NHS Vs. Private Crown

izzybella16

welshdent wrote: »

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.

The structure of a tooth is far more complex then dentists tell you. Besides the main 1-4 canals of a tooth there is lots of accessory canals and millions of dentin tubules running through the tooth. It is impossible to disinfect the tooth. But by blocking up the main canals the body can fight of the infections coming from the smaller ones. Personally long term I would look at replacing any root canalled teeth with an implant.

welshdent

Guess you wont be popping in for an endo then!

brook2jack

Interesting choice when long term survival rates for endodontically treated teeth is better than that of implants http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872851/

Dj_plasma

Just to clarify, this is top first pre-molar (bicuspid) tooth.

I had orthodontic treatment when younger so had canines on both sides removed as they were growing out at wrong angles and pushing other teeth out of the way. So as I stated it is the 3rd tooth in at the top and clearly visible.

Reading from all above it is pretty clear to me that I do not want an NHS silver capped crown as i do not want the black showing at any time. thanks to all for advice and chat.

brook2jack

The other thing you should be aware of is even if a white ceramic crown is provided (privately) as the tooth is root filled the underlying tooth may well be a bit greyer and if your gums receed you may find the exposed tooth looks a little greyer.

It seems as if looks are paramount to you so you will need to discuss this with the dentist who will provide the crown privately. Most people are perfectly satisfied with the looks of a bonded metal white crown as provided on the NHS but different things are important to different people .

wangdoodle

Some interesting discussion on this post...

brook2jack wrote: »

Interesting choice when long term survival rates for endodontically treated teeth is better than that of implants http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872851/

I'm finding this very worrying. After 15 years with my root filled molar, I have just started a treatment plan to replace it with an implant, at dizzying expense.

I am not averse to investing in my dental health, it's very important to me, but now I am worried that the implant will not even last as long as the endodontically treated tooth did. I guess it's too late now and I'll just have to see what happens.

izzybella16

welshdent wrote: »

Guess you wont be popping in for an endo then!

Root canals are important even if in the future you plan to have an implant to preserve the bone. Long term though root canals are a bad thing, especially if you have many and other illnesses.

izzybella16

wangdoodle wrote: »

Some interesting discussion on this post...



I'm finding this very worrying. After 15 years with my root filled molar, I have just started a treatment plan to replace it with an implant, at dizzying expense.

I am not averse to investing in my dental health, it's very important to me, but now I am worried that the implant will not even last as long as the endodontically treated tooth did. I guess it's too late now and I'll just have to see what happens.

Implants usually last a very long time

izzybella16

brook2jack wrote: »

Interesting choice when long term survival rates for endodontically treated teeth is better than that of implants http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872851/

Implants don't have bacteria embedded in them.

GwylimT

izzybella16 wrote: »

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.

The dental problems are solved, the NHS is to solve problems, not to provide cosmetic dentistry. Would you be happy if all children who needed braces could only have them if their parents had £3-5k laying around?