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Medical Forum / General / Dentistry / November 2007Root Canal done. Crown or onlay ?
I had a root canal done on #30. It doesnt have lot of tooth structure. Dentist wants to do a crown with post and core. When I asked about an onlay he said he could do a cerec onlay for about the same price. I am trying to decide to go with a gold crown or the cerec which according to him will preserve more tooth structure. What do you guys think ? thanks, Al Depends who's doing the work (and whether you are a clencher). ;-) Steve > I had a root canal done on #30. It doesnt have lot of tooth > structure. Dentist wants to do a crown with post and core. When I [quoted text clipped - 6 lines] > > Al > I had a root canal done on #30. It doesnt have lot of tooth > structure. Dentist wants to do a crown with post and core. When I [quoted text clipped - 6 lines] > > Al He could do a gold onlay as well and spare just as much tooth structure. If you have a high decay rate still, that would make me lean toward a crown. If you value the esthetics, I'd lean toward the cerec, which can design a variety of restorations. Our very own Amatus is the Master of the Cerec, and may weigh in. ;-) Steve Well, he recommends a PFM because the tooth above it is also a PFM crown. He wants to use "white gold" for the metal part of the crown and also the custom post. If I use regular metal instead of gold, it will be ~$350 less. My question is should I go with his recommendation ? Is white gold commonly used for this ? I dont mind paying a bit extra to prevent future problems, just wondering if it's necessary to use gold even for the post part. thanks for your input. Al > Well, he recommends a PFM because the tooth above it is also a PFM > crown. He wants to use "white gold" for the metal part of the crown [quoted text clipped - 5 lines] > > Al Even with gold approaching $800/oz, that's a pretty big difference. High noble metals machine more easily, but good base metals work OK too. Some here may disagree, and certainly some base metal alloys are to be avoided--esp. those with beryllium (more a hazard for lab technicians than for patients). Even with "white" gold, you don't know how much gold is in it. But certainly you don't want to put gold against porcelain--the porcelain will wear the gold. Frankly, I see no reason to have a precious metal post. Steve >> Well, he recommends a PFM because the tooth above it is also a PFM >> crown. He wants to use "white gold" for the metal part of the crown [quoted text clipped - 16 lines] > >Steve Yeah, a fibre post is a better choice. I agree. The post will break before the root does.  Signature/ Amatus / > >>> Well, he recommends a PFM because the tooth above it is also a PFM [quoted text clipped - 19 lines] > > Yeah, a fibre post is a better choice. And then you get to re-do your post/build up/crown for free when it only lasted 6-18 months <ow!>. I tried fiber posts for a few years and I was underwhelmed by the results. I went back to cemented, pre-fab metal posts. It's already kind of a 'hail Mary' restoration. Why have it fail early and keep repairing it? Put it together so it will last as long as possible. Then if/when it fails, scrap it and go on. Now if the tooth really doesn't need a post, the fiber ones are fine <G>. JMO, D > I agree. The post will break before the root does. Type of post is up to personal preference. I prefer the milder failure of the broken post to the dramatic failure of the fractured root. Either way, it is generally hero-dontics. Signature/ Amatus / > > And then you get to re-do your post/build up/crown for [quoted text clipped - 17 lines] > >> I agree. The post will break before the root does. Since we are on the subject. For a pre-fab metal post have used Dentatus for years. Cemented with fuji 9 now but previously used MiracleMix. Am only trying to achieve more retention for the core so tend to use short small diameter posts with just the very slightest bit of retention when seating by a 1/4 to 1/2 turn just to engage a thread or two. As for pin retention... don't do it anymore except in extreme hero-dontic cases. Even then less is more. >And then you get to re-do your post/build up/crown for >free when it only lasted 6-18 months <ow!>. [quoted text clipped - 16 lines] > >> I agree. The post will break before the root does. >Do not get the post it weakens the root and makes it more suseptable >to fracture, use a composite build-up. 1. For, Dr. Vasserman, you are suggesting to get just the core + crown, instead of the post + Core + crown ? 2. What is the reasoning behind getting a custom post vs a prefabricated one ? Is it because it fits better ? 3. I read that after the root canal, the tooth structure turns brittle and more prone to fracture. I'm only 31, how likely is it that it will fracture at some point in the future and then do you end up extracting it ? Thanks as usual. I need to make a decision by Thur, cant wait to get this over with.... Al >>Do not get the post it weakens the root and makes it more suseptable >>to fracture, use a composite build-up. > >1. For, Dr. <Newbie> >, you are suggesting to get just the core + >crown, instead of the post + Core + crown ? The current general consensus is that posts actually weaken teeth, not strengthen. Can lead to result in non-restorable root fracture. Fibre posts are now recommended if a post is needed. A post is now only recommended to increase retention for the core. We have much better core materials now that actually bond to tooth structure. >2. What is the reasoning behind getting a custom post vs a >prefabricated one ? Is it because it fits better ? Old school reasoning. Now considered even worse than prefab metal posts. Thins the root structure thereby even further weakening and increases chance of root fracture. >3. I read that after the root canal, the tooth structure turns >brittle and more prone to fracture. I'm only 31, how likely is it >that it will fracture at some point in the future and then do you end >up extracting it ? True, RCT'd teeth become brittle. Impossible to predict when or *if* a non-restorable fracture will occur. We all have seen endodontically treated teeth restored with post and crown that have lasted for decades. A key to longevity is to eliminate nocturnal parafunction. Most here recommend an NTI, but any custom made nightguard is better than nothing. Store bought "chew toys" are to be avoided. >Thanks as usual. I need to make a decision by Thur, cant wait to get >this over with.... > >Al Best wishes, -NB I'm obviously nothing more than a gp doing his own limited 'clinical research' (otherwise known as experience), but I have to wonder if some of the research on posts is centered around the types of posts more than the post technique itself. First, if a tooth doesn't really need a post, don't put one in. If you do, please use a size #4 pre-fab post. If the tooth really needs a post to help hold things together, use a post system that saves tooth structure. That pretty much eliminats a cast post and core since you have to 'hog out' a lot of root to get a pattern and make a casting. Pre-fab post can have very conservative preps using a #4 or #5 drill. Use the one that gets clean walls for cement, but does not remove much tooth beyond the gutta-percha. Cement this passively fitting (no threads to engage tooth structure) post with a resin cement. IME, small diameter fiber posts simply have very little resistance to flexing. I know teeth flex, but when I can bend them with my fingers, that's too weak. Rather than drill a #7 size shaft into a root, I choose to use a titanium post with a small diameter. It's stronger than the fiber posts, yet I haven't removed much tooth structure to get it cemented. I don't see root fractures with this combination. I don't have very many post or build-up failures either. When I tried fiber posts for a few years, the results were not good enough to suit me at all. Best wishes, D >>, you are suggesting to get just the core + >>crown, instead of the post + Core + crown ? [quoted text clipped - 6 lines] > for the core. We have much better core materials now > that actually bond to tooth structure. > Best wishes, > > -NB >I'm obviously nothing more than a gp doing his own limited >'clinical research' (otherwise known as experience), but I [quoted text clipped - 3 lines] >First, if a tooth doesn't really need a post, don't put one >in. If you do, please use a size #4 pre-fab post. Follow so far, but what brand of post are we talking about ? >If the tooth really needs a post to help hold things together, >use a post system that saves tooth structure. That pretty much [quoted text clipped - 5 lines] >not remove much tooth beyond the gutta-percha. Cement this passively >fitting (no threads to engage tooth structure) post with a resin cement. Which resin cement are you using ? >IME, small diameter fiber posts simply have very little resistance >to flexing. I know teeth flex, but when I can bend them with my >fingers, that's too weak. Rather than drill a #7 size shaft into >a root, I choose to use a titanium post with a small diameter. OK, yeah titanium has some flex to it. >It's stronger than the fiber posts, yet I haven't removed much tooth >structure to get it cemented. > >I don't see root fractures with this combination. I don't have very >many post or build-up failures either. When I tried fiber posts for >a few years, the results were not good enough to suit me at all. Thanks for the tutorial. >Best wishes, >D [quoted text clipped - 13 lines] >> >> -NB > Follow so far, but what brand of post are we talking about ? Parapost. > Which resin cement are you using ? Rely-X 'clicker' or cemented at the same time as the build-up with Bond 1 and Build-it (my most common approach). Many of these cases are for purely economic reasons. A patient might be able to get endo/post/crown for $700-800 out of pocket expense where an implant would be $2700 and a bridge $1400 OOP. JME, D > I had a root canal done on #30. It doesnt have lot of tooth > structure. Dentist wants to do a crown with post and core. When I [quoted text clipped - 6 lines] > > Al Do not do cerec 3D on tooth #30 with small amount of tooth structure. Get a PFM semi-precious with 360 degree all porcelain margin. You will not see any gold when the crown is cemented. Or if you do not care about the looks an all gold crown is ideal. Do not get the post it weakens the root and makes it more suseptable to fracture, use a composite build-up. After about ten years of CEREC fabrication, I will tell you that any tooth (that is restorable) can be restored with machine milled ceramic. However, teeth with nothing above the gum-line seldom last long regardless of how they are restored. Personally, I like CEREC better on teeth with less tooth structure remaining. But that is just me. Signature/ Amatus / >> I had a root canal done on #30. It doesnt have lot of tooth >> structure. Dentist wants to do a crown with post and core. When I [quoted text clipped - 13 lines] > Do not get the post it weakens the root and makes it more suseptable > to fracture, use a composite build-up. |
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