Question:
History: I'm a 53 yo male with a history of bruxism and clenching
(Operating a business, helping rear 5 children and coaching baseball
on the side may be a contributing factor??). Started nightly use of a
lower teeth orthodic several years back, switched to an upper after
crowns on #'s 8 & 9, except for the one year before I replaced the one
I lost. Reside north of Atlanta.
I'm now at a cross road regarding an alternative to the expensive
cycle of crown -> pin/wear holes in or decay under crown -> root canal
-> new crown -> implant. My dentist and I recently discussed a therapy
plan, which is to include extractions of #'s 8 & 9 (one crowned, one
w/ temp) , an implant at #7, bridgework spanning 7 & 10 (implant 3 yrs
ago), plus replacement of 4 crowns.
The significance and expense of this work prompted me to find
alt.sci.dentristy this weekend. After reading many posts and replies
and googling the archives, it appears most posts and replies are
legitimate. Also, I'm sufficiently impressed with the thoughtful and
professional replies from the dental professionals who take the time
to answer questions to post one myself.
Now, getting to my question. Tooth under old crown on #11 sheared off
recently - I'm probably guilty of rocking on my cuspids over the
years. There's enough tooth remaining over which a new crown can be
placed. My dentist, whom I have used most of my life and have always
trusted, but whose advise I have not always promptly followed for
financial reasons, referred me to an endodontist for a root canal
prior to crown replacement. However, there are none of the
prerequisite symptoms Dr. Eichen mentions, i.e., periapical abscess,
sensitivity to percussion, dull ache, sensitivity to heat or swelling.
Answer:
You should get an explanation for why the root canal is necessary. I'm
getting the impression that the dentist wants the retention from a post
in order to hold a crown in place, though you've said "...There's enough
tooth remaining over which a new crown can be
> placed." Yes, a post can only be placed in a root-canal treated
tooth. But if you have a severe grinding problem, putting a long post
in a tooth can greatly increase the chances of fracturing your root.
It is quite possible I'm inferring something completely wrong about the
root canal. It is quite possible a tooth would require root canal
without any overt symptoms.
That was precisely my thoughts. Placing a post in the cuspid of a bruxer is
an almost sure recipe for a fractured root in the near future. You've made
it sound as if he's doing the root canal because the tooth is too short to
hold a crown and he needs the additional retention of a post. But, like I
(and Steve) said before, posts in cuspids of a bruxer many times leads to a
root fracture.
My feeling is that if #11 has insufficient length to hold a crown without a
post, then I'd consider having it removed, placing an implant, and splinting
the implant to the bridge from #7-10. Otherwise, when and if that root
fractures somewhere down the road, you'll be getting a single implant in the
area of #11...and will be unable to splint it to any other implants without
completely redoing the bridge from #7-10. A single implant in the cuspid
region of a bruxer has a lot poorer prognosis than one that is splinted to
another implant.
My first choice would be to do a crown on the tooth without a post (if
possible), and splint it to a new crown on #12...but only if #12 already has
either a large restoration or an existing crown that isn't already part of a
bridge.
