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No crown with root canal?
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gdelzer
medicine forum beginner


Joined: 03 Jul 2006
Posts: 5

PostPosted: Mon Jul 03, 2006 6:49 pm    Post subject: No crown with root canal? Reply with quote

Hello. My tooth (upper-left, fifth tooth back starting from front)
broke yesterday morning while eating cereal. Its a tooth I had a root
canal done on about three years ago, and now the inside half is gone
(to the gumline--I believe the root is still there), the outer half and
the filling are both still intact.

I've called around for prices, etc. and it looks to be $750 to $1000 to
fix, but the other response I keep getting is, "They should have put a
crown on when the root canal was done. Otherwise, they become brittle
and crack in a couple years." Now, I had decent dental insurance at the
time, but, of course, no dental insurance now. So, I am a bit steamed
at the prospect of laying down a thousand for work that I wouldn't have
had to pay for when it should have been done. Is this a legitimate
complaint? Are crowns regularly done when there is a root canal?

--Greg
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Mark & Steven Bornfel
medicine forum Guru


Joined: 30 Apr 2005
Posts: 888

PostPosted: Mon Jul 03, 2006 9:01 pm    Post subject: Re: No crown with root canal? Reply with quote

gdelzer wrote:

Quote:
Hello. My tooth (upper-left, fifth tooth back starting from front)
broke yesterday morning while eating cereal. Its a tooth I had a root
canal done on about three years ago, and now the inside half is gone
(to the gumline--I believe the root is still there), the outer half and
the filling are both still intact.

I've called around for prices, etc. and it looks to be $750 to $1000 to
fix, but the other response I keep getting is, "They should have put a
crown on when the root canal was done. Otherwise, they become brittle
and crack in a couple years." Now, I had decent dental insurance at the
time, but, of course, no dental insurance now. So, I am a bit steamed
at the prospect of laying down a thousand for work that I wouldn't have
had to pay for when it should have been done. Is this a legitimate
complaint? Are crowns regularly done when there is a root canal?

--Greg



It's tough to make presumptions and draw specific inferences to your
own situation. Generally, premolars that have required root canal due
to caries or fracture should be crowned or onlays placed after root canal.
There may have been extenuating circumstances--perhaps there was a
possible problem with the root canal, suspicion of fracture etc. that
could have made placement of the crown a waste if the tooth was
subsequently lost. Maybe more likely you just fell through the cracks
due to a disorganized office.
Whatever the cause, if the fracture isn't too far under the gumline,
hopefully the crown can be done now.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
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Pat Coghlan
medicine forum beginner


Joined: 05 Jul 2006
Posts: 3

PostPosted: Wed Jul 05, 2006 5:25 pm    Post subject: Re: No crown with root canal? Reply with quote

Getting a crown may be more invasive than Cerec. It's probably worth
looking into the latter. My mother-in-law is in the same situation
right now.

gdelzer wrote:
Quote:
Hello. My tooth (upper-left, fifth tooth back starting from front)
broke yesterday morning while eating cereal. Its a tooth I had a root
canal done on about three years ago, and now the inside half is gone
(to the gumline--I believe the root is still there), the outer half and
the filling are both still intact.

I've called around for prices, etc. and it looks to be $750 to $1000 to
fix, but the other response I keep getting is, "They should have put a
crown on when the root canal was done. Otherwise, they become brittle
and crack in a couple years." Now, I had decent dental insurance at the
time, but, of course, no dental insurance now. So, I am a bit steamed
at the prospect of laying down a thousand for work that I wouldn't have
had to pay for when it should have been done. Is this a legitimate
complaint? Are crowns regularly done when there is a root canal?

--Greg
Back to top
gdelzer
medicine forum beginner


Joined: 03 Jul 2006
Posts: 5

PostPosted: Wed Jul 05, 2006 5:30 pm    Post subject: Re: No crown with root canal? Reply with quote

Thank you for your reply.

I don't believe there were any extenuating circumstances with the root
canal. None that I was told of anyway. It was due to a deep cavity.

And I don't think a disorganized office is the cause. This was an
office/clinic of a reasonably large dental insurance/clinic
corporation, the type of place that you can't even call direct to make
an appointment--you have to call one of those 1-800 numbers.

So, I know you dentists love to hear this term, but I don't see how
this wasn't malpractice. I know you can't comment on this without the
particulars. I also know that even if it technically is malpractice,
the costs of proving this would be well beyond what I might possibly
recoup. So, that point is moot.

Here's what I am wondering. Does it make sense at all to call this
company or maybe show up at the dental office (which is near my home)
and explain the situation and complain? Would I have a leg to stand on?
Would I possibly get any recompense other than a "We're sorry."? Or is
my time better spent setting up an appointment elsewhere and taking my
lumps?

--Greg Delzer

Mark & Steven Bornfeld wrote:
Quote:
gdelzer wrote:

Hello. My tooth (upper-left, fifth tooth back starting from front)
broke yesterday morning while eating cereal. Its a tooth I had a root
canal done on about three years ago, and now the inside half is gone
(to the gumline--I believe the root is still there), the outer half and
the filling are both still intact.

I've called around for prices, etc. and it looks to be $750 to $1000 to
fix, but the other response I keep getting is, "They should have put a
crown on when the root canal was done. Otherwise, they become brittle
and crack in a couple years." Now, I had decent dental insurance at the
time, but, of course, no dental insurance now. So, I am a bit steamed
at the prospect of laying down a thousand for work that I wouldn't have
had to pay for when it should have been done. Is this a legitimate
complaint? Are crowns regularly done when there is a root canal?

--Greg



It's tough to make presumptions and draw specific inferences to your
own situation. Generally, premolars that have required root canal due
to caries or fracture should be crowned or onlays placed after root canal.
There may have been extenuating circumstances--perhaps there was a
possible problem with the root canal, suspicion of fracture etc. that
could have made placement of the crown a waste if the tooth was
subsequently lost. Maybe more likely you just fell through the cracks
due to a disorganized office.
Whatever the cause, if the fracture isn't too far under the gumline,
hopefully the crown can be done now.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
Back to top
Mark & Steven Bornfel
medicine forum Guru


Joined: 30 Apr 2005
Posts: 888

PostPosted: Wed Jul 05, 2006 6:33 pm    Post subject: Re: No crown with root canal? Reply with quote

gdelzer wrote:

Quote:
Thank you for your reply.

I don't believe there were any extenuating circumstances with the root
canal. None that I was told of anyway. It was due to a deep cavity.

And I don't think a disorganized office is the cause. This was an
office/clinic of a reasonably large dental insurance/clinic
corporation, the type of place that you can't even call direct to make
an appointment--you have to call one of those 1-800 numbers.

So, I know you dentists love to hear this term, but I don't see how
this wasn't malpractice. I know you can't comment on this without the
particulars. I also know that even if it technically is malpractice,
the costs of proving this would be well beyond what I might possibly
recoup. So, that point is moot.

Here's what I am wondering. Does it make sense at all to call this
company or maybe show up at the dental office (which is near my home)
and explain the situation and complain? Would I have a leg to stand on?
Would I possibly get any recompense other than a "We're sorry."? Or is
my time better spent setting up an appointment elsewhere and taking my
lumps?

--Greg Delzer

The problem with your situation is that while generally crowns or
onlays should be done after root canal, there may have been extenuating
circumstances which caused the dentist to make an exception. You are
certainly within your rights to ask why a crown wasn't made at the time;
one can even argue that damages could be demonstrated if you lost the
tooth. But if your complaint is that it's going to cost you now for a
crown because you no longer have dental insurance, I don't think that's
going to fly. The decision not to crown is a clinical judgement, and
each judgement must be made individually--not general rules. You may
find a sympathetic ear and the dentist may feel like being a nice guy
and making an adjustment in the fee for a crown, but IMO he/she is under
no obligation to do so--esp. if there is a rationale we're not hearing
about.
If there is no explanation that makes sense to you, you should consider
whether you want to stay with this dentist.

Steve
Quote:

Mark & Steven Bornfeld wrote:

gdelzer wrote:


Hello. My tooth (upper-left, fifth tooth back starting from front)
broke yesterday morning while eating cereal. Its a tooth I had a root
canal done on about three years ago, and now the inside half is gone
(to the gumline--I believe the root is still there), the outer half and
the filling are both still intact.

I've called around for prices, etc. and it looks to be $750 to $1000 to
fix, but the other response I keep getting is, "They should have put a
crown on when the root canal was done. Otherwise, they become brittle
and crack in a couple years." Now, I had decent dental insurance at the
time, but, of course, no dental insurance now. So, I am a bit steamed
at the prospect of laying down a thousand for work that I wouldn't have
had to pay for when it should have been done. Is this a legitimate
complaint? Are crowns regularly done when there is a root canal?

--Greg



It's tough to make presumptions and draw specific inferences to your
own situation. Generally, premolars that have required root canal due
to caries or fracture should be crowned or onlays placed after root canal.
There may have been extenuating circumstances--perhaps there was a
possible problem with the root canal, suspicion of fracture etc. that
could have made placement of the crown a waste if the tooth was
subsequently lost. Maybe more likely you just fell through the cracks
due to a disorganized office.
Whatever the cause, if the fracture isn't too far under the gumline,
hopefully the crown can be done now.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001




--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
Back to top
gdelzer
medicine forum beginner


Joined: 03 Jul 2006
Posts: 5

PostPosted: Wed Jul 05, 2006 9:39 pm    Post subject: Re: No crown with root canal? Reply with quote

I agree with the extenuating circumstances possibility, but none of
that was discussed with me at the time. If extenuating circumstances
did exist, I would have expected to have been told of that and further
why no crown was advisable.

My complaint is that if indeed this current situation arose because a
crown SHOULD have been done but wasn't, that some fault lies with the
original dentist (or office, or company, etc.). The insurance part of
this is that I wouldn't worry so much if I currently had insurance, as
the brunt of the cost of the mistake would still be paid by the
insurance. So, my lack of insurance currently means that I am paying
out-of-pocket for a problem that possibly shouldn't exist if the
correct procedures were done at the time.

And I don't even have all the information yet, so I am speculating. But
my complaint is certainly due to the unexpected expense I may have to
lay out, yes.

I did put in a call to the corporate offices. They called the
particular office and relayed my situation. Unfortunately, the office
manager is on vacation until next week (this seems to be a popular week
for dental office vacations--my timing is never good), so I should
receive a call back on Monday.

--Greg
Mark & Steven Bornfeld wrote:
Quote:
gdelzer wrote:

Thank you for your reply.

I don't believe there were any extenuating circumstances with the root
canal. None that I was told of anyway. It was due to a deep cavity.

And I don't think a disorganized office is the cause. This was an
office/clinic of a reasonably large dental insurance/clinic
corporation, the type of place that you can't even call direct to make
an appointment--you have to call one of those 1-800 numbers.

So, I know you dentists love to hear this term, but I don't see how
this wasn't malpractice. I know you can't comment on this without the
particulars. I also know that even if it technically is malpractice,
the costs of proving this would be well beyond what I might possibly
recoup. So, that point is moot.

Here's what I am wondering. Does it make sense at all to call this
company or maybe show up at the dental office (which is near my home)
and explain the situation and complain? Would I have a leg to stand on?
Would I possibly get any recompense other than a "We're sorry."? Or is
my time better spent setting up an appointment elsewhere and taking my
lumps?

--Greg Delzer

The problem with your situation is that while generally crowns or
onlays should be done after root canal, there may have been extenuating
circumstances which caused the dentist to make an exception. You are
certainly within your rights to ask why a crown wasn't made at the time;
one can even argue that damages could be demonstrated if you lost the
tooth. But if your complaint is that it's going to cost you now for a
crown because you no longer have dental insurance, I don't think that's
going to fly. The decision not to crown is a clinical judgement, and
each judgement must be made individually--not general rules. You may
find a sympathetic ear and the dentist may feel like being a nice guy
and making an adjustment in the fee for a crown, but IMO he/she is under
no obligation to do so--esp. if there is a rationale we're not hearing
about.
If there is no explanation that makes sense to you, you should consider
whether you want to stay with this dentist.

Steve

Mark & Steven Bornfeld wrote:

gdelzer wrote:


Hello. My tooth (upper-left, fifth tooth back starting from front)
broke yesterday morning while eating cereal. Its a tooth I had a root
canal done on about three years ago, and now the inside half is gone
(to the gumline--I believe the root is still there), the outer half and
the filling are both still intact.

I've called around for prices, etc. and it looks to be $750 to $1000 to
fix, but the other response I keep getting is, "They should have put a
crown on when the root canal was done. Otherwise, they become brittle
and crack in a couple years." Now, I had decent dental insurance at the
time, but, of course, no dental insurance now. So, I am a bit steamed
at the prospect of laying down a thousand for work that I wouldn't have
had to pay for when it should have been done. Is this a legitimate
complaint? Are crowns regularly done when there is a root canal?

--Greg



It's tough to make presumptions and draw specific inferences to your
own situation. Generally, premolars that have required root canal due
to caries or fracture should be crowned or onlays placed after root canal.
There may have been extenuating circumstances--perhaps there was a
possible problem with the root canal, suspicion of fracture etc. that
could have made placement of the crown a waste if the tooth was
subsequently lost. Maybe more likely you just fell through the cracks
due to a disorganized office.
Whatever the cause, if the fracture isn't too far under the gumline,
hopefully the crown can be done now.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001




--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
Back to top
gdelzer
medicine forum beginner


Joined: 03 Jul 2006
Posts: 5

PostPosted: Mon Jul 10, 2006 9:03 pm    Post subject: Re: No crown with root canal? Reply with quote

Well, the initial response I received from the office manager is that
crowns are routinely placed on molars that have root canals but not
pre-molars because pre-molars aren't used for biting down as hard. This
strikes me as completely arbitrary.

Does this make sense from a scientific or dental standpoint?

The dentist himself is supposed to contact me tomorrow.

--Greg

Mark & Steven Bornfeld wrote:
Quote:
gdelzer wrote:

Thank you for your reply.

I don't believe there were any extenuating circumstances with the root
canal. None that I was told of anyway. It was due to a deep cavity.

And I don't think a disorganized office is the cause. This was an
office/clinic of a reasonably large dental insurance/clinic
corporation, the type of place that you can't even call direct to make
an appointment--you have to call one of those 1-800 numbers.

So, I know you dentists love to hear this term, but I don't see how
this wasn't malpractice. I know you can't comment on this without the
particulars. I also know that even if it technically is malpractice,
the costs of proving this would be well beyond what I might possibly
recoup. So, that point is moot.

Here's what I am wondering. Does it make sense at all to call this
company or maybe show up at the dental office (which is near my home)
and explain the situation and complain? Would I have a leg to stand on?
Would I possibly get any recompense other than a "We're sorry."? Or is
my time better spent setting up an appointment elsewhere and taking my
lumps?

--Greg Delzer

The problem with your situation is that while generally crowns or
onlays should be done after root canal, there may have been extenuating
circumstances which caused the dentist to make an exception. You are
certainly within your rights to ask why a crown wasn't made at the time;
one can even argue that damages could be demonstrated if you lost the
tooth. But if your complaint is that it's going to cost you now for a
crown because you no longer have dental insurance, I don't think that's
going to fly. The decision not to crown is a clinical judgement, and
each judgement must be made individually--not general rules. You may
find a sympathetic ear and the dentist may feel like being a nice guy
and making an adjustment in the fee for a crown, but IMO he/she is under
no obligation to do so--esp. if there is a rationale we're not hearing
about.
If there is no explanation that makes sense to you, you should consider
whether you want to stay with this dentist.

Steve

Mark & Steven Bornfeld wrote:

gdelzer wrote:


Hello. My tooth (upper-left, fifth tooth back starting from front)
broke yesterday morning while eating cereal. Its a tooth I had a root
canal done on about three years ago, and now the inside half is gone
(to the gumline--I believe the root is still there), the outer half and
the filling are both still intact.

I've called around for prices, etc. and it looks to be $750 to $1000 to
fix, but the other response I keep getting is, "They should have put a
crown on when the root canal was done. Otherwise, they become brittle
and crack in a couple years." Now, I had decent dental insurance at the
time, but, of course, no dental insurance now. So, I am a bit steamed
at the prospect of laying down a thousand for work that I wouldn't have
had to pay for when it should have been done. Is this a legitimate
complaint? Are crowns regularly done when there is a root canal?

--Greg



It's tough to make presumptions and draw specific inferences to your
own situation. Generally, premolars that have required root canal due
to caries or fracture should be crowned or onlays placed after root canal.
There may have been extenuating circumstances--perhaps there was a
possible problem with the root canal, suspicion of fracture etc. that
could have made placement of the crown a waste if the tooth was
subsequently lost. Maybe more likely you just fell through the cracks
due to a disorganized office.
Whatever the cause, if the fracture isn't too far under the gumline,
hopefully the crown can be done now.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001




--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
Back to top
Mark & Steven Bornfel
medicine forum Guru


Joined: 30 Apr 2005
Posts: 888

PostPosted: Mon Jul 10, 2006 9:33 pm    Post subject: Re: No crown with root canal? Reply with quote

gdelzer wrote:

Quote:
Well, the initial response I received from the office manager is that
crowns are routinely placed on molars that have root canals but not
pre-molars because pre-molars aren't used for biting down as hard. This
strikes me as completely arbitrary.

Does this make sense from a scientific or dental standpoint?

No. Speak to the dentist.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
Back to top
Joel M. Eichen
medicine forum Guru


Joined: 24 Mar 2005
Posts: 4062

PostPosted: Tue Jul 11, 2006 1:06 am    Post subject: Re: No crown with root canal? Reply with quote

This was a Seinfeld episode where George wanted a
crown with his root canal but the tooth Nazi said,
"What? You get no crown with your root canal."

PS~! In your case a crown may have been indicated,
but its hard to guess from here.


--
Joel344
------------------------------------------------------------------------
Joel344's Profile: http://dentalcom.net/forum/member.php?userid=12
View this thread: http://dentalcom.net/forum/showthread.php?t=4614
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gdelzer
medicine forum beginner


Joined: 03 Jul 2006
Posts: 5

PostPosted: Wed Jul 12, 2006 11:10 pm    Post subject: Re: No crown with root canal? Reply with quote

Finally got a call back from the dentist today.

"The data doesn't indicate that crowns are necessarily a good idea on
pre-molars that have root canals."

Of course, he didn't have immediate access to what he meant by "the
data" (nor did I expect him to), but he said that if I researched
studies related to outcomes of root canals on pre-molars that I would
find that the need for crowns isn't generally indicated.

Does anyone know more specifically what data or study/studies he might
be referring to?

Do I follow up with the dental corporation (I'm guessing that naming
them is against decorum, though I'm not sure how to refer to the
conglomerate.)?

Thanks again for any help.

--Greg Delzer

Mark & Steven Bornfeld wrote:
Quote:
gdelzer wrote:

Well, the initial response I received from the office manager is that
crowns are routinely placed on molars that have root canals but not
pre-molars because pre-molars aren't used for biting down as hard. This
strikes me as completely arbitrary.

Does this make sense from a scientific or dental standpoint?

No. Speak to the dentist.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
Back to top
Mark & Steven Bornfel
medicine forum Guru


Joined: 30 Apr 2005
Posts: 888

PostPosted: Wed Jul 12, 2006 11:56 pm    Post subject: Re: No crown with root canal? Reply with quote

gdelzer wrote:

Quote:
Finally got a call back from the dentist today.

"The data doesn't indicate that crowns are necessarily a good idea on
pre-molars that have root canals."

Of course, he didn't have immediate access to what he meant by "the
data" (nor did I expect him to), but he said that if I researched
studies related to outcomes of root canals on pre-molars that I would
find that the need for crowns isn't generally indicated.

Does anyone know more specifically what data or study/studies he might
be referring to?

Do I follow up with the dental corporation (I'm guessing that naming
them is against decorum, though I'm not sure how to refer to the
conglomerate.)?

Thanks again for any help.

--Greg Delzer


This is a clinical judgement call--the rules aren't set in stone.
If you're referring to the dental group this dentist works for, if you
explain the situation they may feel like making a concession on the fee
(but they're under no legal obligation to do so).
As far as the reputed "data", IMO almost all of these teeth need either
onlays or crowns. Since porcelain or resin onlays are relatively new
(though they certainly have their advantages), most of the time this
means a crown. And if there's any research contradicting this
well-established, time-honored conviction which any dentist who's been
around the block can verify by remembering all the patients with your
experience (I'm out of school 30 years now), I would LOVE to see it.
If they aren't sympathetic, chalk it up, and find another dentist.

Steve


Quote:
Mark & Steven Bornfeld wrote:

gdelzer wrote:


Well, the initial response I received from the office manager is that
crowns are routinely placed on molars that have root canals but not
pre-molars because pre-molars aren't used for biting down as hard. This
strikes me as completely arbitrary.

Does this make sense from a scientific or dental standpoint?

No. Speak to the dentist.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001




--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
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