A crown is a full coverage restoration. One of our dentists may recommend a crown for a tooth which has been badly broken down or lacks structural strength. The crown will be designed to fully cover the tooth with either: metal, metal and porcelain, or all porcelain. We will need to remove a certain amount of tooth structure from all around the tooth and from the chewing or biting surface to allow enough room for the crown material to surround the tooth with adequate thickness for strength. Although a crown will fully cover the exposed part of the tooth, it still must be kept very clean as the bacteria which cause cavities can still collect at the edges of the crown and cause cavities/decay. A standard crown is designed to last anywhere from about 15 to 25 years, but the long-term success of a crown will also be based on how well it is maintained and the amount of wear that it receives.
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A root canal procedure is recommended when the pulp (“nerve”) of the tooth has been compromised to the point that it cannot be healed. This includes a pulp that is in the process of irreversible pulpitis (“dying”) or necrotic (“dead”). One of our dentists may recommend a root canal based on a variety of signs and symptoms. A patient may complain of increasing history of pain, especially to cold, which now lingers when stimulated or has become spontaneous. Pain at night or when someone is lying down is not unusual. This is evidence of a pulp experiencing acute irreversible pulpitis. Another patient may complain about a “bubble” (parulis) above their tooth. This is an indication of a necrotic pulp. The size of the parulis may change (it may swell/fill, then break and seem to go away), but is generally not painful. Some patients may have no symptoms at all and we may just notice a change in the bone surrounding the tip of the root on a routine x-ray suggesting a necrotic pulp.
A tooth may require root canal therapy due to a number of reasons. The tooth may have experienced trauma which restricted the blood supply to the pulp causing it to die. A deep cavity may have allowed bacteria to enter into the pulp and cause it to die. On rare occasion, a root canal may be recommended in order to gain access to the space in which the pulp exists to allow a more predictable long-term restoration of the tooth.
In order to perform a root canal procedure, we have to perform the procedure with a rubber dam to create a clean environment free from bacteria. We will open the tooth and remove the damaged pulp tissue and any bacteria that may be colonizing the inside of the tooth. We will clean the inside of the tooth both physically (with files of increasing size and by flushing fluid into the pulp space) and chemically (using sodium hypochlorite/”bleach”). We may want to perform this at two different appointments, to ensure adequate cleaning (evidenced by healing of the bone between appointments which we can see on x-rays) of the inside of the tooth. Once the pulp space has been adequately cleaned, we will fill the space with a material that the body does react to called gutta percha. This serves as a seal, in combination with a special cement, to prevent bacteria within the blood stream from re-colonizing the inside of the tooth. We will often recommend the placement of a crown following root canal therapy as many teeth requiring the treatment are often quite structurally compromised.
The cost of root canal therapy is generally dictated by the number of pathways that the pulp takes through the tooth. This cannot often be determined before the treatment is started. For more complicated cases (roots with significant curves, roots still open at the end, pul spaces that are smaller than normal, etc.), we may recommend that the procedure be performed by a specialist, an Endodontist.