Dental Crowns: When to Consider Root Canals

Fabrication of dental crowns

Hello, Doctor.
I am currently in the process of making a dental bridge for my upper front teeth.
I have already had the left upper and right central incisors root-canaled, and the right central incisor was also treated during the process of reshaping the tooth.
My dentist has left the decision to root canal the remaining tooth up to me, but I am unsure how to weigh the pros and cons of having it done versus not having it done.
I do not want to unnecessarily damage the tooth nerve, but I am concerned that since I will be traveling abroad, if this tooth suddenly becomes painful, it could be quite troublesome.
Initially, when I received the temporary crown, I did not feel much discomfort in this tooth.
However, after taking an impression with a cord last week, I experienced a slight aching sensation for a few days, but it did not affect my daily life—just a feeling of foreignness along with occasional mild pain.
I have researched but still cannot determine if this is due to the crown not fitting properly after the adjustments, normal gum adaptation, or if there is indeed a problem.

Could you please explain under what circumstances it is generally recommended for a patient to undergo a root canal? My dentist mentioned that having the root canal done before placing the final crown would not have a significant impact.
I would appreciate any additional advice to help me decide whether to proceed with the root canal.

Additionally, since I am having four teeth done together, the temporary crown is designed as a single unit connecting all four teeth.
I am curious if this is a standard practice.
I initially thought that temporary crowns were meant to allow me to experience the feel of fixed prosthetics, and my dentist also mentioned that the final crowns would be separate and fit more closely with the gums.
If the final crowns are uncomfortable, would that mean they need to be completely redone? Thank you in advance for your response!

Jennifer, 30~39 year old female. Ask Date: 2022/11/14

Dr. Zeng Guanghui reply Dentistry

1.
If three of the four front teeth have undergone root canal treatment and one has not, discomfort or pain in the untreated tooth during the temporary crown fitting may be due to poor marginal adaptation of the temporary crown or irritation of the dental pulp from occlusal forces, leading to pulpitis.
If symptoms persist, it is advisable to consult a dentist to consider root canal treatment before placing a permanent crown.

2.
Whether the four teeth are treated together or separately, the margins of the crowns can be made to fit very closely.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2022/11/14

More Info

When considering dental crowns and the potential need for root canals, it's essential to understand the underlying conditions that may necessitate such treatments. Based on your description, it seems you are currently in the process of getting crowns for your upper front teeth, with some already having undergone root canal treatment. The decision to perform a root canal on the remaining tooth hinges on several factors, including the tooth's health, the presence of pain, and the overall prognosis.

Root canals are typically recommended when the dental pulp, which contains nerves and blood vessels, becomes inflamed or infected. This can occur due to deep cavities, trauma, or repeated dental procedures. If you are experiencing mild discomfort or a sensation of pressure, it could indicate that the pulp is under stress, potentially leading to further complications if left untreated.
In your case, the fact that you have had previous root canals on adjacent teeth suggests that the remaining tooth may also be at risk, especially if it has been subjected to similar stresses or decay. The discomfort you are feeling after the impression procedure could be due to several factors: the temporary crown may not be fitting correctly, causing irritation to the gums, or there may be underlying issues with the tooth itself that require attention.

A common practice in dentistry is to recommend a root canal if there are signs of pulpitis (inflammation of the pulp) or if the tooth has a significant risk of infection. If your dentist has indicated that the tooth may need a root canal before placing the final crown, it is likely because they want to ensure the tooth is healthy and free of infection before sealing it with a permanent restoration. This is crucial, as a tooth that is not treated properly may lead to more severe pain, abscess formation, or even tooth loss, especially when traveling or in situations where dental care may not be readily available.

Regarding your concern about the temporary crown being made as a single unit for four teeth, this is not uncommon. Temporary crowns are often fabricated as a single piece to provide stability and aesthetics while the final crowns are being prepared. However, it is essential to ensure that they fit well and do not cause discomfort. If the final crowns are not fitting correctly, adjustments can often be made, but in some cases, a complete remake may be necessary. Your dentist should be able to assess the fit of the temporary crown and make any necessary adjustments to ensure comfort.

In summary, the decision to perform a root canal should be based on a thorough evaluation of the tooth's condition, including any symptoms you are experiencing. If there is any doubt about the health of the tooth, it is generally safer to proceed with the root canal to prevent future complications. Additionally, while temporary crowns can be made as a single unit, it is crucial to monitor their fit and comfort, as this will impact your overall experience with the final crowns. Always communicate openly with your dentist about your concerns and preferences, as they can provide tailored advice based on your specific situation.

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