steve OH wait.... Though you said STD... ;-) >>>> A patient who clenches needs to have his teeth restored in a fashion >>>> that there is still something there to fix if he overpowers the [quoted text clipped - 5 lines] >>> But cant I prevent this by RELIGIOULSY wearing the NTI >>> device at night >>>Buy a new car and drive it off of the lot. Then put 50K miles on >>>it in city traffic every year, rarely change the oil, ride the [quoted text clipped - 28 lines] > > Though you said STD... ;-) No, I DO know the dental equivalent of STD. Steve >>>>>A patient who clenches needs to have his teeth restored in a fashion >>>>>that there is still something there to fix if he overpowers the [quoted text clipped - 5 lines] >>>>But cant I prevent this by RELIGIOULSY wearing the NTI >>>>device at night SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Well you guys have convinced me to get the root canal..... but now I'm confused abt what TYPE of crown to put on top of it. I was originally told by my dentist to go for gold crown.....should I reconsider and go for porcelain after all? My comments about porcelain vs gold, only hold true for machine milled ceramic. It does not hold true for laboratory fired porcelain. Signature/ Amatus / > Well you guys have convinced me to get the root > canal..... but now I'm confused abt what TYPE of crown [quoted text clipped - 3 lines] > crown.....should I reconsider and go for porcelain > after all? I don't know. What? Saliva?.....maybe that's just motor oil. STP is an additive to motor oil....OK, Beer? D > If an NTI is a governor, what is the dental equivalent of STP? > > Steve Needs to be thick like caramel. Signature/ Amatus / > > I don't know. What? [quoted text clipped - 8 lines] >> >> Steve Guinness? D > Needs to be thick like caramel. McCallan, or Balvenie Signature/ Amatus / > > Guinness? > > D > >> Needs to be thick like caramel. Cask 191 >McCallan, or Balvenie > [quoted text clipped - 3 lines] >> >>> Needs to be thick like caramel. > Cask 191 Isn't that the name of the nuclear warheads in "24"? Steve >>McCallan, or Balvenie >> [quoted text clipped - 3 lines] >>> >>>>Needs to be thick like caramel. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Cask 191 > > Isn't that the name of the nuclear warheads in "24"? > >Steve It may well be, I don't watch the show personally. Was referring to this: http://www.thebalvenie.com/cask_191.html Only 83 bottles in the world. >>>McCallan, or Balvenie >>> [quoted text clipped - 3 lines] >>>> >>>>>Needs to be thick like caramel. > Was referring to this: http://www.thebalvenie.com/cask_191.html > Only 83 bottles in the world. Cool. Only 83 bottles in the world? Sounds really exclusive. Well done for sourcing one of those, what a great privilege. Good to hear you don't live in your president's jurisdiction - according to wikipedia, "Of Texas' 254 counties, 44 are completely dry and 169 are partially dry or "moist". The patchwork of laws can be confusing, even to residents. In some counties, only 4% beer is legal. In others, beverages that are 14% or less alcohol are legal. In some "dry" areas, a customer can get a mixed drink by paying to join a "private club," and in some "wet" areas a customer needs a club membership to get liquor-by-the-drink". Wisconsin ? Signature/ Amatus / > >> Was referring to this: http://www.thebalvenie.com/cask_191.html [quoted text clipped - 10 lines] > and in some "wet" areas a customer needs a club membership to get > liquor-by-the-drink". Ahh, anyone remember 'Motor Honey' ? >Needs to be thick like caramel. > [quoted text clipped - 9 lines] >>> >>> Steve yup Signature/ Amatus / > > Ahh, anyone remember 'Motor Honey' ? [quoted text clipped - 12 lines] >>>> >>>> Steve > Needs to be thick like caramel. How about Borscht? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I don't know. What? > > Saliva?.....maybe that's just motor oil. > > STP is an additive to motor oil....OK, Beer? Sounds about right. Steve > D > >> If an NTI is a governor, what is the dental equivalent of STP? >> >> Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 She don't love me, she love my automobile. She don't love me, she love my automobile. Well she would do anything just to slide behind the wheel. She said what's it gonna take for you to lay your top on down? She said what's it gonna take for you to lay your top on down? I said honey why don't you ask me when we get to the outskirts of town. Well now she don't care if I'm stoned or sloppy drunk. Well she don't care if I'm stoned or sloppy drunk, Long as she got the keys and there's a spare wheel in her trunk. <She Loves My Automobile Lyrics - ZZ Top> >Buy a new car and drive it off of the lot. Then put 50K miles on >it in city traffic every year, rarely change the oil, ride the [quoted text clipped - 28 lines] >> But cant I prevent this by RELIGIOULSY wearing the NTI >> device at night >The better maintenance, higher quality repairs, less abuse, and >proper diet, the longer your teeth and restorations will last. OK But in the end are you saying I'm doomed to eventually loosing my teeth? >>The better maintenance, higher quality repairs, less abuse, and >>proper diet, the longer your teeth and restorations will last. [quoted text clipped - 3 lines] > But in the end are you saying I'm doomed to eventually > loosing my teeth? Well, if you live long enough. Probably not though. carabelli >>The better maintenance, higher quality repairs, less abuse, and >>proper diet, the longer your teeth and restorations will last. [quoted text clipped - 3 lines] >But in the end are you saying I'm doomed to eventually >loosing my teeth? Not necessarily, no one can predict the future. If I could, would have gone 'short' on the DOW today. >If I could, would have gone 'short' on the DOW today. HAHAHA No doubt!! damn a 500 pt drop! > I personally do not do metal crowns anymore. Why not? John After the third long term study showing machine milled ceramic having fewer failures than gold inlays (or gold crowns), I had my own observations confirmed. The last study,,,, was a fifteen year study. If I can get the same longevity without cutting the only solid dentin off the tooth, I am going to do it. Plus the material wears identical to enamel, Machine milled ceramic has a coefficient of expansion which is the average between dentin and enamel. Its shear strength is almost the same as enamel. With onlays and large inlays (even to the point of being 80% the width of the tooth), the tooth retains much of its ability to flex along its entire length, and abfraction is not focused on a 2 mm band at the CEJ. And, someday, when the restoration needs to be re-done, I will have tons more tooth to work with. You average crown prep will leave less than 1 mm of residual dentin to give lateral support to the clinical crown. If you only replace what is missing with an onlay/inlay, you get to keep 3-5 mm thick areas of dentin, especially at the cervical aspect. Add to the mix that I do not need to mess with PVS impressions, temporaries, opposing models or seating appointments. Want to discuss why the "ferrule effect" on a crown prep is the worst thing we can do as dentists? Signature/ Amatus / >> I personally do not do metal crowns anymore. > > Why not? > > John > After the third long term study showing machine milled ceramic having fewer > failures than gold inlays (or gold crowns), I had my own observations [quoted text clipped - 10 lines] > You average crown prep will leave less than 1 mm of residual dentin to give > lateral support to the clinical crown. Wow--really? Not in my office--certainly not in vital teeth, and probably not even in non-vital teeth. Steve If you only replace what is missing > with an onlay/inlay, you get to keep 3-5 mm thick areas of dentin, > especially at the cervical aspect. [quoted text clipped - 4 lines] > Want to discuss why the "ferrule effect" on a crown prep is the worst thing > we can do as dentists? SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Take the average tooth being treated with crown. Prep it for a crown, then remove all the filling in the tooth. Then we will talk. Take all the filling out of your next crown prep first, then study where the residual tooth structure is the thickest. Signature/ Amatus / > >> After the third long term study showing machine milled ceramic having [quoted text clipped - 27 lines] >> Want to discuss why the "ferrule effect" on a crown prep is the worst >> thing we can do as dentists? > Take the average tooth being treated with crown. Prep it for a crown, then > remove all the filling in the tooth. Then we will talk. > > Take all the filling out of your next crown prep first, then study where the > residual tooth structure is the thickest. I've done either and both a time or two. The answer would vary, depending on the pattern of previous and current decay, previous fillings, fractures, tooth inclination, etc. If the decay or fractures come close to the gingival margin, I am doubtless going to prepare to or below the gingival margin. Either way, it is rare that I wouldn't get an axial wall significantly greater than the 1 mm you site. Perhaps I am not understanding your scenario. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 You are allowed to disagree with me. Most teeth getting a crown for the first time, have thick axial walls on the buccal or lingual (or both) near the CEJ. Because the tooth tapers and becomes more narrow towards the root tip, the average crown prep removes a lot of tooth structure to get adequate thickness for the crown margins at the CEJ. You cut away the thickest part of the tooth -- a few mm coronal to the CEJ in order to get your converging axial walls to the crown prep and still get adequate reduction at the margins. If the tooth had a wide amalgam or composite through the center of the tooth, the resultant vertical wall of dentin left after the crown prep, may be very tall, but is also very thin. A better way to restore the tooth would be to simply cut off the coronal 1/3 of the tooth, clean out the caries and old restoration, smooth the internal walls, and fabricate something which can be bonded to the inner surfaces and the top of shortened cusp tips. You would be left with 3 times more original tooth structure, and more of the inherent flexibility of the tooth would remain -- abfraction would not be localized the CEJ, but could spread out a few mm in both directions. If you bond the restoration, choose color of Porcelain and adhesive properly, and finish the margins on the tooth, the line will not be visible beyond 1-3 inches away. Signature/ Amatus / > >> Take the average tooth being treated with crown. Prep it for a crown, [quoted text clipped - 12 lines] > > Steve > You are allowed to disagree with me. > [quoted text clipped - 18 lines] > of Porcelain and adhesive properly, and finish the margins on the tooth, the > line will not be visible beyond 1-3 inches away. I think that sometimes we are biased by the results of our own techniques. By this I mean that the clinical sequellae of what we've done in the past often reinforces our restorative decisions. The biggest example that comes to mind to me is the use of amalgams. If we are in a fairly working class environment, proximal caries often gets restored as amalgam (or resin, but I don't have the years of experience here to comment). So after years and years of doing this, you can imagine I have seen a lot of upper premolars with old MOD amalgams where either the B or P cusps have fractured. More often than not, the fracture is close to or under the gingival margin. Even someone as thick as I am knows what this means--I have pushed the restorative material past the point at which I can reasonably expect it to work well. The result is a lot of upper premolar (and other!) crowns with subgingival margins. I may have saved patients a fee with the amalgam, but there's always a piper to be paid. Looked at this way, your greater use of onlays doesn't look like an extravagance--it looks like a good long-term clinical decision based solely on my experience. My biggest objection is that in patients with high caries rate, I am not thrilled about giving them restoration with miles of supragingival margins. But even so, the example I've given you of the upper premolar with the too-wide MOD may very well be in a patient who is no longer a high decay risk. Clearly there is something to be said for case selection, and especially onlaid restorations in cases where I (perhaps shortsightedly) will place a large amalgam. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I think that sometimes we are biased by the results of our own >techniques. By this I mean that the clinical sequellae of what we've [quoted text clipped - 22 lines] > >Steve Quit placing MOD amal, esp in bicuspids, early in my career. IIRC in my first year of practice. Only incipient leisons got an MOD in molars. Now however with the resins instead of an MOD you can do both an MO and a DO in the same tooth in the smaller cases. If we are talking about replacing a G.V.Black amalgam prep, your options are much more limited. Most of my onlays are simply oversize inlays in appearance. In the past 7 years (of CEREC use) I have only had one or two get recurrent caries. And, I use this on every patient. Signature/ Amatus / >> You are allowed to disagree with me. >> [quoted text clipped - 46 lines] > > Steve It seems pretty obvious to me that we differ in our methods of restoring some teeth. Considering that we all went to different dental schools, grew up in different parts of the country, and practice in very different settings, that doesn't surprise me. AC may be thinking 'we' take a large, coarse diamond and whack back a molar with a 1+mm shoulder prep all the way around the tooth. 'We' may think he's trying to bond a large onlay onto a flat chunk of tooth with a bit of the ML cusp standing. The truth is that we have all been restoring teeth for over 20 years. We have adapted what we learned in dental school, subsequent seminars, and real life practice to find dependable, long lasting methods to repair decayed and fractured teeth. AC loves his Cerec. I'm pretty fond of composite, and SB & I both like 'conventional crowns' for many cases. If our methods have proven to be successful over years of actual use, arguing over Physics that we cannot ourselves prove, may be of little practical use and may even point to something within the quoted Physics that may not apply. JMO, D > I've done either and both a time or two. The answer would vary, > depending on the pattern of previous and current decay, previous [quoted text clipped - 5 lines] > > Steve "> If our methods have proven to be successful over years of actual use, > arguing over Physics that we cannot ourselves prove, may be of little > practical use and may even point to something within the quoted Physics > that may not apply. But it is so much more fun to debate the physics of it!! Who wants to debate whether 3M or Kerr makes the best adhesive? You keep going. Someday I may make a few bonded indirect onlays myself. ;-) D > "> If our methods have proven to be successful over years of actual use, > [quoted text clipped - 4 lines] > But it is so much more fun to debate the physics of it!! Who wants to > debate whether 3M or Kerr makes the best adhesive? > It seems pretty obvious to me that we differ in our methods of restoring > some teeth. Considering that we all went to different dental schools, [quoted text clipped - 21 lines] > JMO, > D I'm not likely to give up using conventional crowns anytime soon--my results with them has been too good. But there is something about my case selection that certainly might best be tweaked, and AC gives me a good reminder not to just do something because I've always done it that way. Steve >> I've done either and both a time or two. The answer would vary, >> depending on the pattern of previous and current decay, previous [quoted text clipped - 6 lines] >> >> Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Now that I've come home from work I can participate. I can say that I understand why you prefer to do an inlay/onlay over a crown. I remember hearing Ray Bertolotti speak last year and he says he also does them most of the time as the bonding systems nowadays are so much better. I've done lots of inlay/onlays myself (empress, not cerec, but some also in gold). But what about if you can't control moisture? What if that distal margin is a bit subgingival? No way, an inlay/onlay not a better choice, IMO in these cases. Better a conventional crown, and a cemented (ie. not bonded) one at that. John I can always control moisture. It is just is a question as to whether or not it is worth it. For teeth such as you describe, I place a dead soft band and wedge (if there is a neighbor tooth), or simply tighten well to keep gingival fluids off the prep. So long as the patient does not have tardive diskinesia or some other disorder where they cannot keep their tongue still, it is never a problem. Occasional cases get laser treatment to lower tissue height and control seepage. I do these all day long with sub-gingival margins. They do fine. I am getting up to do one right now. Distal margin on a first molar is 2-3 mm sub-gingival. Signature/ Amatus / "John & Ninetta" <jsuljak@sentex.net> wrote in message news:WpGdnU- > > Now that I've come home from work I can participate. I can say that I [quoted text clipped - 8 lines] > > John That has to be tricky, but I deal with those issues when placing posterior composites too. Though it seems like that would be harder when bonding the onlay with a band in place. Do you have any insurance hassles when you submit for an MOB onlay instead of a crown? D > I can always control moisture. It is just is a question as to whether or > not it is worth it. [quoted text clipped - 9 lines] > getting up to do one right now. Distal margin on a first molar is 2-3 mm > sub-gingival. > That has to be tricky, Realy is very easy and fast. It only takes a few seconds to set a Tofflemeyer retainer and band. you use a dead soft band so that the band is extra thin and deforms as you push the onlay in place so as not to interfer with seating. About once every 40-50 times, you have to loosen the retained a tiny bit as you push the restoration in place. The wedges still keep the cervical portion sealed from sulcular fluid and blood. I am waiting for one to mill right now. It is 4 mm below the gingival crest interproximally on a upper second molar. >but I deal with those issues when placing > posterior composites too. Though it seems like that would be harder > when bonding the onlay with a band in place. I would say easier with bonding the onlay as you only have to keep it dry for about 20-30 seconds. > Do you have any insurance hassles when you submit for an MOB > onlay instead of a crown? None. If the patient has crown coverage, the carrier happily pays for the onlay at the same percentage. BCBS will insist that a cusp tip is actually replaced. All the other carriers just want to see that we re restoring a major part of the tooth. They are probably happy to pay for an onlay at a lot less money than a core and crown. Amatus Cremona >> I can always control moisture. It is just is a question as to whether or >> not it is worth it. [quoted text clipped - 13 lines] >> getting up to do one right now. Distal margin on a first molar is 2-3 mm >> sub-gingival. ">> That has to be tricky, > Realy is very easy and fast. It only takes a few seconds to set a > Tofflemeyer retainer and band. you use a dead soft band so that the band [quoted text clipped - 4 lines] > am waiting for one to mill right now. It is 4 mm below the gingival crest > interproximally on a upper second molar. So, you keep the band on to bond it in place.....the band still has a dimension, so its impossible that it cannot affect the seating. However, I'm glad it works for you, but I personally wouldn't do it. John Use a dead soft band. Does not interfere at all with seating. The band deforms and stretches as you seat the restoration. Lots of CEREC doc's do this. It is our big secret. Signature/ Amatus / > > ">> That has to be tricky, [quoted text clipped - 12 lines] > > John >">> That has to be tricky, >> Realy is very easy and fast. It only takes a few seconds to set a [quoted text clipped - 11 lines] > >John Have seen AC's technic in person. He trial fits the onlay without a band and adjusts contacts if necessary. Which is rare due to the tolerances of the milling machine. IIRC ~40 microns. Be assured that with the wedges in place the adjacent teeth are displaced enough for the 0.0015 thickess of the band. His margins are virtually undetectable even with magnification, and cannot be felt with an explorer. > Have seen AC's technic in person. He trial fits the onlay > without a band and adjusts contacts if necessary. [quoted text clipped - 4 lines] > of the band. His margins are virtually undetectable even > with magnification, and cannot be felt with an explorer. I don't mean to be disrespectful, but I would have to see this one to believe it. Sorry about being a skeptic. John Want to drive over? I buy dinner for you and "N". I'll schedule a case for you to watch. Get R & CA to ride in with you (I am pretty sure he wants one done). Signature/ Amatus / > > >> Have seen AC's technic in person. He trial fits the onlay [quoted text clipped - 10 lines] > > John > Want to drive over? I buy dinner for you and "N". I'll schedule a case > for you to watch. Get R & CA to ride in with you (I am pretty sure he > wants one done). It could be costly...you know, I prefer Kobe steaks. :) Just kidding. John >> Want to drive over? I buy dinner for you and "N". I'll schedule a case >> for you to watch. Get R & CA to ride in with you (I am pretty sure he >> wants one done). > > It could be costly...you know, I prefer Kobe steaks. :) Just kidding. > John Apparently, we should consider this place... http://tinyurl.com/2xjyd5 Steve I wonder what Mr. Lang's "steak vault" actually looks like? I've never heard of such a thing. We all know it as a fridge. John >>> Want to drive over? I buy dinner for you and "N". I'll schedule a case >>> for you to watch. Get R & CA to ride in with you (I am pretty sure he [quoted text clipped - 8 lines] > > Steve Ok! Everyone to Bornfeld's place. HE is buying dinner at this place. :-) Signature/ Amatus / >>> Want to drive over? I buy dinner for you and "N". I'll schedule a case >>> for you to watch. Get R & CA to ride in with you (I am pretty sure he [quoted text clipped - 8 lines] > > Steve > Ok! Everyone to Bornfeld's place. HE is buying dinner at this place. :-) Be sure to bring the kids. Steve Meet you there at 8 Signature/ Amatus / >> Ok! Everyone to Bornfeld's place. HE is buying dinner at this place. >> :-) > > Be sure to bring the kids. > > Steve The offer still holds. Signature/ Amatus / > >> Want to drive over? I buy dinner for you and "N". I'll schedule a case [quoted text clipped - 3 lines] > It could be costly...you know, I prefer Kobe steaks. :) Just kidding. > John >> Have seen AC's technic in person. He trial fits the onlay >> without a band and adjusts contacts if necessary. [quoted text clipped - 9 lines] > >John It's good to be a skeptic. Was skeptical too until I saw it in person. I assure you "gentlemen, this is no humbug" ;-]] Newbie, Tell John to drive down for a day and visit. Signature/ Amatus / > >>> Have seen AC's technic in person. He trial fits the onlay [quoted text clipped - 14 lines] > Was skeptical too until I saw it in person. > I assure you "gentlemen, this is no humbug" ;-]] >I can always control moisture. It is just is a question as to whether or >not it is worth it. I, respectfully, disagree that moisture can *always* be controlled. You have to take that band off sometime to bond your onlay which will allow seapage, even just a little bit in those subgingival cases. Laser treatment or electorsurg won't stop the seapage. Now, the seapage clinically significant? Maybe, maybe not. Lets talk in a few years. This is different from doing a direct composite where the band stays in place. This is also different from taking an impression where you need dryness for a very short time until you get that impression material around the margins and barring someone who has a severe saliva problem, your VPS impression will be fine. John The band stays in place during cementation. :-) Hey, we had breakfast together in TO a few years back, right? Signature/ Amatus / > >I can always control moisture. It is just is a question as to whether or > >not it is worth it. [quoted text clipped - 12 lines] > > John > Hey, we had breakfast together in TO a few years back, right? Yes, that was over 6 years ago. As I recall, we hammered out amendments to NAFTA over steak and eggs. :) John That is one of my good memories. Signature/ Amatus / > >> Hey, we had breakfast together in TO a few years back, right? [quoted text clipped - 3 lines] > > John >Now that I've come home from work I can participate. I can say that I >understand why you prefer to do an inlay/onlay over a crown. I remember [quoted text clipped - 7 lines] > >John >what about if you can't control moisture? How would you control moisture for an impression. Then there is always the electrosurg. >Should I go ahead and get a root canal before having >crown replaced even tho both dentists are unclear if [quoted text clipped - 4 lines] >have a root canal months later if problem persists and >then drilling thru this gold crown! If you were my patient I certainly would do RCT on that tooth before making a new crown. Your thinking is spot on. Could this be cracked tooth syndrome? Regards, George >Could this be cracked tooth syndrome? is there such a name? such a condition? Yes. I just extracted an upper premolar where the patient ignored the symptoms too long. The tooth split down through the root and was not restorable. D >>Could this be cracked tooth syndrome? > > is there such a name? > > such a condition? I understand the upper first pre-molar is the most common tooth to be replaced with implants. Fractures due to clenching is given for the reason. Signature/ Amatus / > Yes. > [quoted text clipped - 9 lines] >> >> such a condition? This gal refused any help with her clenching many years ago as well. D > I understand the upper first pre-molar is the most common tooth to be > replaced with implants. Fractures due to clenching is given for the reason. Can you guys give me some insight to what this rot canal will feel like while he is doing it? I've never had a RCT before and am obviously a bit apprehensive is it not as uncomfortable as it sounds? You will be numb and feel some vibration. One out of 200 will have some sharp sensations which last a second or two. Once the procedure is well underway, this stops too. Signature/ Amatus / > Can you guys give me some insight to what this rot > canal will feel like while he is doing it? [quoted text clipped - 3 lines] > > is it not as uncomfortable as it sounds? >If you were my patient I certainly would do RCT on >that tooth before making a new crown. > >Your thinking is spot on. well I REALLY appreciate everyone's advice here! I am not expert in these matters so differ to you guys for help I want to take as good of my teeth as possible..... > I'm 48 yr old male > [quoted text clipped - 25 lines] > have a root canal months later if problem persists and > then drilling thru this gold crown! Get the root canal and don't be afraid. Root canals are cool as heck and wish I could get one everyday. Signature. |
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