Hi Dr Hall,
First of all I appreciate the good work that you are doing.
Regarding my question: my daughter had yellow staining on her right front tooth. The doc did an x-ray and said the root canal is getting calcified and suggested a root canal. After the root canal we suggested to leave it as such but he said the tooth would fracture and a crown is a must. The crown he suggested was LAVA. We were not happy with the finish so we are trying an e.max or perhaps a metal-free ceramic. To push us to decide fast he frightened us that the gums are falling down. But I am happy I did not go with a badly made crown. I would like to know whether I have been taken for a ride and two which is the best crown to use? My gratitude for your enlightening blog I shall recommend to all my colleagues. My prayers and God Bless
– Bransdon from India
Bransdon,
I’m glad to be able to help.
First of all, I’m not sure why your daughter needs a root canal on this tooth. Just because the canal is getting calcified? As long as it’s not infected, she doesn’t need a root canal treatment. Calcification of a root canal is just the depositing of extra dentin inside the tooth. It can happen after a traumatic injury – it’s the tooth’s attempt to protect itself against infection of the canal. Also, all teeth tend to have their canals get a little calcified as we get older.
Second, even if she has a root canal treatment, she doesn’t necessarily need a crown on this front tooth. While a back tooth that has had a root canal treatment will be prone to fracture if it doesn’t have a crown, a crown on a front tooth with a root canal treatment will weaken the neck of the tooth. A back tooth has a chewing surface. Chewing pressure on this surface will tend to push apart the cusps of the tooth, possibly causing it to split. But if a front tooth breaks, it tends to break around the neck of the tooth, and it just breaks off entirely at that point rather than splitting as back teeth do.
The Lava crown and the e.max crown are very similar to each other. They both have a very strong lithium disilicate base overlaid with a feldspathic porcelain, but they are made by different companies. They are a good crown for dentists who aren’t very good at cosmetic dentistry procedures, but they require aggressive tooth reduction, which will further weaken this tooth.
In India, you have to be very careful with getting crowns or any type of complicated dental care. I’m not all that familiar with their standards there, but I know they aren’t as high as they are here in the United States. But the best thing to do for a front tooth that does not have a large filling, which sounds like it is your daughter’s situation, is, after the root canal treatment (if it needs that), to then have a translucent fiberglass post placed to strengthen the tooth. Before placing the post, all of the root canal cement and root canal filling materials should be cleaned out from the inside of the visible part of the tooth – this will help insure against discoloration. If the color is off, I would have that fixed with a thin porcelain veneer. That will help the tooth retain its maximum strength. And I would try to seek out a dentist who is somewhat familiar with cosmetic dentistry procedures. There are dentists in India who are members of the American Academy of Cosmetic Dentistry, and I would seek out one of those. (You can go to the AACD website and pull up a membership list.)
I do not recommend, in the United States, relying on membership in the AACD for any type of assurance that a dentist will do good cosmetic dental work. But in India, it does show a strong level of commitment to cosmetic dentistry to be willing to fly to the United States to learn these procedures.
– Dr. Hall
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About David A. Hall
Dr. David A. 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 advanced internet marketing for dentists.
Dr. Hall,
I’m dentist and have been practicing for a year. I wanted to know about calcified canals.
If there is calcification in a canal then it needs to be negotiated.
But what if the coronal part of the canal is calcified, and the patient has a periapical infection? How can the periapical infection develop if the canals are calcified?
Dr. Simran Gill
Response by Dr. Hall:
When a root canal is calcified, it means that dentin has built up in the canal, causing blockage in the canal. But the blockage isn’t total, which is how an infection can still develop. The canal can usually be negotiated with ultra-fine root canal instruments. Root canal specialists will also often use ultrasonic vibrations to break through the calcification.
Ruth commented: I had a crown put on tooth #7 about 40 years ago but no root canal.
She went on to give an interesting story about this tooth breaking off, which I have used for a separate blog post – Whose fault is it that this tooth broke off?
I had a cyst removed about 3 years ago just above my two front teeth, and the dental surgeon told me I might need a root canal in the future. When I went to my dentist about a year ago, she noticed that I have some infection where the cyst was removed (some pus) and she removed it and told me I should get a root canal. I waited a good 9 months and when I went back I decided to get the root canal done, but when she started, she had to stop to take 2 x-rays (2 teeth, big one on left and the one next to it. Then she looked at the x-rays and told me the canals were calcified and I would need to see a specialist. They are quite expensive and my plan doesn’t have enough left in it to cover all the work (I am retired). So I have decided not to get it done right now as I don’t feel any pain in my mouth, except that my gums seem a bit swollen at times, but I use salt and warm water and it helps a great deal. Because she found some pus in the area of the cyst removal should I get a root canal or not? I feel dentists today seem to go that way. I have had 3 root canals from a different dentist and am now wondering about this one! Confused! Help! The pus has never returned in that area either.
Thank you.
Cara Derochie
Response from Dr. Hall:
From what you’re telling me, it sounds like you have needed a root canal treatment on this tooth for some time. You have to manage your budget, of course, but you need to get this done. The longer it goes on, the greater the risk of complications when you actually do it. I’m pretty confident you have had this infected tooth for at least the three years.
I’m pretty sure that you will find that you will feel a little surge in energy in your body once you get this long-standing infection resolved by getting the root canal treatment. You get used to these infections after they’ve been around for a while, but they will sap some of your energy.
I had porcelain veneers put on tooth number 8 and 9 in 2007. In 2014, a “floating” dental hygienist at my dental office broke the veneer on #8. My dentist said that his lab told him both veneers would have to be replaced in order to get the shade to match. Both veneers were replaced. I should mention that #9 has had a calcified canal for 49 years. A periapical abscess was found, upon x-ray, on tooth #9 late 2020. (First x-ray taken since second veneer was placed). Large amt of bone loss. I have since had an apicoectomy. I cannot help but think this is all tied to the veneers. Tooth #9 calcified canal was absolutely causing no issue until veneers X 2. Any thoughts you may have are greatly appreciated. – Kathleen Novak
Response by Dr. Hall,
It’s hard to say without an examination, but if the porcelain veneers were done with the recommended preparation of removing only 0.5 mm of enamel, they are very unlikely to even irritate your tooth, much less cause an abscess.