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Dear Dr Backlund
I have a molar which has already been extensively filled - there is very little actual tooth left.
There is also some decay, but the tooth is not really giving me any pain.
I'm happy for a crown to be fitted once the decay has been dealt with. However, I'm concerned that the tooth may need, either now or in the near future, RCT.
I appear to have several options: 
OPTION 1. 
Have RCT now, even though I'm not getting any pain. Then have the crown done.
OPTION 2. 
Have the tooth prepped for a crown, have an impression for a permanent crown, and have a temporary crown fitted.
See what happens in the next 2 or 3 weeks. 
A. If all looks well, have the permanent crown fitted. (If later on I start to get significant pain, have RCT through the permanent crown).
B. If I start getting significant pain during the 2 to 3 week period, have RCT.
My question here though is: is the RCT done with the temporary crown in place, or is it removed in order to do the RCT? 
And presumably after the RCT, a new impression will need to be taken in order to make a new crown?
Also, presumably it will be best not to manufacture the crown right away, but wait a few weeks in case the tooth needs to be re-prepped? 
OPTION 3. 
Have the tooth prepped for a crown, but without doing an impression for the crown, ie just have a temporary crown fitted.
See how things go over the next 2 to 3 weeks.
A. If all is well, proceed to a permanent crown (but, as with 2A, with the possibility of RCT through the permanent crown later on).
B. If I start getting significant pain in the 2 to 3 week period, have RCT. Again, as in 2B, this is done with or without the temporary crown in place? 
Then have the tooth finally prepped for a permanent crown.
Option 1 is "foolproof", and I should finish up with a very good, clean result, with no unpleasant surprises in the future, but it involves possibly unnecessary and expensive RCT.
Options 2 and 3 are similar - and both could leave me with an unsightly hole in the crown following RCT. Maybe the "2 to 3 week wait-and-see period" could be extended? 
But Option 3 at least avoids the possibility of prepping/ manufacturing the permanent crown twice.
My preference therefore is for Option 3.
However, I should be grateful for your views.
Thank you!
Ben

Answer
Hi Ben,

It's obvious you have thought this out very thoroughly...good for you. Many people don't deal with these issues logically. Let me try to help here.

Option 1 is actually NOT foolproof. Root canals can fail, so doing treatment that you don't need could lead to problems in the future. I would rule this option out.

Option 2 & 3 really are the same. It just depends on what your dentist feels to be the best approach. In our office, we like to see as much work done on the tooth as possible so that ANY irritation of the pulp is done and over with before cementing the final crown. Your idea of extending the wait & see time is a good one. We will sometimes wait up to 3 months before finally cementing the crown. If a root canal is needed while the temporary crown is still on, we usually take the crown off so we don't have leakage, unless there are condition that make it better to leave it on like difficulty in isolation during the root canal. In either option, it would not be necessary to re-prep the tooth since a root canal is done through the biting surface and the critical fit for a crown is along the gum line.

If the permanent crown has been cemented and you then need a root canal, the hole that is made on the biting surface could be filled with a white filling or a silver one...your preference. Gold would be a problem to replace. In either event, it would seal the access and restore function to the crown.

I hope this helps explain things. If you need further clarification, please write back.

Happy New Year and all the best for 2014!

Gary Backlund DMD, MSD

Dentistry

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Gary Backlund, DMD, MSD

Expertise

I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.

Experience

25 years practicing as a specialist

Organizations
American Association of Endodonists, Past President Washington State Association of Endodontists.

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