Facing a root canal or extraction

#49 05-18-2008, 01:34 PM

I use fibre posts only (I will occasionally place a metal post "Up North"
since they have not bought a stock of fibre posts yet.) My attitude is that
posts are only good for teeth with poor prognoses. The tooth is going to be
lost anyway in the next 3 months to 3 years. The post is designed to gain
some time with comfort until the patient can afford the implant. I know
this tooth is going to fail. I use the fibre posts because the failure then
will occur at the point where the post enters the root. If I use a metal
post, the failure occurs by cracking the root vertically at the tip of the
post. I simply prefer having the crown fall off over having the tooth split
in half.

JMPO

--
/

Amatus

/
"Steven Fawks" <tuthjockey[at]myturbonet.com> wrote in message
news:1210809906_93865[at]news.newsville.com...
- quote -

>
> > So a crown WITHOUT a post is a possibility? I mean that in the
> > general sense; I know you can't comment on MY case specifically
> > without seeing my teeth.
> >
> > Also, should I ask for the rubber dam during post/crown (as I did for
> > RCT), or is it not necessary?
>
> A post is needed to help hold the build up in place for certain
> teeth. It does not strengthen the tooth itself. I have not been
> happy with my experience of fiber posts, but use titanium instead.
> (I switched to fiber posts for 4-5 years with quite high failure
> rates before going back to metal).
>
> When I place a post, it is on a questionable tooth that I am trying
> to get a few more years out of before placing an implant or bridge.
>
> It is not for a case where I am anticipating 10-30 years of service.
>
> Sticking a post into a tooth that doesn't need one is easy and
> adds to the bill. You have to trust your dentist as to whether
> it is really needed.
>
> JMO,
> Steve

#48 05-15-2008, 03:33 AM

- quote -

> So a crown WITHOUT a post is a possibility? I mean that in the
> general sense; I know you can't comment on MY case specifically
> without seeing my teeth.
>
> Also, should I ask for the rubber dam during post/crown (as I did for
> RCT), or is it not necessary?

A post is needed to help hold the build up in place for certain
teeth. It does not strengthen the tooth itself. I have not been
happy with my experience of fiber posts, but use titanium instead.
(I switched to fiber posts for 4-5 years with quite high failure
rates before going back to metal).

When I place a post, it is on a questionable tooth that I am trying
to get a few more years out of before placing an implant or bridge.

It is not for a case where I am anticipating 10-30 years of service.

Sticking a post into a tooth that doesn't need one is easy and
adds to the bill. You have to trust your dentist as to whether
it is really needed.

JMO,
Steve

#47 05-15-2008, 01:49 AM

On Apr 22, 1:44 pm, "Amatus Cremona" <Nic...[at]sottovocce.com> wrote:
- quote -

> 20 years ago all the dental schools taught to do a post and a crown after
> every RCT.
>
> I have not done a metal post now in about 8 years (a couple of exceptions
> may have occurred).

So a crown WITHOUT a post is a possibility? I mean that in the
general sense; I know you can't comment on MY case specifically
without seeing my teeth.

Also, should I ask for the rubber dam during post/crown (as I did for
RCT), or is it not necessary?

#46 04-22-2008, 06:44 PM

20 years ago all the dental schools taught to do a post and a crown after
every RCT.

I have not done a metal post now in about 8 years (a couple of exceptions
may have occurred).

The more tooth which is remaining, the less restoration you have to do.
Most cases should have the biting surface covered with some sort of indirect
restoration. Sometimes (not too often) you can get away with just bonding
in some direct filling material.

Post an image of the tooth and the x-ray image and we can be specific.

--
/

Amatus

/
<electronic_dave[at]hotmail.com> wrote in message
news:7d62e5eb-6631-42c8-9f1e-6aa12a3bc1b2[at]m44g2000hsc.googlegroups.com...
- quote -

> hey guys... It's been almost two weeks since RCT and everything seems
> OK. I was informed today that my insurance will not cover the cost of
> a post and will only partially pay for the crown, and therefore I'll
> have to pay $250 out of my own pocket. Is there any alternative, e.g.,
> simply replacing my temp filling with a permanent one, or is a crown
> ALWAYS done after a root canal? This is an upper first molar and I'm
> not concerned about cosmetics.
>
> I'll get the crown if I must but I could really use the money for
> frivolities like gas, rent and groceries

#45 04-22-2008, 05:32 PM

hey guys... It's been almost two weeks since RCT and everything seems
OK. I was informed today that my insurance will not cover the cost of
a post and will only partially pay for the crown, and therefore I'll
have to pay $250 out of my own pocket. Is there any alternative, e.g.,
simply replacing my temp filling with a permanent one, or is a crown
ALWAYS done after a root canal? This is an upper first molar and I'm
not concerned about cosmetics.

I'll get the crown if I must but I could really use the money for
frivolities like gas, rent and groceries

#44 04-14-2008, 10:35 AM

Sometimes there just isn't enough keratinized tissue to do that within my
comfort range. Not often.

--
/

Amatus

/
<Newbie[at]bix.nex> wrote in message
news:merqv39fi9ojcp7bepnlhvdrrr0dnji62g[at]4ax.com...
- quote -

> On Wed, 09 Apr 2008 20:45:14 GMT, "Amatus Cremona"
> <Nicola[at]sottovocce.com> wrote:
>
> > If we are doing an over-denture abutment tooth RCT with NO rubber
> > dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair
> > of cotton forceps in one hand at all times, and no one is allowed to
> > distract us. If the patient cannot sit *real* still, we start tying floss
> > to each file. Rotary files at least don't slip out into the mouth.
>
>
> Then do what endo buddy and me do...
>
> You ain't gonna like it though, *clamp the bone* !
> It will heal just fine, try to stay in the attached tissue.
>
> Afterall this is an OD abutment right ?
> Or would that be an OCD abutment <vbseg>

#43 04-10-2008, 05:33 PM

On Thu, 10 Apr 2008 14:59:29 GMT, Mark & Steven Bornfeld
<bornfeldmung[at]dentaltwins.com> wrote:

- quote -

> electronic_dave[at]hotmail.com wrote:
> > Now here's another "what if?"
> >
> > Suppose the patient has trouble breathing through his nose. What then?
>
>
>
> It is possible to make a hole in a non-critical area of the rubber dam
> that will still allow protection of the working area.
>
> Steve

Certainly less drastic than a trach !

#42 04-10-2008, 02:59 PM

electronic_dave[at]hotmail.com wrote:
- quote -

> Now here's another "what if?"
>
> Suppose the patient has trouble breathing through his nose. What then?

It is possible to make a hole in a non-critical area of the rubber dam
that will still allow protection of the working area.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

#41 04-10-2008, 02:50 PM

Now here's another "what if?"

Suppose the patient has trouble breathing through his nose. What then?

#40 04-10-2008, 01:37 AM

On Wed, 9 Apr 2008 16:29:13 -0700 (PDT), electronic_dave[at]hotmail.com
wrote:

- quote -

> On Apr 9, 3:45 pm, "Amatus Cremona" <Nic...[at]sottovocce.com> wrote:
> > If we are doing an over-denture abutment tooth RCT with NO rubber
> > dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair
> > of cotton forceps in one hand at all times, and no one is allowed to
> > distract us. If the patient cannot sit *real* still, we start tying floss
> > to each file. Rotary files at least don't slip out into the mouth.
>
> If I understand all I've been reading correctly, the purpose of the
> dam (along with preventing swallowing or aspiration of instruments) is
> to protect the root canals from saliva and also to prevent ingestion
> of the chemical(s) that are used to disinfect the root canals. In
> cases where a dam cannot be used for whatever reason, how are these
> two factors dealt with?

Probable extraction.

- quote -

>
> I've found several photos and even a couple of video clips showing a
> dam in place and all these examples involve a lower tooth. My
> procedure involves my upper right first molar. Does this make any
> difference? (I suspect not).

No. Little to no difference.
Isolating the tooth is the goal. It's just easier to take pictures
of lowers. When photographing upper the patient must stand
on their head.

- quote -

>
> I'm getting the feeling that if they refuse to use a dam without good
> reason, I should probably get up and walk out. Would you?

I would.
- quote -

>
> I'm still not totally clear on the reasons why RCT is "better" than
> extraction but I suppose that's a topic for another thread. Me, I'd
> just as soon have them take the damn thing out and be done with it

Bornfeld answered this question, and I agree with him but would
problably shorten the time between RCT and crown to 6 weeks.

#39 04-10-2008, 01:32 AM

On Wed, 09 Apr 2008 20:45:14 GMT, "Amatus Cremona"
<Nicola[at]sottovocce.com> wrote:

- quote -

> If we are doing an over-denture abutment tooth RCT with NO rubber
> dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair
> of cotton forceps in one hand at all times, and no one is allowed to
> distract us. If the patient cannot sit *real* still, we start tying floss
> to each file. Rotary files at least don't slip out into the mouth.

Then do what endo buddy and me do...

You ain't gonna like it though, *clamp the bone* !
It will heal just fine, try to stay in the attached tissue.

Afterall this is an OD abutment right ?
Or would that be an OCD abutment <vbseg>

#38 04-10-2008, 01:29 AM

On Wed, 9 Apr 2008 08:51:20 -0700 (PDT), electronic_dave[at]hotmail.com
wrote:

- quote -

> On Apr 9, 11:49*am, Dartos <tuthjoc...[at]myturbonet.com> wrote:
> > > As I mentioned, it's been a month since my pulpotomy. I think my temp
> > > filling is holding up OK but I'm not sure how long I have before
> > > something MUST be done. I'd love to just call the whole thing off and
> > > go to another practice but I can't afford it.
> >
> > Welcome to HMO dentistry.
> >
> > Cost cutting usually leads to compromises in treatment. *Of course,
> > some dentists charge regular fees and still cut corners, but lower
> > fees almost guarantee it.
> >
> > On the affordability issue, what will happen if the root canal is
> > poorly done, and you have to pay a specialist (or other dentist) to
> > do it over? *What if the tooth is lost?
> >
> > D
>
> I take your point, but I don't have seveal hundred to a thousand bucks
> or more hanging out in the bank. I barely have enough for gas and
> groceries once the bills are paid. I'm not looking for sympathy, I'm
> just telling you this by way of explaining why I feel like I don't
> have many options as far as choosing where and by whom the procedure
> is to be done.
>
> yeah, HMOs are great, all right

Is there a dental school near you ?

#37 04-10-2008, 01:28 AM

On Wed, 9 Apr 2008 07:51:30 -0700 (PDT), electronic_dave[at]hotmail.com
wrote:

- quote -

> Unfortunately, they're one of only two practices in this
> area that accept my insurance--

HMO ?

#36 04-10-2008, 01:26 AM

On Wed, 9 Apr 2008 07:03:14 -0700 (PDT), electronic_dave[at]hotmail.com
wrote:

- quote -

> Hmmm... I've been reading up on the procedure and one consensus I seem
> to be finding around the web is that a rubber dam must be used for
> safety. A dam was not used for my pulpotomy, and I called the office
> to ask if one would be used for my root canal and was told "most of
> our dentists don't use them, but *maybe* your dentist will use one if
> you request it." (I don't think he was in the office when I called,
> otherwise it would've made sense just to ask HIM, right?). Anyway, the
> woman to whom I spoke reacted in a way that indicated she thought it
> odd that I was even asking about it. Yikes... Should I *insist* on the
> dam or no deal?

Yep, rubber dam is considered standard of care.

Endodontists have said that if the tooth cannot
be isolated with a rubber dam, it should be extracted.

Now to include full disclosure many many RCTs have been
sucessfully done without a rubber dam in the past and perhaps
even now.

If it were my tooth --> Rubber dam is mandatory.

You can learn more about endodontics here: www.aae.org

#35 04-09-2008, 11:46 PM

electronic_dave[at]hotmail.com wrote:
- quote -

> On Apr 9, 3:45 pm, "Amatus Cremona" <Nic...[at]sottovocce.com> wrote:
> > If we are doing an over-denture abutment tooth RCT with NO rubber
> > dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair
> > of cotton forceps in one hand at all times, and no one is allowed to
> > distract us. If the patient cannot sit *real* still, we start tying floss
> > to each file. Rotary files at least don't slip out into the mouth.
>
> If I understand all I've been reading correctly, the purpose of the
> dam (along with preventing swallowing or aspiration of instruments) is
> to protect the root canals from saliva and also to prevent ingestion
> of the chemical(s) that are used to disinfect the root canals. In
> cases where a dam cannot be used for whatever reason, how are these
> two factors dealt with?
>
> I've found several photos and even a couple of video clips showing a
> dam in place and all these examples involve a lower tooth. My
> procedure involves my upper right first molar. Does this make any
> difference? (I suspect not).

Isolation of the upper teeth is easier, since any saliva flows down.
In those instances where you cannot get a dam to stay (very rare), you
pack the mouth with a lot of gauze, and tie all your instruments.

- quote -

>
> I'm getting the feeling that if they refuse to use a dam without good
> reason, I should probably get up and walk out. Would you?

Probably.
- quote -

>
> I'm still not totally clear on the reasons why RCT is "better" than
> extraction but I suppose that's a topic for another thread. Me, I'd
> just as soon have them take the damn thing out and be done with it

There is no one answer. You have to look at what kind of shape the
tooth is in--both structurally and periodontally. You're putting a lot
of effort into saving the tooth and the effort and/or money isn't worth
it if there isn't a reasonable expectation of long-term success--that
is, you save the tooth for a long time. The decision may also depend
somewhat on the condition of the other teeth in the mouth.
Since cash is a problem, I assume there is no consideration for a
bridge or implant-retained prosthesis.
Your circumstances may change down the road, and you may be able to
afford a fancy prosthesis, so this should be weighed against the chance
of success with a root canal and crown.
If you can't get the crown done, and you have no reasonable expectation
of being able to do the crown within a year or so, this makes the case
for doing a root canal much weaker IMO.

Steve
- quote -

>

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

#34 04-09-2008, 11:29 PM

On Apr 9, 3:45 pm, "Amatus Cremona" <Nic...[at]sottovocce.com> wrote:
- quote -

> If we are doing an over-denture abutment tooth RCT with NO rubber
> dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair
> of cotton forceps in one hand at all times, and no one is allowed to
> distract us. If the patient cannot sit *real* still, we start tying floss
> to each file. Rotary files at least don't slip out into the mouth.

If I understand all I've been reading correctly, the purpose of the
dam (along with preventing swallowing or aspiration of instruments) is
to protect the root canals from saliva and also to prevent ingestion
of the chemical(s) that are used to disinfect the root canals. In
cases where a dam cannot be used for whatever reason, how are these
two factors dealt with?

I've found several photos and even a couple of video clips showing a
dam in place and all these examples involve a lower tooth. My
procedure involves my upper right first molar. Does this make any
difference? (I suspect not).

I'm getting the feeling that if they refuse to use a dam without good
reason, I should probably get up and walk out. Would you?

I'm still not totally clear on the reasons why RCT is "better" than
extraction but I suppose that's a topic for another thread. Me, I'd
just as soon have them take the damn thing out and be done with it

#33 04-09-2008, 08:45 PM

If we are doing an over-denture abutment tooth RCT with NO rubber
dam,,,,,,,,,,, I am more OCD than normal. My assistant has to hold a pair
of cotton forceps in one hand at all times, and no one is allowed to
distract us. If the patient cannot sit *real* still, we start tying floss
to each file. Rotary files at least don't slip out into the mouth.

--
/

Amatus

/
"Dartos" <tuthjockey[at]myturbonet.com> wrote in message
news:1207771112_79504[at]news.newsville.com...
- quote -

>
>
> 10-4 good buddy!
>
> On one dental list, it is commonly stated that if there is a
> malpractice claim against a dentist that involves a root canal,
> and the dentist did not use a rubber dam, it is an automatic
> win for the plaintiff.
>
> One aspirated or swallowed file, and life as a dentist has
> been forever changed.
>
> D
>
> Amatus Cremona wrote:
> > Unless the front desk person misunderstood and thought the patient wanted
> > a rubber dam for restorative work.
> >
> > I agree that a rubber dam should be used whenever possible for RCT. Once
> > in a great while, you have a tooth which cannot easily accept a dam-clamp
> > and you do it without the rubber dam, but that is barely one case every
> > 2-3 years. Most teeth that will not hold clamp in place are not good
> > enough to do RCT on. Sometimes, they are still good enough for
> > over-denture abutments.
> >
>

#32 04-09-2008, 07:36 PM

10-4 good buddy!

On one dental list, it is commonly stated that if there is a
malpractice claim against a dentist that involves a root canal,
and the dentist did not use a rubber dam, it is an automatic
win for the plaintiff.

One aspirated or swallowed file, and life as a dentist has
been forever changed.

D

Amatus Cremona wrote:
- quote -

> Unless the front desk person misunderstood and thought the patient wanted a
> rubber dam for restorative work.
>
> I agree that a rubber dam should be used whenever possible for RCT. Once in
> a great while, you have a tooth which cannot easily accept a dam-clamp and
> you do it without the rubber dam, but that is barely one case every 2-3
> years. Most teeth that will not hold clamp in place are not good enough to
> do RCT on. Sometimes, they are still good enough for over-denture
> abutments.
>

#31 04-09-2008, 06:02 PM

Yes

and

Perhaps (often Yes)

--
/

Amatus

/
<electronic_dave[at]hotmail.com> wrote in message
news:924320b8-d760-42cb-ab8a-8dffd8e31dbf[at]2g2000hsn.googlegroups.com...
On Apr 9, 11:29 am, "Amatus Cremona" <Nic...[at]sottovocce.com> wrote:
- quote -

> > Unfortunately, they're one of only two practices in this area that
> > accept
> > my insurance--
>
> Danger Will Robinson ! ! ! {Waving arms in air}

You mean, my insurance sucks? (I knew that).
Or the practice must suck if they accept my sucky insurance?

#30 04-09-2008, 03:51 PM

On Apr 9, 11:49*am, Dartos <tuthjoc...[at]myturbonet.com> wrote:
- quote -

> > As I mentioned, it's been a month since my pulpotomy. I think my temp
> > filling is holding up OK but I'm not sure how long I have before
> > something MUST be done. I'd love to just call the whole thing off and
> > go to another practice but I can't afford it.
>
> Welcome to HMO dentistry.
>
> Cost cutting usually leads to compromises in treatment. *Of course,
> some dentists charge regular fees and still cut corners, but lower
> fees almost guarantee it.
>
> On the affordability issue, what will happen if the root canal is
> poorly done, and you have to pay a specialist (or other dentist) to
> do it over? *What if the tooth is lost?
>
> D

I take your point, but I don't have seveal hundred to a thousand bucks
or more hanging out in the bank. I barely have enough for gas and
groceries once the bills are paid. I'm not looking for sympathy, I'm
just telling you this by way of explaining why I feel like I don't
have many options as far as choosing where and by whom the procedure
is to be done.

yeah, HMOs are great, all right

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