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Medical Forum / General / Dentistry / May 2008Facing a root canal or extraction
Hi. I was recently referred to a dentist by my physician due to swelling of my right cheek and pain in the root area of my upper right 1st molar. She also wrote a script for Augmentin, which I have been taking for a couple of days now. On my first visit to the dentist yesterday, he found a cavity in the tooth as well as a fine fracture extending into the root; he believes the latter trauma is due to hard biting or bruxism. (I was grinding my teeth in my sleep quite a bit last month, according to my girlfriend). He said the infection is in its early stages, i.e., little or no pus despite inflammation of the gum around the tooth. The dentist performed a pulpotomy, filled the tooth with something that looks like white caulk and instructed me to come back in a week for a followup. He says that since the fracture is fine, it may be possible to save the tooth with RCT depending on how it responds to pulpotomy in the interim. Otherwise, it must be extracted. My question is, which of the two procedures is less likely to give me problems in the long term? I've read some dire warnings on some dental practices' websites about extraction releasing more bacteria into the bloodstream. But if you'll forgive my cynicism, I can't help but wonder if there isn't some self-interest involved here since RCT is a more expensive procedure than extraction. A friend of mine (non- dentist, administrative staff) who works at another dental practice tells me that in the case of a fracture, they usually pull the tooth. She was surprised when I told her that the dentist thinks it might be a candidate for RCT. My main concern is my overall health, with cosmetics a distant second. Since this is a molar, it's not really visible from the front anyway. On Mar 15, 10:33 am, electronic_d...@hotmail.com wrote: > Hi. I was recently referred to a dentist by my physician due to > swelling of my right cheek and pain in the root area of my upper right [quoted text clipped - 26 lines] > My main concern is my overall health, with cosmetics a distant second. > Since this is a molar, it's not really visible from the front anyway. If you value your long-term health instead of just short-term comfort, then either procedure will ultimately involve similar costs. Don't make a decision based just on the cost of the FIRST procedure, as all procedures involve followup costs too. Yes, when a tooth is extracted, that is only the first installment on a lifetime of costs due to the loss of the tooth. So don't think that extraction is cheaper. It isn't. This tooth will eventually either have a root canal, or be extracted. Let's look at those two alternatives. If the tooth can be saved by root canal treatment, then it will need a crown after the root canal procedure is finished. If the tooth is extracted, then you will need to replace it (considering that you stated you are concerned about your overall health). The first choice for replacement is generally an implant as it usually has fewer complications and better health results, than other methods of replacement. Either way, there are similar costs involved, although in my region of the country, the total implant costs are somewhat more than the alternative of saving the tooth with a root canal and crown treatment. If the tooth has a fractured ROOT, then its chances of survival diminish. It sounds like your dentist is attempting to determine whether the fracture is confined to the upper, repairable, part of the tooth, or whether the crack extends into the root. The first choice is root canal and crown, if possible. If not possible due to the size and location of the fracture, then extraction and implant should generally be done. - dentaldoc Thanks for the reply. My understanding is that the crack is very fine but does, indeed, extend into the root. The dentist is not a native English speaker and it was not easy to understand him, but I repeated what I *thought* he had said back to him and he nodded in assent. > On Mar 15, 10:33 am, electronic_d...@hotmail.com wrote: > [quoted text clipped - 64 lines] > > - dentaldoc I also have a tangential question regarding the temporary filling. I don't know what type was used, but it was mixed together by the hygienist under the dentist's guidance and resembles white bathroom caulk. Should I avoid brushing around the area of the filled tooth? Should I avoid certain types of toothpaste? (Usually, I brush with Sensodyne). I brushed the tooth *very gently* today and in doing so, I think I may have removed a tiny bit of the caulk, but it's hard to tell. The "hole" in the tooth still appears to be well-covered. > I also have a tangential question regarding the temporary filling. I > don't know what type was used, but it was mixed together by the [quoted text clipped - 6 lines] > have removed a tiny bit of the caulk, but it's hard to tell. The > "hole" in the tooth still appears to be well-covered. Unlikely to be critical, as long as the pulp chamber is sealed. Probably some kind of zinc oxide and eugenol filling. Fairly soft, and not designed to hold up forever--just until a decision is made on the fate of the tooth. Steve >> I also have a tangential question regarding the temporary filling. I >> don't know what type was used, but it was mixed together by the [quoted text clipped - 13 lines] > >Steve Am currently using Fuji 9 as 'temp'. Sometimes IRM for a 'hot' tooth. > Am currently using Fuji 9 as 'temp'. > Sometimes IRM for a 'hot' tooth. Is Fuji 9 a glass ionomer? Steve >> Am currently using Fuji 9 as 'temp'. >> Sometimes IRM for a 'hot' tooth. > > Is Fuji 9 a glass ionomer? > >Steve Yes, comes in a trituration capsule with delivery spout. So very easy to use, just squirt it in. It comes with it's own etchant and a LC overlay. Get the intro pack as it comes with the 'special' delivery/activator device. Great for closing up endo teeth too ! Am currently bonding some flowable over the orifices and pulpal floor. Then placing some 'bonded' Fuji 9 to close access and act as a core BU. Have even cemented crowns, rebuilt cusps, and used as a restorative <its intended purpose> It's great stuff and cuts much like enamel. A diamond is best for gross contouring. and then you can finish it much like composite. >>> Am currently using Fuji 9 as 'temp'. >>> Sometimes IRM for a 'hot' tooth. [quoted text clipped - 18 lines] > much like enamel. A diamond is best for gross contouring. > and then you can finish it much like composite. Thanks. Is it reinforced? I've used Ketac-fill for years, but it certainly doesn't cut anything like enamel--very soft by comparison. Steve >>>> Am currently using Fuji 9 as 'temp'. >>>> Sometimes IRM for a 'hot' tooth. [quoted text clipped - 23 lines] > >Steve Am not sure if reinforced or not. Have used Ketac-fill before and you are correct, it is very soft comparatively speaking. First time I used Fuji 9 thought it would cut like composite and used a 'goldie' on it. Dang, it wouldn't even make a dent. Went to using a diamond, and then finishing burs. Fuji 9 is great as a BU material, get a sample pack. You will be glad you did. Am using a Wig-L-Bug for 10 seconds to mix. Funny, it takes 10 sec for the primer/etchant. Kewl. You do have to rinse the etchant, and as I'm closing an endo the dam is already on so... Prime/Mix/Rinse/Apply, man it takes less than 15 sec. Wait ~4 min to set. Even sets up hard in a wet environment. Once your assistant gets familiar with the capsule activation, it's a breeze. Shake/Plunge/Click once/Mix/Click 2 more/ hand to Dr. You can 'pack' the material using a mini-brush with the LC liquid. You actually don't have to cure it unless you are using as a restoration (looks much better if you do). Not the best esthetic material as a core but much better than Fuji 2 Miracle Mix. Can even use Fuji 9 underneath all ceramics. Also works well in abfractions. Cut a little retention though. 331 Try it ! You'll like it ! >>>>> Am currently using Fuji 9 as 'temp'. >>>>> Sometimes IRM for a 'hot' tooth. [quoted text clipped - 53 lines] > > Try it ! You'll like it ! Thanks! Steve >> Try it ! You'll like it ! > >Thanks! > >Steve You are most welcomed sir. About time I was able to give *you* a tip. 8^]] > Thanks for the reply. My understanding is that the crack is very fine > but does, indeed, extend into the root. The dentist is not a native > English speaker and it was not easy to understand him, but I repeated > what I *thought* he had said back to him and he nodded in assent. This is not a dental response, just one based on years of experience in a bilingual society... I have worked a bit with non-native speakers. From bad experience I can tell you to never take a nod as evidence of understanding. To the other person, It could just be a polite way of ending the conversation so that her (or she) can get on with business. If it is a sign of understanding, you are still left without evidence that there has been no misunderstanding. The only way to assure mutual understanding is to do whatever it takes to achieve it. Draw a picture if necessary. Vaughn >The first choice for replacement is generally an implant as >it usually has fewer complications and better health results, than >other methods of replacement. Disagree. Depends on the rest of the arch, and proximity of the sinus, or mandibular canal. First choice is generally an FPD, implant is second. > Hi. I was recently referred to a dentist by my physician due to > swelling of my right cheek and pain in the root area of my upper right [quoted text clipped - 26 lines] > My main concern is my overall health, with cosmetics a distant second. > Since this is a molar, it's not really visible from the front anyway. It is a myth that RCT saves a tooth. The tooth will be dead. http://www.integratedhealthpractice.com/treatment.asp#Root All root cancel fillings have the potential to casue bad health. This is because, althought the nerve has been removed, bacteria still colonise in the minute tubules of a tooth. These bacteria produce toxins which enter the body causing potential harm. An area of residual infection which is left under the gum, usually following, but sometimes a long time after an extraction can cause problems. Symptoms can be coincided with the energetic links to the body as well as localised problems. http://www.drshankland.com/rootcanal.html http://www.dentistry-toothtruth.com/faq.htm#treatment What is the worst treatment done by dentists? While mercury is toxic and can do terrible things to nerve tissue, it does it slowly over decades. The treatment that can have the biggest and fastest impact on the body is root canal therapy. The idea of keeping a dead, infected organ in the body is only thought to be a good idea by dentists. A root canal-treated tooth always negatively affects your immune system. >But if you'll forgive my cynicism, Nope. >I can't help but >wonder if there isn't some self-interest involved here I stopped right there. If the root is fractured the tooth is non-restorable in most cases. A root amputation can sometimes be sucessful for an upper 1st molar. We are in the business of saving teeth. The options after extraction aren't near as optimal as fixing one 'broken' tooth and are even more expensive. >>But if you'll forgive my cynicism, > > Nope. Note: The author of this message requested that it not be archived. This message will be removed from Groups in 6 days (Mar 23, 10:06 am). I'm sorry you took offense. When I made a living fixing things (electronic) for paying customers, I expected and even welcomed a healthy amount of skepticism on their part, and I was ready and willing to answer all their questions. I didn't take it as a personal affront. Dentists may see these procedures (root canals and extractions) as routine, but I have never had anything like this done before. Naturally, I want to know what I'm getting into. On Mar 16, 10:06 am, New...@bix.nex wrote: > On Sat, 15 Mar 2008 10:33:54 -0700 (PDT), electronic_d...@hotmail.com > wrote: [quoted text clipped - 14 lines] > The options after extraction aren't near as optimal as > fixing one 'broken' tooth and are even more expensive. >I'm sorry you took offense. Whereas, some dentists may truly be unscrupulous and not have the patients' best interest at heart, I believe this is a very small percentage of practitioners. My reputation as an honest and skilled dentist is highly valued by me. No one lasts very long in dental practice as a money grubbing charlatan only focused on self-interest. >When I made a living fixing things >(electronic) for paying customers, I expected and even welcomed a >healthy amount of skepticism on their part, and I was ready and >willing to answer all their questions. I didn't take it as a personal >affront. If you are sitting in my chair and we are discussing your options, all your questions would be answered. On the Internet... not so much. >Dentists may see these procedures (root canals and extractions) as >routine, but I have never had anything like this done before. >Naturally, I want to know what I'm getting into. Agreed. >On Mar 16, 10:06 am, New...@bix.nex wrote: >> On Sat, 15 Mar 2008 10:33:54 -0700 (PDT), electronic_d...@hotmail.com [quoted text clipped - 15 lines] >> The options after extraction aren't near as optimal as >> fixing one 'broken' tooth and are even more expensive. <Newbie@bix.nex> Note: The author of this message requested that it not be archived. This message will be removed from Groups in 6 days (Mar 28, 9:01 pm). == Any poster who makes this request is ashamed of their posts. Very telling. Totally dependent on how far the fracture extends.  Signature/ Amatus / > Hi. I was recently referred to a dentist by my physician due to > swelling of my right cheek and pain in the root area of my upper right [quoted text clipped - 26 lines] > My main concern is my overall health, with cosmetics a distant second. > Since this is a molar, it's not really visible from the front anyway. >Totally dependent on how far the fracture extends. If it's #3 and one of the buccal roots is fractured a root amp may be done. Hero-dontics. If it's the palatal, cold steel and sunshine baby ! Hmmm... I've been reading up on the procedure and one consensus I seem to be finding around the web is that a rubber dam must be used for safety. A dam was not used for my pulpotomy, and I called the office to ask if one would be used for my root canal and was told "most of our dentists don't use them, but *maybe* your dentist will use one if you request it." (I don't think he was in the office when I called, otherwise it would've made sense just to ask HIM, right?). Anyway, the woman to whom I spoke reacted in a way that indicated she thought it odd that I was even asking about it. Yikes... Should I *insist* on the dam or no deal? > Hmmm... I've been reading up on the procedure and one consensus I seem > to be finding around the web is that a rubber dam must be used for [quoted text clipped - 6 lines] > odd that I was even asking about it. Yikes... Should I *insist* on the > dam or no deal? Using a dam is the well-established standard of treatment. Takes little time, not much inconvenience for doc or patient most of the time. If they're taking shortcuts here, where else might they be? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Apr 9, 10:43 am, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > electronic_d...@hotmail.com wrote: > > Hmmm... I've been reading up on the procedure and one consensus I seem [quoted text clipped - 18 lines] > Brooklyn, NY > 718-258-5001 Thanks, that's kinda what I've been thinking. Although my pulpotomy went well (as far as I can tell, a month later) the general vibe I get from the practice doesn't give me a lot of confidence. Unfortunately, they're one of only two practices in this area that accept my insurance--the other practice is a total unknown outside of name and address and I can't find any feedback from anyone who's used them. As I mentioned, it's been a month since my pulpotomy. I think my temp filling is holding up OK but I'm not sure how long I have before something MUST be done. I'd love to just call the whole thing off and go to another practice but I can't afford it. > On Apr 9, 10:43 am, Mark & Steven Bornfeld > <bornfeldm...@dentaltwins.com> wrote: [quoted text clipped - 32 lines] > something MUST be done. I'd love to just call the whole thing off and > go to another practice but I can't afford it. Check your mailbox. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Unfortunately, they're one of only two practices in this area that accept > my insurance-- Danger Will Robinson ! ! ! {Waving arms in air} > > Unfortunately, they're one of only two practices in this area that accept > > my insurance-- > > Danger Will Robinson ! ! ! {Waving arms in air} You mean, my insurance sucks? (I knew that). Or the practice must suck if they accept my sucky insurance? ;) Yes and Perhaps (often Yes) Signature/ Amatus / On Apr 9, 11:29 am, "Amatus Cremona" <Nic...@sottovocce.com> wrote: > > Unfortunately, they're one of only two practices in this area that > > accept > > my insurance-- > > Danger Will Robinson ! ! ! {Waving arms in air} You mean, my insurance sucks? (I knew that). Or the practice must suck if they accept my sucky insurance? ;) >> Unfortunately, they're one of only two practices in this area that accept >> my insurance-- > > Danger Will Robinson ! ! ! {Waving arms in air} Robby the Robot had more, um, gravitas in "Forbidden Planet". Also, Anne Francis... Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > As I mentioned, it's been a month since my pulpotomy. I think my temp > filling is holding up OK but I'm not sure how long I have before > something MUST be done. I'd love to just call the whole thing off and > go to another practice but I can't afford it. Welcome to HMO dentistry. Cost cutting usually leads to compromises in treatment. Of course, some dentists charge regular fees and still cut corners, but lower fees almost guarantee it. On the affordability issue, what will happen if the root canal is poorly done, and you have to pay a specialist (or other dentist) to do it over? What if the tooth is lost? D > > As I mentioned, it's been a month since my pulpotomy. I think my temp > > filling is holding up OK but I'm not sure how long I have before [quoted text clipped - 12 lines] > > D I take your point, but I don't have seveal hundred to a thousand bucks or more hanging out in the bank. I barely have enough for gas and groceries once the bills are paid. I'm not looking for sympathy, I'm just telling you this by way of explaining why I feel like I don't have many options as far as choosing where and by whom the procedure is to be done. yeah, HMOs are great, all right :( >> > As I mentioned, it's been a month since my pulpotomy. I think my temp >> > filling is holding up OK but I'm not sure how long I have before [quoted text clipped - 21 lines] > >yeah, HMOs are great, all right :( Is there a dental school near you ? >Unfortunately, they're one of only two practices in this >area that accept my insurance-- HMO ? Unless the front desk person misunderstood and thought the patient wanted a rubber dam for restorative work. I agree that a rubber dam should be used whenever possible for RCT. Once in a great while, you have a tooth which cannot easily accept a dam-clamp and you do it without the rubber dam, but that is barely one case every 2-3 years. Most teeth that will not hold clamp in place are not good enough to do RCT on. Sometimes, they are still good enough for over-denture abutments. Signature/ Amatus / >> Hmmm... I've been reading up on the procedure and one consensus I seem >> to be finding around the web is that a rubber dam must be used for [quoted text clipped - 12 lines] > > Steve 10-4 good buddy! On one dental list, it is commonly stated that if there is a malpractice claim against a dentist that involves a root canal, and the dentist did not use a rubber dam, it is an automatic win for the plaintiff. One aspirated or swallowed file, and life as a dentist has been forever changed. D > Unless the front desk person misunderstood and thought the patient wanted a > rubber dam for restorative work. [quoted text clipped - 5 lines] > do RCT on. Sometimes, they are still good enough for over-denture > abutments. If we are doing an over-denture abutment tooth RCT with NO rubber dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair of cotton forceps in one hand at all times, and no one is allowed to distract us. If the patient cannot sit *real* still, we start tying floss to each file. Rotary files at least don't slip out into the mouth. Signature/ Amatus / > > 10-4 good buddy! [quoted text clipped - 18 lines] >> enough to do RCT on. Sometimes, they are still good enough for >> over-denture abutments. > If we are doing an over-denture abutment tooth RCT with NO rubber > dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair > of cotton forceps in one hand at all times, and no one is allowed to > distract us. If the patient cannot sit *real* still, we start tying floss > to each file. Rotary files at least don't slip out into the mouth. If I understand all I've been reading correctly, the purpose of the dam (along with preventing swallowing or aspiration of instruments) is to protect the root canals from saliva and also to prevent ingestion of the chemical(s) that are used to disinfect the root canals. In cases where a dam cannot be used for whatever reason, how are these two factors dealt with? I've found several photos and even a couple of video clips showing a dam in place and all these examples involve a lower tooth. My procedure involves my upper right first molar. Does this make any difference? (I suspect not). I'm getting the feeling that if they refuse to use a dam without good reason, I should probably get up and walk out. Would you? I'm still not totally clear on the reasons why RCT is "better" than extraction but I suppose that's a topic for another thread. Me, I'd just as soon have them take the damn thing out and be done with it :) >> If we are doing an over-denture abutment tooth RCT with NO rubber >> dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair [quoted text clipped - 13 lines] > procedure involves my upper right first molar. Does this make any > difference? (I suspect not). Isolation of the upper teeth is easier, since any saliva flows down. In those instances where you cannot get a dam to stay (very rare), you pack the mouth with a lot of gauze, and tie all your instruments. > I'm getting the feeling that if they refuse to use a dam without good > reason, I should probably get up and walk out. Would you? Probably. > I'm still not totally clear on the reasons why RCT is "better" than > extraction but I suppose that's a topic for another thread. Me, I'd > just as soon have them take the damn thing out and be done with it :) There is no one answer. You have to look at what kind of shape the tooth is in--both structurally and periodontally. You're putting a lot of effort into saving the tooth and the effort and/or money isn't worth it if there isn't a reasonable expectation of long-term success--that is, you save the tooth for a long time. The decision may also depend somewhat on the condition of the other teeth in the mouth. Since cash is a problem, I assume there is no consideration for a bridge or implant-retained prosthesis. Your circumstances may change down the road, and you may be able to afford a fancy prosthesis, so this should be weighed against the chance of success with a root canal and crown. If you can't get the crown done, and you have no reasonable expectation of being able to do the crown within a year or so, this makes the case for doing a root canal much weaker IMO. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Now here's another "what if?" Suppose the patient has trouble breathing through his nose. What then? > Now here's another "what if?" > > Suppose the patient has trouble breathing through his nose. What then? It is possible to make a hole in a non-critical area of the rubber dam that will still allow protection of the working area. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Now here's another "what if?" >> [quoted text clipped - 4 lines] > >Steve Certainly less drastic than a trach ! >> If we are doing an over-denture abutment tooth RCT with NO rubber >> dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair [quoted text clipped - 8 lines] >cases where a dam cannot be used for whatever reason, how are these >two factors dealt with? Probable extraction. >I've found several photos and even a couple of video clips showing a >dam in place and all these examples involve a lower tooth. My >procedure involves my upper right first molar. Does this make any >difference? (I suspect not). No. Little to no difference. Isolating the tooth is the goal. It's just easier to take pictures of lowers. When photographing upper the patient must stand on their head. >I'm getting the feeling that if they refuse to use a dam without good >reason, I should probably get up and walk out. Would you? I would. >I'm still not totally clear on the reasons why RCT is "better" than >extraction but I suppose that's a topic for another thread. Me, I'd >just as soon have them take the damn thing out and be done with it :) Bornfeld answered this question, and I agree with him but would problably shorten the time between RCT and crown to 6 weeks. >If we are doing an over-denture abutment tooth RCT with NO rubber >dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair >of cotton forceps in one hand at all times, and no one is allowed to >distract us. If the patient cannot sit *real* still, we start tying floss >to each file. Rotary files at least don't slip out into the mouth. Then do what endo buddy and me do... You ain't gonna like it though, *clamp the bone* ! It will heal just fine, try to stay in the attached tissue. Afterall this is an OD abutment right ? Or would that be an OCD abutment <vbseg> Sometimes there just isn't enough keratinized tissue to do that within my comfort range. Not often. Signature/ Amatus / > >>If we are doing an over-denture abutment tooth RCT with NO rubber [quoted text clipped - 10 lines] > Afterall this is an OD abutment right ? > Or would that be an OCD abutment <vbseg> hey guys... It's been almost two weeks since RCT and everything seems OK. I was informed today that my insurance will not cover the cost of a post and will only partially pay for the crown, and therefore I'll have to pay $250 out of my own pocket. Is there any alternative, e.g., simply replacing my temp filling with a permanent one, or is a crown ALWAYS done after a root canal? This is an upper first molar and I'm not concerned about cosmetics. I'll get the crown if I must but I could really use the money for frivolities like gas, rent and groceries ;) 20 years ago all the dental schools taught to do a post and a crown after every RCT. I have not done a metal post now in about 8 years (a couple of exceptions may have occurred). The more tooth which is remaining, the less restoration you have to do. Most cases should have the biting surface covered with some sort of indirect restoration. Sometimes (not too often) you can get away with just bonding in some direct filling material. Post an image of the tooth and the x-ray image and we can be specific. Signature/ Amatus / > hey guys... It's been almost two weeks since RCT and everything seems > OK. I was informed today that my insurance will not cover the cost of [quoted text clipped - 6 lines] > I'll get the crown if I must but I could really use the money for > frivolities like gas, rent and groceries ;) > 20 years ago all the dental schools taught to do a post and a crown after > every RCT. > > I have not done a metal post now in about 8 years (a couple of exceptions > may have occurred). So a crown WITHOUT a post is a possibility? I mean that in the general sense; I know you can't comment on MY case specifically without seeing my teeth. Also, should I ask for the rubber dam during post/crown (as I did for RCT), or is it not necessary? > So a crown WITHOUT a post is a possibility? I mean that in the > general sense; I know you can't comment on MY case specifically > without seeing my teeth. > > Also, should I ask for the rubber dam during post/crown (as I did for > RCT), or is it not necessary? A post is needed to help hold the build up in place for certain teeth. It does not strengthen the tooth itself. I have not been happy with my experience of fiber posts, but use titanium instead. (I switched to fiber posts for 4-5 years with quite high failure rates before going back to metal). When I place a post, it is on a questionable tooth that I am trying to get a few more years out of before placing an implant or bridge. It is not for a case where I am anticipating 10-30 years of service. Sticking a post into a tooth that doesn't need one is easy and adds to the bill. You have to trust your dentist as to whether it is really needed. JMO, Steve I use fibre posts only (I will occasionally place a metal post "Up North" since they have not bought a stock of fibre posts yet.) My attitude is that posts are only good for teeth with poor prognoses. The tooth is going to be lost anyway in the next 3 months to 3 years. The post is designed to gain some time with comfort until the patient can afford the implant. I know this tooth is going to fail. I use the fibre posts because the failure then will occur at the point where the post enters the root. If I use a metal post, the failure occurs by cracking the root vertically at the tip of the post. I simply prefer having the crown fall off over having the tooth split in half. JMPO Signature/ Amatus / > >> So a crown WITHOUT a post is a possibility? I mean that in the [quoted text clipped - 21 lines] > JMO, > Steve >Hmmm... I've been reading up on the procedure and one consensus I seem >to be finding around the web is that a rubber dam must be used for [quoted text clipped - 6 lines] >odd that I was even asking about it. Yikes... Should I *insist* on the >dam or no deal? Yep, rubber dam is considered standard of care. Endodontists have said that if the tooth cannot be isolated with a rubber dam, it should be extracted. Now to include full disclosure many many RCTs have been sucessfully done without a rubber dam in the past and perhaps even now. If it were my tooth --> Rubber dam is mandatory. You can learn more about endodontics here: www.aae.org |
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