NHS Vs. Private Crown

Dj_plasma

Let's not argue in this post, I'm not concerned with whether or whether not to have a crown, as brook2jack states the consultant recommended this at the end of the treatment. Whilst I believe it is for preventative measures as he also said the tooth is currently strong enough and there was no rush to have the crown done, he would still recommend it.

I am very concerned with having the black of the silver cap visible with receding gum later in life as have seen this on someone and I believe it is very unattractive. Guessing I arrange the private treatment after all with dental insurance I'd effectively only be paying for one of them.

izzybella16

I have seen people have amalgam fillings on root canalled molars for years and they are fine. Dentists have a tendency to go over the top recommending crowns on root canalled teeth. The crown itself may be stronger than composite material, but it doesn't make the rest of the tooth stronger, still a non vital tooth,

GwylimT

Crowns with the metal showing look awful, it looks like a rotting bit of tooth.

I have one crown, personally I have never used an NHS dentist, my crown was 3d printed in the surgery so I didn't need a temporary one. Mine was to repair a broken tooth. For the actual tooth to be made it was around ten minutes at most.

izzybella16

GwylimT wrote: »

Crowns with the metal showing look awful, it looks like a rotting bit of tooth.

I have one crown, personally I have never used an NHS dentist, my crown was 3d printed in the surgery so I didn't need a temporary one. Mine was to repair a broken tooth. For the actual tooth to be made it was around ten minutes at most.

This is what I mean about NHS dentistry, it gives a false sense of security and poor standard of treatment. Should scrap contracts and make 100% private, people will take more care and not be under the impression they are going to have their dental problems solved when they are not.

welshdent

Dj_plasma wrote: »

Let's not argue in this post, I'm not concerned with whether or whether not to have a crown, as brook2jack states the consultant recommended this at the end of the treatment. Whilst I believe it is for preventative measures as he also said the tooth is currently strong enough and there was no rush to have the crown done, he would still recommend it.

I am very concerned with having the black of the silver cap visible with receding gum later in life as have seen this on someone and I believe it is very unattractive. Guessing I arrange the private treatment after all with dental insurance I'd effectively only be paying for one of them.

Its not so much the crown as the cusp coverage and fully sealing the pulp chamber space. When a tooth is root filled they often have a lot of damage to them but perhaps this isn't the case for you. What IS the case is that to access the pulp chamber space a great deal of dentine will have to have been removed which alters the internal strength of the tooth leaving it prone to fracture. if they DO fracture then often the extent is too great for the tooth to be restored.
When the nerve is removed then the tooth has no way to a) warn you if there is a problem, with pain or b) respond to try and remove the nerve from the source of an irritation by laying down more dentine.

root filings are needed for diseases caused by bacteria which was demonstrated in 1965 by a chap called kakehashi. We clean them out as best we can when we do the procedure but if you do not seal the pulp chamber properly or seal it with something that can leak such as amalgam then it is very easy for the tooth to become reinfected as the bacteria will swarm to the spaces left following the treatment. It takes 3 weeks for bacteria to reinfect a well root filled tooth that has been exposed. That doesn't always mean pain in 3 weeks. it means there is bacteria where before there was not which in time will mean the procedure will fail.
A crown will achieve the goals as will an onlay type restoration which is basically a smaller crown which needs less preparation of the tooth.

A lecturer once told me the best time to crown root filled tooth was before it broke.

This article is good https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0ahUKEwjhr6a-qNrKAhXCPRoKHTKcA4YQFgg6MAQ&url=http%3A%2F%2Fwww.rcdso.org%2Fsave.aspx%3Fid%3D68f72e1f-1fd1-42ba-bf6b-21c884da92e0&usg=AFQjCNHzX0Ktwh5ZqxR_gfYCcXgAO5muVg&sig2=msq7hLCTGQvrSFNDGLTsBw

This is a review article and their sources are in the reference list.

Some key quotes are
"Analysis of the reason for all extractions of
endodontically treated teeth over a period of 1 year in a
busy military clinic revealed that almost 60% of these
were unrestorable tooth fractures, 32% involved
periodontal problems and only 7% were endodontic
failures"

"close to half of all failures were due to fracture of the natural coronal
tooth structure and appeared to involve either
uncrowned teeth or crowned teeth without definitive
anchorage"

"Teeth with crowns showed
longer clinical life than non-crowned teeth"

"THE NEED FOR EXTRA-CORONAL SUPPORT
The clinical longevity of endodontically treated posterior
teeth (molars and bicuspids) is significantly improved
with coronal coverage.12,28,29 The evidence strongly
supports that placement of a crown to encircle the tooth
can increase the resistance of posterior teeth to fracture
and a high incidence of failure for posterior
endodontically treated teeth without cusp coverage has
been reported.12 In a retrospective study of uncrowned
endodontically treated teeth, the overall survival rates of
molars without crowns at 1, 2, and 5 years were 96%, 88%
and 36% respectively.29 The amount of remaining tooth
structure was a significant factor in tooth survival.
Aqualina et al28 found that endodontically treated teeth
without crowns failed at a 6 times greater rate than
uncrowned teeth."


Now this is from 2008. Anecdotally I find that the last say 6 - 7 years has seen a large increase in onlay type restorations due to the desire to preserve as much tooth tissue as possible but still protect it and strengthen it. When the studies reviewed were done these were not common restorations but the literature is beginning to catch up. What is clear though is that NOT placing these restorations greatly increases the risk that your nicely root filled tooth will not last as long as it would had you had the crown or onlay placed. It is your choice though at the end of the day. Personally I would have one done.

welshdent

GwylimT wrote: »

Crowns with the metal showing look awful, it looks like a rotting bit of tooth.

I have one crown, personally I have never used an NHS dentist, my crown was 3d printed in the surgery so I didn't need a temporary one. Mine was to repair a broken tooth. For the actual tooth to be made it was around ten minutes at most.

I provide NHS treatments and I use that same machine. It is called cerec

Gloomendoom

Anecdotal, I know, but I had a root filled tooth filled with amalgam. It got reinfected and I had to have the job done again. It is now crowned

izzybella16

A root canal is sealed independently of the restoration

Retired_at_55

I hope this is not hijacking but this post got me thinking. I have a very nice NHS Dentist and should be lucky that some time ago a white NHS crown was fitted to a molar. When I open my mouth widely or smile you can see the top of the crown where it meets the gum - and it looks 'bad' with a black/dark ring around the top. It has always been like that.

It is healthy and I was told that this was to enable better cleaning of the crowned tooth. I wondered if having this NHS crown removed and replaced would a private crown go all the way up to the gum without the black 'ring' showing? I wonder if this would mean that a crown going all the way upto the gum would be difficult to clean properly. Any advice would be appreciated. (My NHS crowns at the front go all the way upto the gum and don't have any dark rings at the gum.)

I've never been happy with the crown because of the 'black ring' at the gum but I am pleased it is healthy. I'm grateful to have an NHS dentist. Sorry if this post is not right to be included here with someone else's question - could it be moved?

Thank you.

Retired at 55

izzybella16

A metal free crown would have nothing to show