One of St. Lawrence Dentistry’s goals is to try to help you avoid procedures like root canals and dental crowns. However, in some cases they are needed. A root canal through a dental crown is a subset of root canal treatment which requires more time, skill, and specialized equipment to complete compared to a regular root canal treatment. St. Lawrence Dentistry has performed thousands of successful root canal treatments under these circumstances.
Dental crowns are the strongest and most anatomically correct type of dental restoration. They are done when a tooth has been heavily damaged and not enough tooth structure exists to put a proper simple filling in place. The procedure of doing a dental crown involves shaving a tooth down about 1-2mm in all directions. This process is called the ‘crown preparation’ and is done to make space for the crown. The act of shaving the tooth down creates trauma to the tooth nerve (dental pulp). Most of the time the nerve recovers after one to two weeks. However, in some circumstances the tooth nerve may not recover and that can necessitate the need for root canal treatment.
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Root canal treatment involves cleaning out the dental pulp of the tooth or its remnants, sterilizing the space created by the clean out, and filling it with Gutta Percha Rubber.
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It can be frustrating for someone who has already went through the time and expense of having a dental crown placed to find out they need also need root canal treatment after their crown has been cemented. It is important for the dentist to explain this possibility to the patient before any crown treatment is initiated. Fortunately St. Lawrence Dentistry can often preserve your dental crown and do any needed root canal treatment while keeping your crown in place.
The first step involves making an opening through your crown. Dr. Hawryluk will gently remove some of the porcelain (and possible metal) to access the tooth underneath. This step will be done slowly to minimize any stress on the surrounding porcelain to reduce any craze lines developing in it. Next the canals will be located and cleaned out. Using a dental microscope is key when doing root canals through dental crowns as visibility is often reduced compared to working through teeth without crowns. After the root canal is completely cleaned it will be packed sterilized, and sealed completely. Finally, the opening through the crown will be sealed with composite resin.
Some crowns are more difficult than others to do root canals through. The traditional ‘porcelain fused to metal’ crown is the most challenging type of crown to do a root canal though. This is because the metal substructure causes the working area to be darker. In addition, the machine which measures the length of the root (apex locator) can give erroneous readings in the presence of the metal. Dr. Hawryluk Jr. has ample experience dealing with the nuances this type of crown creates. The newer type crowns such as ‘Emax’ are much simpler to work through.
Aggregate statistics show that over 20% of teeth which have had a crown treatment in North America will need root canal at some point. This makes the above procedure quite common. One way to avoid a root canal through a crown is to try and avoid dental crowns in the first place. This can be accomplished by good oral hygiene and making sure any cavities are caught early and fillings are kept small. In some cases root canal treatment is done preemptively before a crown is placed. If Dr. Hawryluk finds your tooth is overly sensitive, or an x-ray reveals your tooth has an abscess the root canal treatment can be done just before your crown is made. The can be all done in one day and doing the treatment preemptively will of course mean you will not need a root canal though a crown.
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