Endodontic Treatment with Crown
Preparation
Do the endodontic treatment, Dude!
by
Dennis Brave, DDS and Kenneth Koch, DMD
A question we often hear from general
practitioners is, "When do I do the endodontic treatment?"
This question is usually asked in reference to the old direct pulp cap vs.
root canal dilemma. The overwhelming majority of endodontists (including
us) believe that direct pulp caps are best utilized on young patients with
minimal exposures. The increased vascularity of a young pulp will
decidedly help the patient. However, we are not proponents of direct caps
on adult teeth, as their success rate is very low. Additionally, some
dentists remain confused on the endodontic treatment for prosthodontic expediency
issue. Let's look at a few examples.
Pink teeth — Have you ever done a crown preparation on a peg lateral and
then turned away from the patient for a few minutes? Then, when you turn
back to the patient, you see a nice, pink little tooth. It is cute, but,
unfortunately, it's cooked! Do the endodontic treatment.
Brownish/purple teeth — What about the crown preparation that turns a dark
brownish- purple color? Can you save this tooth by adding eugenol to the
temporary cement? Not really. This is actually thrombosis that has taken
place in the prepared tooth. Do the endodontic treatment.
Bunny teeth — Some people have exceptionally long incisors. These
sometimes are referred to as "bunny teeth." Yes, they are cute as well,
but, unfortunately, they have very high pulp horns. You need to factor
this information into your crown preparation. If you get an exposure and
see a pink halo around the defect, what do you do? Do the endodontic
treatment.
The last question is, "When do we do a RCT for prophylactic reason?" This
is often a clinical decision and can be difficult. For example, after
presenting the patient with a treatment plan for six anterior units of
crown and bridge, you don't want to add an additional $500 for the root
canal on tooth No. 10. However, if No. 10 is blushed or very close to
requiring a root canal, take our advice and do the RCT.
The worst case scenario is to do a beautiful crown, only to have to open
the tooth and do a root canal two to three weeks later. Patients seldom
appreciate having holes drilled into their new crowns. An even bigger
nightmare is if the tooth is part of a six-unit bridge and you break the
porcelain or shear off the glass while making your endodontic access.
There goes your lab bill!
We have never in our combined 55-plus years of experience had a patient
who did not understand why we had to do a RCT to prevent further damage.
No one exactly welcomes this treatment; certainly, no one wants to pay an
extra $500. Patients do understand. However, they cannot and will not
understand if you go through a beautiful new crown to perform a RCT, only
to have the porcelain shatter. The way to avoid this nightmare is simple:
Do the endodontic treatment, Dude!
Hopefully, these few examples will make your Endo/Prosth life a little
easier. Never forget that endodontics and prosthodontics complement each
other. In the meantime, we will continue to give you, "Just the Facts —
Nothing but the Facts."
About the authors:
Dr. Dennis Brave is a diplomate of the American Board of Endodontics and
was the senior managing partner of a group specialty practice for 27
years. Dr. Kenneth Koch is the founder and past director of the new
program in postdoctoral endodontics at the Harvard School of Dental
Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic
education company. They can be reached at (866) RWE-ENDO, or visit their
Web site at www.RealWorldEndo.com.
This article originally appeared in Dental Economics December, 2002 |
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