In the USA, by the time you pay for records, template, abutment and crown,
plus the surgical fee, you will end up paying $3.5K; another $600 if you
need grafting.

To treat such a tooth, you spend $1K for surgical crown lengthening, $1K for
RCT, $400 for a core, and $1K+ for the crown.  That is about $3.5K for a
tooth with a questionable prognosis.

I cannot speak for fees in the UK.  I understand that the NHS has messed up
dentistry for many years over there.  I suppose your fee estimate might be
higher if you were quoted for sedation or general anesthetic.  That can add
another $400-700 to fees on this side of the Big Pond.

Frankly,,,,,,,,, a tooth with a significant fracture which was visible
without high magnification, that subsequently develops symptoms such as you
describe, is very likely to be cracked right through the roots.  If you
choose, you could ask your dentist to remove the entire onlay, and chase the
crack to its terminus.  However, be prepared to have the tooth removed after
he chases the fracture below the level of bone.  I *suspect* you would be
better off doing the work-up for an implant, and having the surgeon, who
will be placing the implant fixture, extract the tooth and examine the bony
socket while the tooth is out.  He can determine if grafting will be
necessary, determine if an implant can be placed that day, or what the
preferred treatment plan would be.

Your dentist may not perform the surgical portion of the implant placement,
but should be well qualified to fabricate an abutment and crown over the
healed implant.  If not,,,,,,,,,,,,, well,,,,,,,,,,,,,,,,,
ummmmmm,,,,,,,,,,,,,,,   you might think of,,,,,,,,,,,,,,,,,,,
well,,,,,,,,,,,,,,, ummmmmmm,,,,,,,,,,,,,,,,,,,,,,,,,,,,,     you know what
I am trying to say.

On 10 Mar, 15:29, "Amatus Cremona" <Nic...@sottovocce.com> wrote:

Thank you, Amatus, for this very succinct and informative reply. But
this raises another question, and I'd be very grateful if you and
anyone else here can offer their opinions.

I'm due to see my dentist about this tooth in a couple of weeks, but
I'm in a dilemma. Being a layman, I certainly don't know how far the
crack has spread, and I'd have thought my dentist wouldn't be able to
tell either without at least removing the onlay (the original crack
went exactly through a the rearmost cusp on the tongue side, so what
remains of the crack may not be very accessible to the eye).

I am guessing that the onlay can only be removed by destroying it.

Even then, he may not know whether the crack reaches the pulp chamber
(indicating RCT) or goes right down to the root (indicating
extraction) until he grinds the tooth down.

My dilemma is: I don't have much money, and can (just about) afford an
implant OR root canals and a crown, but not both. Also, to complicate
matters, my dentist doesn't do implants.

So, I really don't know how this visit will proceed, and what I should
say to my dentist when I see him. I'd really appreciate any advice
anyone can give here.

(BTW, one factor here is the cost of dental treatment where I live,
the UK. Amatus mentioned RCT at about $1,000 and crown lengthening at
another $1,000, and said you "could basically get an implant placed
surgically for that money". Well, here in the UK things seem to be
more expensive - about two to three thousand pounds for an implant
(that's nearly $6,000 at present exchange rates), and about £800 for
RCT on a molar, plus £600 for the crown).

    You sound very informed, but just to be sure, make sure you know what
that 3 thousand pounds is buying you.  Hard to believe there would be
such a differential in fees.  It may include the fixture, the abutment
and the crown, in which case it's probably not an unusual fee for (say)
a good dentist in Manhattan.  For just the implant fixture I don't know
how that can be justified by the market.  I'd think that with the
national health, those competing for the (relatively few) private
patients would drive fees down, not up.  But what do I know.
    In any case, we don't know where the crack goes, and as it's quite
possible the tooth is impossible to save, we don't know what the real
options are at this point.  Yes, the dentist will almost certainly have
to remove the onlay to find out what's going on.  Once you know what is
possible, the options open to you will be clearer.

Good luck,
Steve