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Root canal – Remove crown to complete root canal?

Price: $805 for root canal therapy (not including crown)

When presented with a painful crowned tooth the question arises should you remove the crown in order to complete the root canal.  Obviously, there are some pro and cons to removing or drilling through the crown in order to perform root canal therapy.  We believe removing the crown is always favorable since you gain more information regarding the status of the post-operatively treated tooth.    ”Saving the crown” is not a justified reason to attempt a root canal through the crown.  This is because vision is impaired which would increase the chances of missing an extra canal or crack in the root complex,  perforating the root,  or bad access leading to gouging the remaining tooth which is supporting the crown.   Removing the crown improves access which is vital to long-term root canal success.  It also provides the chance to evaluate the remaining coronal tooth structure which ultimately will support the crown.  Leaving the crown impedes on all the factors which directly affect the longevity of the tooth.

MB #30 pfm pain

This patient had a complaint of constant aching pain on his lower jaw.   A diagnosis was made of partial necrosis of the pulp with acute periodontitis.  Root canal therapy was suggested with the removal of the crown.  Upon removing the crown a crack was found at the disto-lingual (back inside) cavosurface angle extending into the distal canal.  This is where most of the pulpal inflammation was noted as evident by the hyperemic (bled alot) pulp tissue.   All canals were calcified with the mesio-buccal being the most calcified.  An ultrasonic excavator was required in finding this canal.  Once access was created, all canals were instrumented.  The mesiolingual canal (front-inside) canal was tortuous leading down to its connection with the mesio-buccal canal in the apical third of the root.  This procedure was completed in one hour ten minutes.

If we chose to do the root canal without removing the crown, assessing and treating the tooth would have been more difficult.  The extent of the crack would have been hidden within the cement and crown.  Finding the mesio-buccal canal would have had more perforation risk involved and negotiating the mesio-lingual canal would have been more difficult since straight line access through the crown would have been more challenging.  Just a note, at the junction of the two mesial canals inflammed pulp was found and removed.  The remaining portions of the canals were necrotic.

Prior to the procedure, the patient was informed he would need another crown and possible post and core.