Pain after post and core
Rob Usdin
lower left).
Yesterday the dentist did the post and core on this tooth. While
grinding to tooth down in prep - using whatever the tool on the drill
does the grinding (big vibrations) it vibrated quite a bit and even
though I had novocaine I still felt sensitivity and pain as she put
pressure on during the grinding. She also when prepping around the
sides of the tooth said she removed some gum overgrowth (which I also
felt).
She did the temporary fine, and it's on. I am feeling pretty constant
pain right now from the tooth when putting pressure on it and constant
moderate pain in the jaw below. I've felt similar pain on another
root canaled tooth after root canal but I don't recall much soreness
after a post and core being done.
So my question is this - is this even somewhat normal after a post and
core because the tooth is still sensitive? It did hurt for a bit
after the root canal as well which subsided. Is this just re-
irritation that will subside, kind of like a bruise? Or would this be
indicative of a root fracture?
Thanks.
--*Rob
Steven Bornfeld
It sounds like she did a lot more than a post and core--she prepped the
tooth, and there may be gingival pain. There are other possibilities as
well, of which root fracture is the worst (you would almost certainly
lose the tooth). Most of the bad ones (fracture, root perforation,
overextension of the post) can be easily determined by an x-ray, and
significant pain should be checked.
Steve
REP
Rob Usdin <rus...@gmail.com> wrote:
> So my question is this - is this even somewhat normal after a post and
> core because the tooth is still sensitive? It did hurt for a bit
> after the root canal as well which subsided. Is this just re-
> irritation that will subside, kind of like a bruise? Or would this be
> indicative of a root fracture?
For real advice, please see your dentist. Every mouth/tooth is
diffferent; what I am about to post is an anecdote:
I recently had a root canal on #3 (upper right molar) due to nerve death
and fracture. The RC was largely painless ... then again, the nerve was
"dead" before the RC. A week later, I had the crown prep, build up and
casting for post - and it HURT!! Not just being in a bite block for 2
hours, ouch, but apparently there's plenty of nerves left in the gum,
etc! I was surprised at how much it hurt, and my dentist said that that
crown prep was the worst part of the whole thing. (A bunch of xrays
were taken the following week when the post was placed - no root
fracture, and by then the pain had gone to just somewhat achy).
--
"Did Father shoot him? I will eat Grandfather for dinner."
- Helen Keller, on learning of the death of her grandfather
email: aripee at inanna . com
Amatus Cremona
Why bother?
--
/
Amatus
/
"REP" <rep~@inanna.com> wrote in message
news:cb3hi.16313$2v1....@newssvr14.news.prodigy.net...
REP
"Amatus Cremona" <Nic...@sottovocce.com> wrote:
> What is a post and core? Temporary?
>
> Why bother?
It is entirely possible that, being merely an owner of teeth and not a
professional, that I screwed up some terms or used them improperly. I
had a broken tooth with a nerve that was not functional; that tooth had
a root canal; then that tooth was prepared for a custom-made cast-to-fit
post and crown. I am having quite a few crowns - years of poverty - and
my dentist wants to place them at the same time, so I currently have 3
temporary crowns and will have another in about 10 days. Why bother?
Need the temporaries to protect what remains of the teeth before they
are crowned, or so my dentist tells me. Personally, I'd rather have the
temps than be forced to sit on the porch and play my banjo.* Sure, the
work is all on molars, but same principle.
The point of my anecdote (which was labeled as an anecdote, and not as
gospel or full of correct jargon) was merely that one other person has
recently had a crown prep, that it hurt like fucking hell and was told
that it was normal to hurt like fucking hell.
*"Deliverance"
Amatus Cremona
I did not aim my comment at you. :-)
I was simply pointing out to the professionals on this forum that we need to
find ways to reduce the amount of grinding we actually do on a tooth. This
(in my office) means cores are not done and I do onlays instead of crowns.
Since I use a CAD-CAM system, I do them in one appointment rather than two,
so no temporary is needed.
Your description could indeed be an indication that there is a fracture in
the root. Posts are notorious for cracking roots. Especially if they have
a taper or have screw threads. Even smooth sided straight posts will crack
roots if the patient clenches at night. A lot of us now feel that if we
could not restore the tooth unless we used a post, that the tooth probably
should not be restored, but removed. In retrospect, teeth that survive for
decades with a post in them, never needed the post in the first place.
Do NOT have the finished crown final cemented on the tooth if it still hurts
! ! ! If it hurts with the temporary, it will still hurt with the finished
crown. Find out why it hurts first.
--
/
Amatus
/
"REP" <rep~@inanna.com> wrote in message
news:FQ5hi.18582$RX....@newssvr11.news.prodigy.net...
Steven Bornfeld
> What is a post and core? Temporary?
>
> Why bother?
>
You're slipping. I figured you'd be in within the hour.
Seriously, you never use posts? I'm aware that accepted guidelines
have changed, and I assume your Cerec will create in effect an integral
core/restoration. But in order to create a path of draw, won't that
sometimes require you to remove extra tooth structure?
Steve
Steven Bornfeld
> In article <zk5hi.7312$Rw1....@newssvr25.news.prodigy.net>,
> "Amatus Cremona" <Nic...@sottovocce.com> wrote:
>
>> What is a post and core? Temporary?
>>
>> Why bother?
>
> It is entirely possible that, being merely an owner of teeth and not a
> professional, that I screwed up some terms or used them improperly. I
> had a broken tooth with a nerve that was not functional; that tooth had
> a root canal; then that tooth was prepared for a custom-made cast-to-fit
> post and crown. I am having quite a few crowns - years of poverty - and
> my dentist wants to place them at the same time, so I currently have 3
> temporary crowns and will have another in about 10 days. Why bother?
> Need the temporaries to protect what remains of the teeth before they
> are crowned, or so my dentist tells me. Personally, I'd rather have the
> temps than be forced to sit on the porch and play my banjo.* Sure, the
> work is all on molars, but same principle.
>
> The point of my anecdote (which was labeled as an anecdote, and not as
> gospel or full of correct jargon) was merely that one other person has
> recently had a crown prep, that it hurt like fucking hell and was told
> that it was normal to hurt like fucking hell.
You were misinformed.
As for Amatus, forgive him. We have a running inside joke, and you got
caught in the crossfire.
Apologies,
Steve
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> *"Deliverance"
>
Steven Fawks
> The point of my anecdote (which was labeled as an anecdote, and not as
> gospel or full of correct jargon) was merely that one other person has
> recently had a crown prep, that it hurt like fucking hell and was told
> that it was normal to hurt like fucking hell.
I would not like such pain to exist in any tooth that I have plans
to cement a permanent crown on top of.
If it does not feel pretty good by the cementation appt., I would
not place that crown (or any of the 'neighbors') until the pain
problem is corrected.
Was the root canal just recently done, or was it older treatment?
As far as posts being 'notorious' for cracking roots, that statement
could be a little inflamatory. I have placed many posts over the
last 28 years of dentistry, and the failures have been low. Of those
failures, most have been failures of the build up around the post or
the post itself. Not very many have been root fractures.
These posts have been mostly size #5 pre-fab, cemented posts. Stainless
steel in the early days, then titanium (I tried the fiber posts for
a few years and they failed at an alarming rate, so I'm back to
titanium).
JMO,
Steve Fawks
Amatus Cremona
"Steven Bornfeld" <dentalt...@earthlink.net> wrote in message
news:P09hi.2147$tj6....@newsread4.news.pas.earthlink.net...
> Amatus Cremona wrote:
>> What is a post and core? Temporary?
>>
>> Why bother?
>>
>
> You're slipping. I figured you'd be in within the hour.
You caught me napping :-))
> Seriously, you never use posts?
I will use a fibre-post when I have no supragingival tooth to bond to, and
the patient understands that this is only an effort to get another year or
three out of the root before implants. The forces which broke off the tooth
at the gum-line will still be there. I want the next gfracture to be
supra-gingival which is less likely to be an emergency with pain and
swelling on the weekend I drive Strad up to Interlochen. I threw out all
the metal posts (actually donated them).
>I'm aware that accepted guidelines have changed, and I assume your Cerec
>will create in effect an integral core/restoration.
The machine will replace whatever is missing. You are free to use your
imagination during preparation and clean out the tooth as you see fit. The
technology simply replaces what was removed by caries and dentisty.
> But in order to create a path of draw, won't that sometimes require you to
> remove extra tooth structure?
Line of draw is visual. Whatever the camera can see, is what will be made.
The technology CANNOT make an internal undercut, because the camera does not
see it. Slight internal undercuts of the preparation are simply filled with
the luting agent. Larger ones,,, you have to decide how thick of a core of
luting agent you are comfortable with. More than a full mm, and I will
generally reduce the enamel above it slightly. I like more porcelain in the
tooth and luting agent. My big concern is the side of the tooth, not the top
of it. I want the thick enamel on the buccal and lingual walls to remain
intact at all times. This enamel is generally very well supported by dentin
and is important to the inherent flexibility of the tooth. Abfraction and
fracture are reduced when you keep this part of the tooth. If I see
fracture lines in the base of a cusp or the floor of the preparation, After
imaging the fractgures for my record, I will reduce the height of the cusps
on that side (or both sides) by 3 mm. The porcelain then covers this much
of the cusp in order to prevent spreading the cusp tips apart during
isometric bruxism and further fractgure. I always show the patient the
fractures on the monitor and explain that prognosis is reduced.
Steve, also
Steven Bornfeld
Thanks for the clarification.
Best,
Steve
REP
Steven Fawks <tuthj...@myturbonet.com> wrote:
> > The point of my anecdote (which was labeled as an anecdote, and not as
> > gospel or full of correct jargon) was merely that one other person has
> > recently had a crown prep, that it hurt like fucking hell and was told
> > that it was normal to hurt like fucking hell.
>
> I would not like such pain to exist in any tooth that I have plans
> to cement a permanent crown on top of.
>
> If it does not feel pretty good by the cementation appt., I would
> not place that crown (or any of the 'neighbors') until the pain
> problem is corrected.
>
> Was the root canal just recently done, or was it older treatment?
I meant the prepping was quite painful. The tooth itself is 'dead' - the
nerve had 'died' before the RC had certainly hadn't recovered after it
(and yes, the RC had been done the previous week). It didn't hurt at all
until I had spent 2.5 hours in a bite block, getting many, many
needlesticks, a lot of grinding and some work done on the gum. The tooth
still didn't hurt - but everything around it sure as hell did. A lot.
Again, just an anecdote from someone who had recently had it done to
someone else who recently had something similar done - and please note,
my anecdote began with "see your dentist for real advice."
REP
"Amatus Cremona" <Nic...@sottovocce.com> wrote:
> I am so sorry ! I should have been more clear.
>
> I did not aim my comment at you. :-)
No problem. I was afraid I hadn't been clear enough that I was merely
adding an anecdote that was worth exactly what was paid for it.
> I was simply pointing out to the professionals on this forum that we need to
> find ways to reduce the amount of grinding we actually do on a tooth. This
> (in my office) means cores are not done and I do onlays instead of crowns.
> Since I use a CAD-CAM system, I do them in one appointment rather than two,
> so no temporary is needed.
>
> Your description could indeed be an indication that there is a fracture in
> the root. Posts are notorious for cracking roots. Especially if they have
> a taper or have screw threads. Even smooth sided straight posts will crack
> roots if the patient clenches at night. A lot of us now feel that if we
> could not restore the tooth unless we used a post, that the tooth probably
> should not be restored, but removed. In retrospect, teeth that survive for
> decades with a post in them, never needed the post in the first place.
>
> Do NOT have the finished crown final cemented on the tooth if it still hurts
> ! ! ! If it hurts with the temporary, it will still hurt with the finished
> crown. Find out why it hurts first.
The *tooth* never hurt. The tissue surrounding the tooth hurt like all
hell, due to the needle sticks, grinding, etc. I don't have a digital
xray of the tooth, but even if I did, it doesn't really show how damaged
the erupted areas were - it had large amalgam fillings, which fell out
when the tooth cracked diagonally, taking out the lingual side and most
of the back but the 'footprint' of the tooth was intact, and the roots
are strong and surprisingly healthy. A lot of remaining tooth had to be
removed as it was too thin to be of use (remember, it was honeycombed
with holes from former fillings) and the lingual side was broken just at
the gumline. After the tooth was 'cleaned up,' the casting was made for
the post - all this took some time, and no doubt being in a bite block
for as long as I was contributed to the post-poking pain.
By the time the post was to be intalled, the tissue had recovered and
stopped hurting; the tooth itself remains nonpainful, even with a large,
strange object in it. The only really thing I notice is that it's wider
and thicker than it's been for a year (since the temp is shaped like a
healthy tooth, and not my broken one).
It's been xrayed since the post has been placed (there is some concern
since #2 and #4 are absent) but the post is an excellent fit and so far,
it's fine. Once #30's crown is done - it had an RC due to absess years
ago but I couldn't afford the crown then - we'll all see how #3 does
with another tooth making full contact.
Amatus Cremona
--
/
Amatus
/
"Steven Bornfeld" <dentalt...@earthlink.net> wrote in message
news:k_Ohi.2804$tj6....@newsread4.news.pas.earthlink.net...
Amatus Cremona
will probably be sensitive to chewing forces for the first few weeks, as the
ligament holding the tooth in place re-adapts.
--
/
Amatus
/
"REP" <rep~@inanna.com> wrote in message
news:SL3ii.9829$c06....@newssvr22.news.prodigy.net...
Newbie
>Should have been " I like more porcelain in the tooth and LESS luting agent.
We knew that.
Rob Usdin
this.
The tooth is down to a slight ache. If it was still hurting as much
as it did last week I'd be at the dentist right now, but it may have
just been pain from the prep of the gum, as well as pressure to the
tooth "bruising" the tooth in the socket down to the jaw. I can bite
and eat on it just fine now, I still have a slight ache but it is
controllable with one Advil so I'm thinking there's nothing adverse
going on. I will mention it all to the dentist though when I go to get
the permanent crown placed in 10 days in case she decides it is worth
an x ray just in case.
Also- just curious - are many dentists adopting digital x rays? I had
another root canal early this year and the endodontist used digital x
rays. For me as a computer guy, I thought it was pretty cool how they
could blow it up and get a better look. My regular dentist though
still uses the standard x rays. Just wondering what the adoption rate
on digital is. Is my dentist behind the times or is the endo on the
leading edge?
--*Rob
Newbie
> Is my dentist behind the times or is the endo on the
>leading edge?
>
>--*Rob
Would guess that most endo's have digital and were
early adopters.
Many still use film, such as me, because of the expense
of going digital. It ain't cheap. Mebbe when the price
drops a bit.
Amatus Cremona
Digital is "an expense" to purchase initially, but is paid for entirely by
what you would have spent with film. Depending on how busy the office is,
the break-even point is 2-3 years. After that, it is much cheaper to use
digital.
--
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Amatus
/
"Newbie" <n...@bix.nex> wrote in message
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Amatus Cremona
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Amatus
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"Rob Usdin" <rus...@gmail.com> wrote in message
news:1183385909.3...@n2g2000hse.googlegroups.com...
Newbie
See, that was a perfect set up by me.
Good job AC !
Amatus Cremona
--
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Amatus
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"Newbie" <n...@bix.nex> wrote in message
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