How frustrating is it for us to do a wonderful root canal only for the patient not to get it restored and need extraction!
I had more of these when I started my dental career than I do today and it is not that the dental IQ of my patients is any different from back in the day. It is the way I approach the case from the very beginning.
When a patient presents with pulpal pain, the conversation is usually like this:
Pt: I am in a lot of pain. It hurts when I drink something hot and cold OR it hurts when I bite down!
Dr: Looks like you need a root canal. This will be the cost to you out of pocket!
Pt: Ok let's do it.
Note that nowhere was there a mention of a coronal restoration, leave aside a crown. So one of two things happen when the endo is completed:
1) The patient is then informed about the need for a post-core/build up and crown and given the financial estimate. Patient's normal and expected reaction is "I never knew I had to get that done! That's too much. I can't get that done."
2) The patient is given an apt for a full exam and never shows up.
Either way, it's a lose-lose situation.
What we do now is make the coronal seal and crown part of the root canal therapy. So instead of just saying "You need a root canal", we say "You need a root canal and then some sort of a permanent filling and possibly a crown over it to save the tooth. Failure to do any of the subsequent steps will render the root canal susceptible to infection and fracture and will most likely need extraction!"
Bottom Line: Don't separate the coronal restoration from the root canal therapy!
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