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Medical Forum / General / Dentistry / August 2007

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To crown or not

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grubertm@gmail.com - 23 Jul 2007 23:36 GMT
I have recently had my lower right first molar prepared for a crown.
It's been four weeks and the temporary is to be replaced with a
permanent one later this week.
Before the temporary crown was placed, this tooth was asymptomatic.
Since then it's been running the gamut of possible symptoms but
nothing that's consistent and well defined. Sometimes there's cold or
hot sensitivity- sometimes there's not. Two nights I have woken up
with a soreness in the area but at other times it's fine. To make
things more complicated the premolar next to it also had a composite
placed and the opposing molar on top has a deep filling with
occasional discomfort.
With this mess I went to an endodontist to run some tests and xrays
but the results also were not conclusive. Now I am wondering what I
should do. Put the permanent crown on only to find it needs RCT two
months down the road ? Use a temporary bond for the permanent crown -
would that make any difference ? Have the RCT done just in case ?
Mark & Steven Bornfeld - 24 Jul 2007 00:40 GMT
> I have recently had my lower right first molar prepared for a crown.
> It's been four weeks and the temporary is to be replaced with a
[quoted text clipped - 12 lines]
> months down the road ? Use a temporary bond for the permanent crown -
> would that make any difference ? Have the RCT done just in case ?

    If things aren't clear-cut as far as symptoms go, I would either give
the tooth another week or two to calm down or put in the crown with
temporary cement.  The permanent crown will almost certainly fit and
insulate better than the temporary crown.  If things don't subsequently
calm down, it should be possible to remove the crown, have the
endodontist do the endo, and then re-cement the same crown.

Steve

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

Newbie - 24 Jul 2007 15:04 GMT
>Now I am wondering what I
>should do. Put the permanent crown on only to find it needs RCT two
>months down the road ?

No, not just yet.

> Use a temporary bond for the permanent crown -

A good idea.

>would that make any difference ?

Maybe, but if the tooth needs RCT in a any time soon
the crown can be taken off more easily.

>Have the RCT done just in case ?

No, not unless symptoms become definitive of *irreversible* pulpitis.

Sounds like *reversible* pulpitis to me.
Could just be a leaky temp.
grubertm@gmail.com - 24 Jul 2007 19:00 GMT
Thank you.
grubertm@gmail.com - 07 Aug 2007 00:18 GMT
Well the permanent crown is now on with temporary cement and while the
temperature sensitivity has gone down I still have moderate diffuse
pain in that region without being able to tell for sure which of the
teeth it is coming from.

Is there a rule of thumb when xrays will start to show shadows at the
root after onset of pulpitis ? I would really like to do something
about this but since all three teeth in that region have had
restorations done recently I obviously don't want to have the
endondontist go for the wrong one.
 
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