Need Root Canal on Molar

[Bill A]

I have a molar that has a metal crown on it that needs a root canal. (See image) The endodontist assures me that she can perform the procedure without destroying the metal crown. How much confidence should I place in such an assurance? What is the success rate for this procedure, when the dentist just drills a small hole to perform a root canal?
And should I seek a guarantee that should she fail to complete the root canal without needing to destroy the crown, her dental practice will fit me with a new crown at no additional charge?
Thanks,
Bill in Baltimore

 

[realdentist]

the fact that it's a small hole that will be drilled should not bother you. The important things are that all the canals are located, all necrotic pulp tissue removed and and appropriate antibiotic treatment instituted. You can go ahead and ask for the agreement if you want to.

 

[Bill A]

I thought that my saga dealing with this dental problem was worth an update. The endodontist successfully performed the root canal treatment through a small hole in the crown, with another dentist performing the rest of the restoration work. This tooth did not give me any more problems for 4 and 1/2 years. But at that point the tooth broke off at the gum line. I therefore needed to have an extraction done of the piece of the tooth that was still embedded in my gum. The extraction was a very time-consuming and uncomfortable procedure for me. The reason was that the tooth, having had a root canal procedure performed on it, had fused with my jawbone. I am now having a partial denture fabricated to replace the functionality of this tooth and also of a second tooth that had been previously extracted in my lower jaw.
It would have been better if 4 1/2 years earlier the endodontist had recommended that, instead of performing a root canal, the tooth had simply been extracted. She did mention at the time that the tooth was in poor shape internally. But neither she nor the dentist who was performing the restoration work suggested that this would have been the better course of treatment. One reason for this I think is that I was getting the restoration work done at the University of Maryland Dental School, and the student dentists are not going to recommend an extraction when they can gain experience doing restoration work. But I am disappointed that the endodontist, having the best knowledge of the internal state of my tooth and recognizing what its problems were, did not recommend that an extraction would have been the best course of treatment for me.
I also had the extraction done at the University of Maryland Dental School, and the faculty dentist who was supervising the student dentist's work had to step in and complete the procedure to spare me any more suffering in the chair!

 

[Dr M]

Good day,
I am sorry to hear that in the end, you lost the tooth and that the extraction procedure was uncomfortable for you. Unfortunately any endodontically treated tooth can become very "brittle" with time, due to various factors and if this tooth was also subjected to excessive " biting " forces, it might have accelerated this process resulting in the fracture. It also then makes it very difficult to sometimes extract the remaining pieces, since they might also fracture.
As a dentist myself, I always give my patients all the options before starting with any treatment, because sometimes there are other factors such as finances at play as well. This is part of informed consent.
Without any radiograph, it is difficult to give an opinion with regards to the restorability of the tooth before and after treatment, but I also try and save a tooth most of the time, since nothing that we as human beings can do, can 100% replace a tooth that you were born with. But again-with informed consent from the patient. The fact that the tooth lasted 4 and a half years, is quite good, since the reason for failure at the end of the day might be related to other factors and not to the endodontic process.
Therefor it is always important not to only focus on one tooth at a time, but to take into consideration the patient as a whole, and how the treated tooth will fit into this picture of a well functioning patient.
I also recommend that in the future, you ask the dentist his/her opinion about alternatives, so that you can make a informed decision. Especially when thinking about the long run.
Just my opinion.
I wish you best of luck with the rest of your teeth. Might your smile still last a long time!