After a root canal is completed what still has to be done to finish my tooth?

Today a patient came in who had finished his root canal over a year ago on his left maxillary molar. He reported that something had broken. I looked at his tooth and it was missing the interim filling that my endoodontist had placed and the tooth's buccal wall had a mesial distal fracture line and the entire buccal wall was movable but not yet separated from the gums holding it.

After numbing my patient I removed the moving buccal wall and it was clear that it had separated approximately at the level of the bone and in some places the tooth had fractured sub crestal. I explained that this tooth was best removed because too much bone would have to be removed in order to successfully restore it.

My patient was surprised since his root canal was done and that the specialist had finished. Why did this happen?The answer is even if the root canal is finished, most specialists leave the tooth with an interim "temporary" filling. Most back teeth need a core (a filling) and a crown to protect them afterwards or the tooth is at risk for fracture. Possibly he misunderstood the conversation with my endodontist ... I do not know for sure, but most endodontists are careful to explain to their patients that they should return to their general dentists or prosthodontist to have the tooth restored.

Most molar or premolar tooth have a fairly large access hole that the endodontist makes plus most teeth requiring root canal have compromised tooth structure even before the root canal was started. Afterwards these teeth are at risk for fracture and covering them with a permanent crown is thought to provide protection from the forces of  chewing.

Anterior teeth, those from canine to canine tend to do better with just a filling since these teeth experience a greater amount of horizontal loading and preparing them for crowns can actually weaken these teeth further. Also Anterior teeth are used primarily for "cutting food" and the forces placed on them are less than posterior teeth. A great many anterior teeth are restored with composite fillings,  if enough tooth structure remains.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/04/after-root-canal-is-completed-what.html - http://lspindelnycdds.blogspot.com/

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