Expert: Tony Appleton BDS DPDS - 11/14/2008

Question
Hi,
My question is regarding a root canal my husband had just today.  He was having pain under a tooth which has a crown.  Two weeks ago when my husband went to the dentist to have it checked out, the dentist found that there was an abcess, and he performed a pulpotomy and instructed my husband to come back in two weeks for a root canal.  Today while the dentist was drilling through the crown to clean out the canal, he missed the canal.  Since he had to drill another hole to get to the canal, he had to cut off the crown as well as cut away part of the tooth (the little stub onto which the crown was cemented.)  The dentist says he will pay for the crown, but my concern is whether there will be sufficient tooth left on which to cement a new crown.  Will there be problems down the road because of the botched root canal?  The only other alternatives I know of if there are problems with this new crown (which are both outrageously expensive) are bridges and implants.  I suppose there is nothing that can be done to fix what was done incorrectly, but is there any kind of assurance/insurance we should ask the dentist to provide in case his mistake results in one of these other expensive alternatives a couple years down the road? How unusual is this kind of mistake?
Thanks for your advice,
Ann

Answer
Hi Ann

This is a difficult one!!  Root canal work is a technically demanding form of treatment at the best of times, and it does not have a 100% success rate.  In other words even the most straightforward root treatment can fail despite our best endeavours.  The treatment your husband is having is significantly harder because the tooth is crowned, and whenever root treatment is performed through a crown there is very real risk that the crown may have to be removed and will be destroyed.

There are a number of reasons for this, such as when there is a crown on the tooth we no longer have any landmarks to use to help us determine the anatomy of the tooth.  Also the presence of the crown means we may not know before we start whether there is any decay under the crown which itself may compromise both the crown and the root canal work.

Whether or not the dentist's treatment was negligent is impossible for me to say, but it sounds like this was probably just an unfortunate incident of which there was a reasonable risk that any dentist may have done the same thing.  I also feel that his offering to pay for the crown is more than reasonable of him.

If the dentist hadn't attempted root canal treatment on this tooth then the only alternative would have been extraction of the tooth anyway.

Regards

Tony Appleton