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Treatment Needed After a Root Canal
After you have a root canal completed it is sometimes an unwelcome surprise to find you now have to have a filling, or cap - or more - done to the tooth you just spent a lot of money to have the root canal done ! And, what's worse is that the cost of it was not included in the cost of the root canal !!! Why is that? Is that FAIR ? Is that normal and customary ? I'll try to answer these questions for you.
Why is anything more needed?
The process of doing a root canal almost all the time involves making a new hole through the chewing surface of the tooth through which the dentist passes thin instruments to clean out the diseased nerve canals inside the roots of the tooth. Sometimes it can be a relatively small hole in a very solid, otherwise healthy tooth [other than the nerve inflammation or infection]. On the other hand, it may be a badly broken down tooth with several old fillings, cracks, untreated areas of decay, pieces of the tooth missing, an old cap that is not in good condition any more, or any of a number of other dental conditions.
Teeth that have been beat up over the years with wear and tear, cracks, decay, and large restorations, are much weaker than a normal tooth. Additionally, when a root canal procedure is done, part of the inside of the tooth is removed so it is partially hollowed out much more than a normal tooth. Current thinking is that a root canal treated tooth also "dries out" from lack of a moist living pulp and nerve tissue inside it, so that it is generally considered fact that the tooth gradually does dry out and become less flexible and more brittle than an untreated tooth. Constant impact and stress from grinding and chewing can more easily crack such a more hollowed out and more brittle root canal treated tooth and so a cap is usually recommended to add considerable strength to the tooth.
If a root canal treated tooth cracks, it often cracks differently than a normal tooth. It often will crack in a way that nothing else can be done to save the tooth and then you are faced with extraction and either a bridge or an implant. Capping the tooth is pretty good insurance against that. It can still crack even with a cap but it's much less likely.
Each situation differs in complexity and time and effort needed to get the tooth back in shape. The root canal treatment itself is often the same in either situation, so the fee quoted for "the root canal" is most often the same either way. Insurances also don't have different benefit allowances for the different initial conditions of the tooth needing root canal treatment [ RCT ]. The exception usually would be a tooth that is so broken down that it needs some rebuilding even BEFORE the root canal, just to get it to the condition where a root canal treatment can be done.... and even then, other restoration will be needed AFTER the completion of the root canal. Insurances understand this and allow benefits for appropriate restoration after the root canal and have separate fees allowable over and above the cost of the root canal treatment. Unfortunately, dental insurances are not standardized and each contract - even within the same insurance company - will have a different benefit schedule which the dentist has no control over.
In the case of a good, solid tooth, where just a small hole is made in the chewing surface, often just a normal, small filling is needed to close the hole. I usually use a tooth-colored bonded composite filling. The cost is the least possible and the result is an almost invisible filling that looks and feels natural.
From there the complexity of needed restoration increases, and therefore, so does the cost. It might be just a more complex filling if the damage is not too great and the tooth is still pretty secure structurally. Often, however, a tooth in need of root canal treatment is a tooth that has had a hard life .... Often it is broken or badly decayed or full of old fillings done at different times in different parts of the tooth. In such cases it is often necessary to remove all the old filling material and any decay and weakened tooth structure and then rebuild the entire tooth with a single bonded composite core material. This is called a "Buildup". Sometimes little screws or "pins" are needed to help hold the buildup securely. Usually the cost of added pins is included in the cost of the buildup if not too many are needed. Sometimes even more security is needed to retain the buildup and a "Post" is cemented about half way down one or more of the root canals. A post is many times thicker an longer than pins. Posts can be made of stainless steel, titanium, or non-metal fiber materials. The idea of the non metal fiber posts sounds good but I have not had such good success with them in the past so I now prefer to use stainless steel or titanium. Adding a post is an added procedure and an added cost to the buildup, and often insurances will pay an added benefit when posts are used.
Whenever a buildup is done, with or without pins and posts, a crown is needed to cover, protect and strengthen the rebuilt tooth. The buildup is quite strong, but not strong enough to chew and grind on for more than a fairly short time. Also the Buildup usually cannot be done in a way that restores the natural appearance, beauty and shape of a normal, natural tooth.
Caps can be made using metal or can be made TOTALLY metal-free. In my practice I hardly ever make a metal cap in recent years. Caps can be made out of high strength porcelains that look and feel very natural, and of course are free of any metals, which is of concern for those worried about possible toxicity. Plus, there is no dark line along the gumline like was usually the case with metal caps made with a tooth-colored covering of porcelain as was and still is a very common type of cap that dentists make.
I wrote another article just about types of caps since many of you have requested such information and because there have been many great advances in recent years. Go back to TOPICS or click here Crowns and Caps, Inlays and Veneers . I hope this has been helpful to clarify an often confusing set of issues!
It is my hope that this article helps readers reach reasonable and rational decisions about their dental health.
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Michael Goldman DDS
3815 East-West Highway
Chevy Chase, Maryland 20815
More info about the following is available if you select "topics".
Holism in dentistry is an approach to dental treatment, primarily caring for patients' health and safety from both a conventional as well as "alternative healthcare" point of view. It is sometimes called "biological" dentistry or "biocompatible" dentistry. In it's fullest sense, I believe it acknowledges and deals with the mind, body and spirit of the patient, not just his or her "teeth". See Topics / Info.....
Cosmetic dentistry is about doing quality , esthetic dentistry in a way that looks natural to begin with, and furthermore, can even improve one's attractiveness through techniques such as bonding, bleaching, veneers, caps, implants and more. It can be like "instant orthodontics" in correcting crooked, twisted or misplaced teeth in many instances. Dark or misshapen teeth can be restored. Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..
Bleaching, veneers, bonding, caps, bridges, and implants are cosmetic dentistry treatments that are also discussed in Cosmetic Dentistry, and more...located in the Bethesda, Chevy Chase, Maryland 20815 area near Washington DC.