Medical Forum / General / Dentistry / July 2007
Pain after post and core
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Rob Usdin - 28 Jun 2007 22:27 GMT Recently had a tooth root canaled (I think it is #22 - pre molar on lower left).
Yesterday the dentist did the post and core on this tooth. While grinding to tooth down in prep - using whatever the tool on the drill does the grinding (big vibrations) it vibrated quite a bit and even though I had novocaine I still felt sensitivity and pain as she put pressure on during the grinding. She also when prepping around the sides of the tooth said she removed some gum overgrowth (which I also felt).
She did the temporary fine, and it's on. I am feeling pretty constant pain right now from the tooth when putting pressure on it and constant moderate pain in the jaw below. I've felt similar pain on another root canaled tooth after root canal but I don't recall much soreness after a post and core being done.
So my question is this - is this even somewhat normal after a post and core because the tooth is still sensitive? It did hurt for a bit after the root canal as well which subsided. Is this just re- irritation that will subside, kind of like a bruise? Or would this be indicative of a root fracture?
Thanks.
--*Rob
Steven Bornfeld - 29 Jun 2007 00:15 GMT Rob Usdin wrote:
> Recently had a tooth root canaled (I think it is #22 - pre molar on > lower left). [quoted text clipped - 22 lines] > > --*Rob It sounds like she did a lot more than a post and core--she prepped the tooth, and there may be gingival pain. There are other possibilities as well, of which root fracture is the worst (you would almost certainly lose the tooth). Most of the bad ones (fracture, root perforation, overextension of the post) can be easily determined by an x-ray, and significant pain should be checked.
Steve
REP - 29 Jun 2007 09:14 GMT > So my question is this - is this even somewhat normal after a post and > core because the tooth is still sensitive? It did hurt for a bit > after the root canal as well which subsided. Is this just re- > irritation that will subside, kind of like a bruise? Or would this be > indicative of a root fracture? For real advice, please see your dentist. Every mouth/tooth is diffferent; what I am about to post is an anecdote:
I recently had a root canal on #3 (upper right molar) due to nerve death and fracture. The RC was largely painless ... then again, the nerve was "dead" before the RC. A week later, I had the crown prep, build up and casting for post - and it HURT!! Not just being in a bite block for 2 hours, ouch, but apparently there's plenty of nerves left in the gum, etc! I was surprised at how much it hurt, and my dentist said that that crown prep was the worst part of the whole thing. (A bunch of xrays were taken the following week when the post was placed - no root fracture, and by then the pain had gone to just somewhat achy).
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Amatus Cremona - 29 Jun 2007 11:40 GMT What is a post and core? Temporary?
Why bother?
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> >> So my question is this - is this even somewhat normal after a post and [quoted text clipped - 15 lines] > were taken the following week when the post was placed - no root > fracture, and by then the pain had gone to just somewhat achy). REP - 29 Jun 2007 12:14 GMT > What is a post and core? Temporary? > > Why bother? It is entirely possible that, being merely an owner of teeth and not a professional, that I screwed up some terms or used them improperly. I had a broken tooth with a nerve that was not functional; that tooth had a root canal; then that tooth was prepared for a custom-made cast-to-fit post and crown. I am having quite a few crowns - years of poverty - and my dentist wants to place them at the same time, so I currently have 3 temporary crowns and will have another in about 10 days. Why bother? Need the temporaries to protect what remains of the teeth before they are crowned, or so my dentist tells me. Personally, I'd rather have the temps than be forced to sit on the porch and play my banjo.* Sure, the work is all on molars, but same principle.
The point of my anecdote (which was labeled as an anecdote, and not as gospel or full of correct jargon) was merely that one other person has recently had a crown prep, that it hurt like f.cking hell and was told that it was normal to hurt like f.cking hell.
*"Deliverance"
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Amatus Cremona - 29 Jun 2007 13:29 GMT I am so sorry ! I should have been more clear.
I did not aim my comment at you. :-)
I was simply pointing out to the professionals on this forum that we need to find ways to reduce the amount of grinding we actually do on a tooth. This (in my office) means cores are not done and I do onlays instead of crowns. Since I use a CAD-CAM system, I do them in one appointment rather than two, so no temporary is needed.
Your description could indeed be an indication that there is a fracture in the root. Posts are notorious for cracking roots. Especially if they have a taper or have screw threads. Even smooth sided straight posts will crack roots if the patient clenches at night. A lot of us now feel that if we could not restore the tooth unless we used a post, that the tooth probably should not be restored, but removed. In retrospect, teeth that survive for decades with a post in them, never needed the post in the first place.
Do NOT have the finished crown final cemented on the tooth if it still hurts ! ! ! If it hurts with the temporary, it will still hurt with the finished crown. Find out why it hurts first.
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> >> What is a post and core? Temporary? [quoted text clipped - 19 lines] > > *"Deliverance" REP - 02 Jul 2007 10:46 GMT > I am so sorry ! I should have been more clear. > > I did not aim my comment at you. :-) No problem. I was afraid I hadn't been clear enough that I was merely adding an anecdote that was worth exactly what was paid for it.
> I was simply pointing out to the professionals on this forum that we need to > find ways to reduce the amount of grinding we actually do on a tooth. This [quoted text clipped - 13 lines] > ! ! ! If it hurts with the temporary, it will still hurt with the finished > crown. Find out why it hurts first. The *tooth* never hurt. The tissue surrounding the tooth hurt like all hell, due to the needle sticks, grinding, etc. I don't have a digital xray of the tooth, but even if I did, it doesn't really show how damaged the erupted areas were - it had large amalgam fillings, which fell out when the tooth cracked diagonally, taking out the lingual side and most of the back but the 'footprint' of the tooth was intact, and the roots are strong and surprisingly healthy. A lot of remaining tooth had to be removed as it was too thin to be of use (remember, it was honeycombed with holes from former fillings) and the lingual side was broken just at the gumline. After the tooth was 'cleaned up,' the casting was made for the post - all this took some time, and no doubt being in a bite block for as long as I was contributed to the post-poking pain.
By the time the post was to be intalled, the tissue had recovered and stopped hurting; the tooth itself remains nonpainful, even with a large, strange object in it. The only really thing I notice is that it's wider and thicker than it's been for a year (since the temp is shaped like a healthy tooth, and not my broken one).
It's been xrayed since the post has been placed (there is some concern since #2 and #4 are absent) but the post is an excellent fit and so far, it's fine. Once #30's crown is done - it had an RC due to absess years ago but I couldn't afford the crown then - we'll all see how #3 does with another tooth making full contact.
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email: aripee at inanna . com
Amatus Cremona - 02 Jul 2007 13:39 GMT IF the lower tooth ahs not had any chewing contact for a L-O-N-G time, it will probably be sensitive to chewing forces for the first few weeks, as the ligament holding the tooth in place re-adapts.
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> >> I am so sorry ! I should have been more clear. [quoted text clipped - 57 lines] > ago but I couldn't afford the crown then - we'll all see how #3 does > with another tooth making full contact. Rob Usdin - 02 Jul 2007 15:18 GMT FIgured I'd follow up with a post since I was the one who started all this.
The tooth is down to a slight ache. If it was still hurting as much as it did last week I'd be at the dentist right now, but it may have just been pain from the prep of the gum, as well as pressure to the tooth "bruising" the tooth in the socket down to the jaw. I can bite and eat on it just fine now, I still have a slight ache but it is controllable with one Advil so I'm thinking there's nothing adverse going on. I will mention it all to the dentist though when I go to get the permanent crown placed in 10 days in case she decides it is worth an x ray just in case.
Also- just curious - are many dentists adopting digital x rays? I had another root canal early this year and the endodontist used digital x rays. For me as a computer guy, I thought it was pretty cool how they could blow it up and get a better look. My regular dentist though still uses the standard x rays. Just wondering what the adoption rate on digital is. Is my dentist behind the times or is the endo on the leading edge?
--*Rob
Newbie - 02 Jul 2007 15:31 GMT > Is my dentist behind the times or is the endo on the >leading edge? > >--*Rob Would guess that most endo's have digital and were early adopters.
Many still use film, such as me, because of the expense of going digital. It ain't cheap. Mebbe when the price drops a bit.
Amatus Cremona - 02 Jul 2007 19:29 GMT I was digital before the local endo guys were.
Digital is "an expense" to purchase initially, but is paid for entirely by what you would have spent with film. Depending on how busy the office is, the break-even point is 2-3 years. After that, it is much cheaper to use digital.
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> >> Is my dentist behind the times or is the endo on the [quoted text clipped - 8 lines] > of going digital. It ain't cheap. Mebbe when the price > drops a bit. Newbie - 02 Jul 2007 19:53 GMT See, that was a perfect set up by me.
Good job AC !
>I was digital before the local endo guys were. > [quoted text clipped - 14 lines] >> of going digital. It ain't cheap. Mebbe when the price >> drops a bit. Amatus Cremona - 03 Jul 2007 11:51 GMT Gee,,,,,,,, thanks
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> > See, that was a perfect set up by me. [quoted text clipped - 19 lines] >>> of going digital. It ain't cheap. Mebbe when the price >>> drops a bit. Amatus Cremona - 02 Jul 2007 19:29 GMT It should not be hurting at this point. Something is wrong.
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> FIgured I'd follow up with a post since I was the one who started all > this. [quoted text clipped - 18 lines] > > --*Rob Steven Bornfeld - 29 Jun 2007 15:53 GMT >> What is a post and core? Temporary? >> [quoted text clipped - 16 lines] > recently had a crown prep, that it hurt like f.cking hell and was told > that it was normal to hurt like f.cking hell. You were misinformed. As for Amatus, forgive him. We have a running inside joke, and you got caught in the crossfire. Apologies, Steve
> *"Deliverance" Steven Fawks - 30 Jun 2007 12:01 GMT > The point of my anecdote (which was labeled as an anecdote, and not as > gospel or full of correct jargon) was merely that one other person has > recently had a crown prep, that it hurt like f.cking hell and was told > that it was normal to hurt like f.cking hell. I would not like such pain to exist in any tooth that I have plans to cement a permanent crown on top of.
If it does not feel pretty good by the cementation appt., I would not place that crown (or any of the 'neighbors') until the pain problem is corrected.
Was the root canal just recently done, or was it older treatment?
As far as posts being 'notorious' for cracking roots, that statement could be a little inflamatory. I have placed many posts over the last 28 years of dentistry, and the failures have been low. Of those failures, most have been failures of the build up around the post or the post itself. Not very many have been root fractures.
These posts have been mostly size #5 pre-fab, cemented posts. Stainless steel in the early days, then titanium (I tried the fiber posts for a few years and they failed at an alarming rate, so I'm back to titanium).
JMO, Steve Fawks
Newbie@bix.nex - 30 Jun 2007 23:33 GMT >> The point of my anecdote (which was labeled as an anecdote, and not as >> gospel or full of correct jargon) was merely that one other person has [quoted text clipped - 3 lines] >I would not like such pain to exist in any tooth that I have plans >to cement a permanent crown on top of. Agreed
>If it does not feel pretty good by the cementation appt., I would >not place that crown (or any of the 'neighbors') until the pain >problem is corrected. This is why I rarely prep for the crown on the RCT appt.
>Was the root canal just recently done, or was it older treatment? > [quoted text clipped - 3 lines] >failures, most have been failures of the build up around the post or >the post itself. Not very many have been root fractures. Agree here but am placing less posts and have eschewed placing pins altogether. AC plans for future and ultimate failure, his practice is much different from mine. One of us dislikes prostho, both are masters of the craft.
>These posts have been mostly size #5 pre-fab, cemented posts. Stainless >steel in the early days, then titanium (I tried the fiber posts for >a few years and they failed at an alarming rate, so I'm back to >titanium). Titanium is an interesting metal. Strong, light, yet a bit flexible. Very difficult to forge and a bit rare, compared to iron (steel) There are some firearms with titanium parts, it's too flexible for the frame.
Am using gold plated Dentatus, post space prepared with the four sided prep instruments that are part of the kit. Cement them in place, use an explorer to coat the walls, seating the post counterclockwise with a vibrating motion. Usually give a 1/4 to 1/3 clockwise turn after full seating Using Fuji 9 as the core/luting agent. Often done in two steps.
Most posts IME fail due to cement failure of the build-up material/post/tooth structure interface. Micro-leakage at the crown margin/cement/tooth interface is the starting point of failure.
Bonding PFM's with a material such as Calibra may become standard, but material science needs to advance a bit further.
Bonding an all ceramic restoration, including silanation and an *absolutely* dry field may be the ultimate cure but not always achievable.
When any restoration can be truly bonded in a 'wet' field, then failures may be a thing of the past.
Of course the cause of cuspal fractures must be addressed, and a preventative must be implemented. NTI is my choice but any other device is better than nothing.
Damn, my soap-box just collapsed; whacked my noggin and hurt myself <g>
>JMO, >Steve Fawks OK TJ, have gone on too long,,,
Time for a nap ;-]]
REP - 02 Jul 2007 10:23 GMT > > The point of my anecdote (which was labeled as an anecdote, and not as > > gospel or full of correct jargon) was merely that one other person has [quoted text clipped - 9 lines] > > Was the root canal just recently done, or was it older treatment? I meant the prepping was quite painful. The tooth itself is 'dead' - the nerve had 'died' before the RC had certainly hadn't recovered after it (and yes, the RC had been done the previous week). It didn't hurt at all until I had spent 2.5 hours in a bite block, getting many, many needlesticks, a lot of grinding and some work done on the gum. The tooth still didn't hurt - but everything around it sure as hell did. A lot.
Again, just an anecdote from someone who had recently had it done to someone else who recently had something similar done - and please note, my anecdote began with "see your dentist for real advice."
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Steven Bornfeld - 29 Jun 2007 15:52 GMT > What is a post and core? Temporary? > > Why bother? You're slipping. I figured you'd be in within the hour. Seriously, you never use posts? I'm aware that accepted guidelines have changed, and I assume your Cerec will create in effect an integral core/restoration. But in order to create a path of draw, won't that sometimes require you to remove extra tooth structure?
Steve
Amatus Cremona - 01 Jul 2007 14:58 GMT >> What is a post and core? Temporary? >> >> Why bother? > > You're slipping. I figured you'd be in within the hour. You caught me napping :-))
> Seriously, you never use posts? I will use a fibre-post when I have no supragingival tooth to bond to, and the patient understands that this is only an effort to get another year or three out of the root before implants. The forces which broke off the tooth at the gum-line will still be there. I want the next gfracture to be supra-gingival which is less likely to be an emergency with pain and swelling on the weekend I drive Strad up to Interlochen. I threw out all the metal posts (actually donated them).
>I'm aware that accepted guidelines have changed, and I assume your Cerec >will create in effect an integral core/restoration. The machine will replace whatever is missing. You are free to use your imagination during preparation and clean out the tooth as you see fit. The technology simply replaces what was removed by caries and dentisty.
> But in order to create a path of draw, won't that sometimes require you to > remove extra tooth structure? Line of draw is visual. Whatever the camera can see, is what will be made. The technology CANNOT make an internal undercut, because the camera does not see it. Slight internal undercuts of the preparation are simply filled with the luting agent. Larger ones,,, you have to decide how thick of a core of luting agent you are comfortable with. More than a full mm, and I will generally reduce the enamel above it slightly. I like more porcelain in the tooth and luting agent. My big concern is the side of the tooth, not the top of it. I want the thick enamel on the buccal and lingual walls to remain intact at all times. This enamel is generally very well supported by dentin and is important to the inherent flexibility of the tooth. Abfraction and fracture are reduced when you keep this part of the tooth. If I see fracture lines in the base of a cusp or the floor of the preparation, After imaging the fractgures for my record, I will reduce the height of the cusps on that side (or both sides) by 3 mm. The porcelain then covers this much of the cusp in order to prevent spreading the cusp tips apart during isometric bruxism and further fractgure. I always show the patient the fractures on the monitor and explain that prognosis is reduced.
Steve, also
Steven Bornfeld - 01 Jul 2007 15:37 GMT > You caught me napping :-)) > [quoted text clipped - 37 lines] > > Steve, also Thanks for the clarification.
Best, Steve
Amatus Cremona - 02 Jul 2007 13:37 GMT Should have been " I like more porcelain in the tooth and LESS luting agent.
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>> >> You caught me napping :-)) [quoted text clipped - 44 lines] > Best, > Steve Newbie - 02 Jul 2007 15:17 GMT >Should have been " I like more porcelain in the tooth and LESS luting agent. We knew that.
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