Root canal on Molar Gold crown

Eastender

Had my gold crown on my second lower molar tooth fitted about 30 years ago, For the first time, I have an abscess under it and was painful. Saw my NHS Dentist yesterday, who is fairly new to the practice.

Now my Gold crown has a tiny spot, not sure if that was the main reason for developing the infection. Anyway she told me if I want to save the tooth, I should have RCT, that involves drilling a hole on crown to do RCT and then seal the crown.

She won't do RCT but would refer to a private Endodontist and would cost £600!, as they're not available on the NHS, which I was quite surprised as they're mentioned on the NHS pricing structure as £53.90. Why not move this RCT to Band 3?

She took an X-ray and saw that I had RCT on the crown, but I can't remember 30 years ago, (I was in my late teens) so now needs re-RCT and gave me some antibiotics.

So my question is.

A - do I need a new crown and can they just drill on the old crown and seal it up for RCT?

B - what are the success rate on this, is it better to extract it and later fit an implant as my third lower molar has repeated infection and will need to be extracted anytime when flairs up, again.

C - If I replace the crown. without RCT, as the crown has a slight surface spot, it might stop food liquid enter the pulp, would be another option? Never had any other RCT done.

Thanks.

welshdent

Speaking as someone that has an interest in root canal tretament -
Firstly they are technically available so that line is slightly misleading - however the dentist can not provide something they do not feel competent doing. The issue would be more of a problem if they said they cant do it on the NHS but if you pay privately they magically become able to do it. So with the dentist referring you to a specialist I see no problem. so while they are technically available, finding someone happy to root treat a second molar through a crown is likely to be extremely tough!!! Add to that it is a re treatment and you immediately move in to one of the hardest dental procedures we do. Extremely technically demanding to say the least. Quite simply the "NHS" is good at telling you what you can have but do not provide the facilities or resources for you to have it.

It isnt as simple as moving to a band 3. band 3 is only for courses of treatment needing lab fees. This is not the place for a discussions on the pros and cons of the NHS fee scale. Lets just say I dont like it.

So on to your questions:

A - It is impossible to answer this from a forum. If you have decay (which often is blocked by the crown structure) you need to remove the crown to remove the decay. The only way realistically to remove the crownb is to drill it off.
Crowns particularly metal ones block the light out. Trying to find a hole at the back of the mouth that is at best 2 mm in diameter is VERY hard. Trying to find approximately 3 is even harder. So I would suggest if they said the crown needs to come off then it more than likely needs to.

B - hard to say success rates. There is no standardised procedure. the research is sparse with reliable studies. We know that using Sodium Hypochlorite is usually conducive to a good outcome. A better question would be to ask the person doing the treatment what their success rates are. Personally I am around the 80 - 90% mark for re treatments but that is meaningless if the guy next door has a different protocol. IF the dentist is happy to proceed then it is a fair chance they are happy it will work. If they arent they would advise extraction. I personally would not have an implant to replace a second molar.

C - This would be pointless. Think of it in house terms. Presently your foundations are bad. if you build a perfect house on poor foundations it wont last long. The tooth is infected. A crown does not manage infection it creates a seal, restores the tooth to function and appearance. But it does nothing to an infection. The root canal treatment disinfects the tooth then seals the root canal system to try and prevent further problems.

I hope that is in someway helpful!

Eastender

welshdent wrote: »

Speaking as someone that has an interest in root canal tretament -
Firstly they are technically available so that line is slightly misleading - however the dentist can not provide something they do not feel competent doing. The issue would be more of a problem if they said they cant do it on the NHS but if you pay privately they magically become able to do it. So with the dentist referring you to a specialist I see no problem. so while they are technically available, finding someone happy to root treat a second molar through a crown is likely to be extremely tough!!! Add to that it is a re treatment and you immediately move in to one of the hardest dental procedures we do. Extremely technically demanding to say the least. Quite simply the "NHS" is good at telling you what you can have but do not provide the facilities or resources for you to have it.

It isnt as simple as moving to a band 3. band 3 is only for courses of treatment needing lab fees. This is not the place for a discussions on the pros and cons of the NHS fee scale. Lets just say I dont like it.

So on to your questions:

A - It is impossible to answer this from a forum. If you have decay (which often is blocked by the crown structure) you need to remove the crown to remove the decay. The only way realistically to remove the crownb is to drill it off.
Crowns particularly metal ones block the light out. Trying to find a hole at the back of the mouth that is at best 2 mm in diameter is VERY hard. Trying to find approximately 3 is even harder. So I would suggest if they said the crown needs to come off then it more than likely needs to.

B - hard to say success rates. There is no standardised procedure. the research is sparse with reliable studies. We know that using Sodium Hypochlorite is usually conducive to a good outcome. A better question would be to ask the person doing the treatment what their success rates are. Personally I am around the 80 - 90% mark for re treatments but that is meaningless if the guy next door has a different protocol. IF the dentist is happy to proceed then it is a fair chance they are happy it will work. If they arent they would advise extraction. I personally would not have an implant to replace a second molar.

C - This would be pointless. Think of it in house terms. Presently your foundations are bad. if you build a perfect house on poor foundations it wont last long. The tooth is infected. A crown does not manage infection it creates a seal, restores the tooth to function and appearance. But it does nothing to an infection. The root canal treatment disinfects the tooth then seals the root canal system to try and prevent further problems.

I hope that is in someway helpful!

Many thanks for your detailed reply, I really appreciate it. Had not looked at the forum for several days.

Just got back from a private dentist for a second opinion, previously never been to private, always had NHS treatment.

Anyway at the checkup, she was more concerned with my moderate gum disease than my gold crown, which is 3rd lower molar, not 2nd as previously mentioned. She told me I needed several hygienist visit to treat the gum disease amounting to £500 and then further £250 to investigate the crown.

From the X-ray photos, she told me it has a slight decay underneath the crown and the crown is damaged, not surprised after nearly 30 years. She has to open the crown and treat the decay, but she won't just treat the crown until I have ALL the hygiene visits. If she takes crown off and a new crown starts from £640, according to her pricelist.

So I am looking at £750 plus at least £650 for a new crown and probably other charges. If I add up that's the price of an implant. So I am pondering what to do now.

brook2jack

A third lower molar is also known as a wisdom tooth. They can have complex and unpredictable anatomy.

Many dentists would not even do root treatment first time in a wisdom tooth, let alone a re root endodontic treatment.

In general if you have your other teeth no implantologist would replace a wisdom tooth with an implant as , in general, wisdom teeth are not particularly useful and the anatomy at the back of the mouth is difficult to place implants in.

The vast majority of people in the U.K. Loose their teeth due to gum disease not decay. The visits to the hygienist will not cure your gum disease but will help you make the changes in cleaning and lifestyle to control your gum disease.

ripplyuk

A third molar. So it's your wisdom tooth? I wouldn't bother with an implant for that. I'd get it extracted. Spend the money on treating the gum disease. That would be my priority.

This is just my personal opinion. You should seek advice from a professional.

Eastender

Sorry folks, it's my first molar lower tooth, which has a gold crown. It can be seen when I open my mouth. The second lower molar gets infected often and will need to be extracted soon, the 3rd lower molar had been extracted.

eDicky

A few years ago I had my lower second molar re-treated for the third time (maybe even fourth) through it's gold crown, by a specialist in London. He was the only one who was confident to do it, and I have had no problem since. He sent me to his brother to fill the hole, as the specialist doesn't do that. I don't recommend moneysaving on dental work - money can be made again, but teeth...