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Medical Forum / General / Dentistry / May 2007Dumb Post-RCT Question
I had a RC on #3. I think it went very well - there's very little pain and my doctor impressed me right off the bat by giving me an absolutely painless injection (I'm not used to that!). My dumb question is this: some of the white material used to pack the tooth is coming off. Should I call the dentist to let him know, or is this okay as long as all the holes are covered? Thank you.  Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather email: aripee at inanna . com This is not a dumb question. I was a Certified Dental assistant for 13 years and currently in dental hygiene school. As long as the hole is covered you are ok. That is a temporary filling used to cover the hole until you get either the post and build up or filling placed. Usually with a root canal (depending on which tooth) it is recommended to have a post and build up put in followed by a crown. The tooth is more apt to break with a root canal. Again that depends on the tooth and DDS's philosophy. Good luck! D >I had a RC on #3. I think it went very well - there's very little pain >and my doctor impressed me right off the bat by giving me an absolutely [quoted text clipped - 3 lines] >tooth is coming off. Should I call the dentist to let him know, or is >this okay as long as all the holes are covered? Thank you. Usually with a root canal > (depending on which tooth) it is recommended to have a post and build up put > in followed by a crown. Wrong again. Post are not usually needed. Crowns are appropriate for most posterior teeth with endo, but not necessarily anteriors. Giving dental advice over the internet is hard enough when you know your facts. Right now, you think you know more than you really do. D Well you are rude. I am giving the information from Endodontists and general DDS's.I did specifiaclly say "depending on which tooth". It is just info for the person to hear and ask questions about. Trying to help and give any information so a person can make an informed decision is all that I am about. I don't pretend to know everything by any means and am shocked by your negativity on sharing info. >Usually with a root canal >> (depending on which tooth) it is recommended to have a post and build up put [quoted text clipped - 7 lines] > >D No Donna, you are giving specific advice about matters which you do not know the specifics. And,,,,, you are a DA, you are not trained to give advice on. Sorry. :-) Signature/ Amatus / > Well you are rude. I am giving the information from Endodontists and > general [quoted text clipped - 17 lines] >> >>D > No Donna, you are giving specific advice about matters which you do not > know the specifics. And,,,,, you are a DA, you are not trained to give > advice on. Sorry. :-) This is Dr Steve (not to be confused with Dr Steve Bornfeld the gentleman )hidding behind a fake name. > / >> Well you are rude. I am giving the information from Endodontists and [quoted text clipped - 18 lines] >>> >>>D > This is Dr Steve (not to be confused with Dr Steve Bornfeld the > gentleman )hidding behind a fake name. I know who he is and I know who you are. Guess whose opinion for which I have any regard. Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather email: aripee at inanna . com Dartos is anything but rude, he is always a gentleman. Giving internet diagnosis and treatment planning is something that the regulars frown upon. It is irresponsible and can lead patients to the wrong conclusion. The fact of the matter is that you are *not* an endodontist or GP, while your knowledge may be better than the average bear, you have not seen the OP. Only a dentist who has seen the patient in person can know the specifics of a case. Sometimes people post radiographs and/or pictures that can help us steer the patient, but still internet diagnosis and treatment planning is unnaceptable in our view. >Well you are rude. I am giving the information from Endodontists and general >DDS's.I did specifiaclly say "depending on which tooth". It is just info for >the person to hear and ask questions about. Trying to help and give any >information so a person can make an informed decision is all that I am about. >I don't pretend to know everything by any means and am shocked by your >negativity on sharing info. >>Usually with a root canal >>> (depending on which tooth) it is recommended to have a post and build up put [quoted text clipped - 7 lines] >> >>D >This is not a dumb question. I was a Certified Dental assistant for 13 years >and currently in dental hygiene school. >As long as the hole is covered you >are ok. That is a temporary filling used to cover the hole until you get >either the post and build up or filling placed. Current endodontic theory and treatment is to create a seal from root tip to cusp tip. This is called the 'monoblock'. I no longer use soft temp materials like IRM or Cavit in endodontic access preps. Now placing a build up of Fuji 9 while the dam is still in place. >Usually with a root canal >(depending on which tooth) it is recommended to have a post and build up put >in followed by a crown. Posts are not generally recommended in endodontically treated teeth anymore. >The tooth is more apt to break with a root canal. True. >Again that depends on the tooth and DDS's philosophy. Good luck! D > [quoted text clipped - 5 lines] >>tooth is coming off. Should I call the dentist to let him know, or is >>this okay as long as all the holes are covered? Thank you. > >Usually with a root canal > >(depending on which tooth) it is recommended to have a post and build up put > >in followed by a crown. > > Posts are not generally recommended in endodontically treated teeth anymore. This tooth is going to be crowned (standard gold crown) and a custom post used. The reason given for the custom post (which made sense to me) is that it's needed because more than 1/2 the tooth is broken off on the lingual side, and pins wouldn't be enough support. I know that without seeing the tooth - the films don't do the horror of it justice - more than a general opinion can't be given, but in general, does a post sound as though it may be the correct thing for this type of situation? Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather email: aripee at inanna . com You will find most dentists now agree that if you cannot restore a tooth without a post, you should not restore it, as it will not last. Studies have shown repeatedly that posts do not prolong the lifespan of a crowned tooth. Often the post will actually shorten the life of it be transferring heavy loads to the thinnest part of the root and fracturing the root. I only use posts when I am trying to stretch an extra 2-3 years out of a tooth which the patient knows needs to come out. Signature/ Amatus / > >> >Usually with a root canal [quoted text clipped - 12 lines] > than a general opinion can't be given, but in general, does a post sound > as though it may be the correct thing for this type of situation? And custom posts are no better (and some studies say worse) than pre-fab bonded posts. Now, I don't think either of us are saying what your dentist is planning will not work. It's more of a caution not to think this tooth is fixed for good. I've rebuilt teeth with posts that have lasted over 20 years. I've also seen some fail in a year or two. There is no doubt that by the time you really need a post to restore a tooth, it is a heroic effort to retain that tooth. Sometimes it's worth a try. Sometimes it's better to plan something else (especially if you are a night time clencher!). JME, D > You will find most dentists now agree that if you cannot restore a tooth > without a post, you should not restore it, as it will not last. Studies [quoted text clipped - 4 lines] > I only use posts when I am trying to stretch an extra 2-3 years out of a > tooth which the patient knows needs to come out. > And custom posts are no better (and some studies say worse) than > pre-fab bonded posts. [quoted text clipped - 10 lines] > Sometimes it's worth a try. Sometimes it's better to plan something > else (especially if you are a night time clencher!). Thank you all - I'm repling to this one because I am a night clencher - that's why I'm missing 4 (okay, 8 if you count 3rd molars) teeth. My followup on #3 is next week (and the loss of temporary material isn't a concern to the dentist since I'm being seen in a few days) and I will ask if the 'custom post' is going to be a custom fiber post or a gold post; if the answer is anything other than fiber ... should I insist on fiber? I am missing 2 and 4, and want to have at least 4 replaced somehow (I'm now leaning toward removable bridge, if it's possible) if this matters in what sort of post would give the best result. Also, if this matters, the opposing tooth (19) will soon have a gold crown as well and will probably require pins at least (1/4 of this tooth is missing). Again, many thanks for all opinions. I really do appreciate the help. PS - 4 had a fractured root and boy do I ever want to avoid that again, though I suppose it is somewhat less hideously painful with a RC'd tooth. Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather email: aripee at inanna . com > Again, many thanks for all opinions. I really do appreciate the help. > > PS - 4 had a fractured root and boy do I ever want to avoid that again, > though I suppose it is somewhat less hideously painful with a RC'd tooth. You're getting into questions that are just not possible to accurately answer over the internet. It's always dicey to get in the middle of another dentist's treatment plan anyway. It 'sounds like' I would be doing a few things differently, but I'm sure your dentist is recommending treatment that has been the most successful in his experience. Having a clenching problem, the first thing I would deal with in the restoration process is to control this. For me, that usually means an NTI-TSS device (and the patient has to wear one the rest of their lives). There is no way to cure clenching at this time. I cannot rebuild teeth stronger than they were in first place. Root canals, posts, large fillings, and crowns all will fail at some point in time. Clenching sure hastens the inevitable. Best wishes, Steve > > Again, many thanks for all opinions. I really do appreciate the help. > > [quoted text clipped - 4 lines] > answer over the internet. It's always dicey to get in the middle > of another dentist's treatment plan anyway. I do understand that, and I appreciate the opinions given, and I do understand they are general opinions based on the limited information I have given. They've helped me quite a bit, though; I have a much better idea of what to ask about. The last bit about wanting to avoid another fractured root was supposed to be funny - though I *do* want to avoid it. > Having a clenching problem, the first thing I would deal with in > the restoration process is to control this. For me, that usually > means an NTI-TSS device (and the patient has to wear one the > rest of their lives). There is no way to cure clenching at this > time. Please keep in mind I am a patient who may be using terms incorrectly - I was actually more of a grinder, and since being treated for sleep apnea, I have been told I no longer grind in my sleep (apparently, it was pretty loud). I will be sure to ask if my teeth show any evidence that I'm still doing it, because what's one more appliance at night? > I cannot rebuild teeth stronger than they were in first place. > Root canals, posts, large fillings, and crowns all will fail > at some point in time. Clenching sure hastens the inevitable. I think I was very lucky that the large fillings in the tooth under discussion lasted as long as it did - over 30 years. Of all the teeth that particular dentist did work on, this is the only one in need of major repair. He was pretty well known for his excellent work. He was a nice guy, too! Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather email: aripee at inanna . com > Please keep in mind I am a patient who may be using terms incorrectly - > I was actually more of a grinder, and since being treated for sleep > apnea, I have been told I no longer grind in my sleep (apparently, it > was pretty loud). I will be sure to ask if my teeth show any evidence > that I'm still doing it, because what's one more appliance at night? Thank you for your understanding. A note on this paragraph: grinders make noise, clenchers don't. Clenching is just as dangerous and grinding. Best wishes, D I think clenchers do more damage than grinders. I like to compare to using sandpaper on a piece of furniture. Light even strokes repeated many, many times will slowly wear down the surface of the wood. Heavy strong forces will either rip the sand paper or tear the wood fibers. Signature/ Amatus / > >> Please keep in mind I am a patient who may be using terms incorrectly - I [quoted text clipped - 11 lines] > Best wishes, > D I agree with Dr. Fawks and would add > I will >ask if the 'custom post' is going to be a custom fiber post or a gold >post; if the answer is anything other than fiber ... should I insist on >fiber? that the dentist should be willing to discuss the pros and cons of any type of post. Insisting can only drive a wedge between you and your dentist. Tis better to discuss it. If you want to avoid future fractures your clenching must be addressed. Most of us here use the NTI-tss device. (www.headachehope.com ) Must admit that any anti-clenching device is better than none. >> And custom posts are no better (and some studies say worse) than >> pre-fab bonded posts. [quoted text clipped - 29 lines] >PS - 4 had a fractured root and boy do I ever want to avoid that again, >though I suppose it is somewhat less hideously painful with a RC'd tooth. > I agree with Dr. Fawks and would add > [quoted text clipped - 6 lines] > of any type of post. Insisting can only drive a wedge between > you and your dentist. Tis better to discuss it. Well, of course I'd be polite to the person with the sharp pointy things! I didn't mean to give the impression I'm one of the patients you dread to see coming through the door - I may ask a lot of dumb-a.s questions, but I know who's the doctor, and it sure isn't me. Again, thank you and to all who responded. I appreciate the time you all have taken and think I'll be able to ask better questions at my next visit. Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather email: aripee at inanna . com >> >Usually with a root canal >> >(depending on which tooth) it is recommended to have a post and build up put [quoted text clipped - 9 lines] >than a general opinion can't be given, but in general, does a post sound >as though it may be the correct thing for this type of situation? As you have said, I would have to see pictures and/or photos of the specific tooth. As a general rule posts are used to hold a core/build-up in place. Current theory is that a fibre post is superior to metal posts because in the case of post failure less tooth structure is likely to be lost. Also this can reduce the incidence of root fracture, which is a catastrophic failure (non-restorable). Best wishes, >I had a RC on #3. I think it went very well - there's very little pain >and my doctor impressed me right off the bat by giving me an absolutely >painless injection (I'm not used to that!). > >My dumb question is this: some of the white material used to pack the >tooth is coming off. Should I call the dentist to let him know, Yes, but not a dumb question. > or is >this okay as long as all the holes are covered? Depends on the material used and how much has been lost. >Thank you. > >I had a RC on #3. I think it went very well - there's very little pain > >and my doctor impressed me right off the bat by giving me an absolutely [quoted text clipped - 13 lines] > > - Show quoted text - > >I had a RC on #3. I think it went very well - there's very little pain > >and my doctor impressed me right off the bat by giving me an absolutely [quoted text clipped - 13 lines] > > - Show quoted text - Sorry....Double post.....I think what the 3 doctors were trying to tell you is contact your dentist, and have him take a look.......... > >I had a RC on #3. I think it went very well - there's very little pain > >and my doctor impressed me right off the bat by giving me an absolutely [quoted text clipped - 4 lines] > > Yes, but not a dumb question. I'll try harder next time. > > or is > >this okay as long as all the holes are covered? > > Depends on the material used and how much has been lost. I have no idea what was used ... so even though the holes are covered and I have no pain, I'll give them a call to be sure. Thanks! Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather email: aripee at inanna . com A week or so of saliva contacting the RCT filling material should not cause a problem. The studies I have seen show that it takes a few months before bacteria can contaminate the canal again, when not covered with a good seal. Signature/ Amatus / > >> >I had a RC on #3. I think it went very well - there's very little pain [quoted text clipped - 15 lines] > I have no idea what was used ... so even though the holes are covered > and I have no pain, I'll give them a call to be sure. Thanks! |
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