The Cosmetic Dentistry Blog

March 12, 2012

I would be asking some serious questions of this dentist, about this root canal and crown

Back in Dec I had a root canal done by an endodontist on tooth 14 that already had a crown. After this procedure I felt fine, no pain or hot/cold sensitivity and went to my dentist and he stated I had to have a new crown. He removed the old crown and gave me a temp for two weeks. I immediately started having sensitivity to hot/cold. After the permanent crown was put on this continued and has for the last month. Any ideas on whats going on here? Thank you.
Jerry from Ohio

Jerry,
I don’t want my comments to be taken as a substitute for an examination by an in-person dentist who can test your tooth and look at x-rays, but I can be helpful and tell you what your problem sounds like.

What you are experiencing is consistent with a missed canal in the tooth. If this is what is happening, the endodontist, in doing the root canal treatment on your molar, thought he or she had treated the entire root canal system but missed a part. If the root canal had been done completely, there would be no sensation whatsoever in this tooth to heat or cold.

Tooth #14 is a maxillary first molar. This tooth has a frequent anomaly in the root canal structure. Usually, there is only one canal per root of a tooth. But in the maxillary first molar, there can be a second canal in the mesiobuccal root. This canal can be hard to find, and studies show that it is the most frequently missed of any canal in root canal treatment. So I would have the endodontist re-check this tooth, test it, and see if this is what is happening.

With a crown already on the tooth, it is only a little more challenging to go back into the tooth and work on the root canal treatment. An opening will need to be made in the crown, and then that opening will need to be sealed over later with a durable filling material. For most crowns, this won’t have an effect on the structural integrity of the crown.

This is a frequent error and I’m confident it has happened to most endodontists, and isn’t necessarily an indication of incompetence or sloppiness. However, I would expect there to be no extra charge to fix this.

And did you mention the sensitivity to the dentist that put the crown on? I’m surprised that he didn’t catch this. When the new crown was seated, it should have been obvious that there was some vitality in this tooth, if it was sensitive to hot and cold. There should not have been any novocain administered for seating a crown on a tooth that had a root canal treatment. So I have two questions for this dentist. The first is why, because of the root canal treatment, you needed a new crown. Was the root canal treatment being used as an excuse for doing an extra procedure? Just having a hole drilled in the crown for the root canal treatment isn’t reason for re-doing the crown – there needs to be something else wrong. And the second question is why he didn’t pick up on the problem with your tooth sensitivity. I would be asking some real questions here.

And realize that in saying what I’m saying, I’m assuming that I have accurate information, and that the source of the sensitivity is this root canal tooth and not really some other tooth and it feels like the root canal tooth. Clinical testing would answer that question.

Dr. Hall

Links: read more about root canal failure.
Read more about pain after a root canal.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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