Root Canal Treatment and the Need for Crowns

Root canal treatment and orthodontic braces?

Hello Dr.
Yang,
I would like to consult with you regarding my dental situation.
About a year ago, I underwent root canal treatment on my upper left incisor.
Recently, I discovered ongoing infection at two different hospitals, which led to a retreatment, and I also had root canal therapy on my upper right incisor.
The appearance of the treated tooth from last year was good, but during this year's treatment, the dentist used a metal framework to stabilize the tooth with dental floss and clamps, and I felt that the dentist was applying considerable force.
After several treatments, both incisors developed what appears to be "scratches" that run vertically from the center of the gum line downwards (the surface of the teeth has slight indentations, resembling scratches from a knife), extending halfway down to the ends of the teeth.
The upper left canine also showed similar signs (this tooth was previously stabilized with a clamp, but it is very healthy).
During my next treatment, I informed the dentist about this condition, and he explained that it was due to a gap between the material inside the upper right incisor (which has been officially treated) and the tooth itself, compounded by discoloration (but the left side also has this issue and has not been fully treated).
He suggested reopening it for a refill to prevent cavities, and if there is not much tooth structure left, a crown would be necessary.
I am skeptical about this explanation.
Aside from the reasons mentioned, I believe that if it were as the dentist described, the marks should be on the inner part of the tooth rather than the surface.
I am particularly concerned about getting a crown (I will be especially careful to protect my teeth to prevent fractures) and I do not wish to reopen a tooth that has already been treated.
Dr.
Yang, could you please provide me with your advice and explain the possible causes of these cracks? Thank you very much!

Shuli, 20~29 year old female. Ask Date: 2005/05/15

Dr. Yang Hui reply Dentistry

Dear Miss Shuli,
1.
I apologize for not being able to clearly understand the cause of the crack from your description.
2.
If the tooth has previously been filled and there is now black discoloration inside, it may indicate recurrent decay, which would require reopening and refilling.
3.
Teeth that have undergone root canal treatment often change color over time.
Therefore, to enhance aesthetics and prevent the crown from fracturing easily, placing a dental crown for protection is a better option.
If you have any further questions, feel free to visit the clinic for an examination.

Reply Date: 2005/05/15

More Info

Dear Patient,
Thank you for your inquiry regarding root canal treatment and the subsequent need for crowns. Your concerns are valid, especially considering the complexities involved in dental treatments and the potential for complications.

Root canal treatment (RCT) is a procedure aimed at removing infected or damaged pulp from inside a tooth. After the treatment, the tooth is often weakened and more susceptible to fractures. This is why dentists typically recommend placing a crown on a tooth that has undergone RCT. A crown provides structural support, protects the tooth from further damage, and restores its function.

In your case, it seems that you have experienced ongoing infections even after retreatment. This could be due to several factors, including the presence of residual infection, inadequate sealing of the root canal, or even issues related to the tooth's structure. The "scratches" or indentations you mentioned could be indicative of several things. They might be a result of the dental instruments used during treatment, or they could be signs of wear and tear on the tooth structure itself.
The fact that your dentist is considering reopening the tooth to address these issues suggests that they are taking a proactive approach to prevent further complications, such as decay or structural failure. If there is a gap between the filling material and the tooth structure, bacteria can enter and cause new decay, which could lead to further infection.
Regarding your concerns about needing a crown, it is essential to understand that while crowns are often necessary after RCT, they are not always the only option. If the tooth structure is still adequate and the root canal is properly sealed, your dentist may be able to restore the tooth with a filling instead. However, if the tooth is significantly weakened or if there is a risk of fracture, a crown would be the more prudent choice.

To assess whether a crown is necessary, your dentist will likely evaluate the amount of remaining tooth structure, the condition of the root canal filling, and the overall health of the tooth. If the tooth has been compromised significantly, a crown can provide the necessary support to prevent future fractures.

In terms of your specific situation, it is crucial to maintain open communication with your dentist. If you feel uncomfortable with the proposed treatment plan or have doubts about the necessity of reopening the tooth, do not hesitate to seek a second opinion from another dental professional. They can provide additional insights and help you make an informed decision about your dental health.

Lastly, it is essential to practice good oral hygiene and attend regular dental check-ups to monitor the health of your teeth, especially after undergoing treatments like RCT. This proactive approach can help catch any potential issues early and ensure the longevity of your dental work.

In summary, while crowns are often recommended after root canal treatment, the decision should be based on a thorough evaluation of the tooth's condition. Your dentist's recommendation to reopen the tooth is likely aimed at preventing further complications, and it is essential to discuss your concerns with them to arrive at the best treatment plan for your situation.

Best wishes for your dental health,
Doctor Q&A Teams

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