Dennis Brave, DDS; Kenneth Koch, DMD
A question we often hear from general practitioners is, "When do I do the endo?"
This question is usually asked in reference to the old direct pulp cap vs. root canal dilemma. The overwhelming majority of endodontists (including us) believe that direct pulp caps are best utilized on young patients with minimal exposures. The increased vascularity of a young pulp will decidedly help the patient. However, we are not proponents of direct caps on adult teeth, as their success rate is very low. Additionally, some dentists remain confused on the endodontics for prosthodontic expediency issue. Let's look at a few examples.
Pink teeth — Have you ever done a crown preparation on a peg lateral and then turned away from the patient for a few minutes? Then, when you turn back to the patient, you see a nice, pink little tooth. It is cute, but, unfortunately, it's cooked! Do the endo.
Brownish/purple teeth — What about the crown preparation that turns a dark brownish- purple color? Can you save this tooth by adding eugenol to the temporary cement? Not really. This is actually thrombosis that has taken place in the prepared tooth. Do the endo.
Bunny teeth — Some people have exceptionally long incisors. These sometimes are referred to as "bunny teeth." Yes, they are cute as well, but, unfortunately, they have very high pulp horns. You need to factor this information into your crown preparation. If you get an exposure and see a pink halo around the defect, what do you do? Do the endo.
The last question is, "When do we do a RCT for prophylactic reason?" This is often a clinical decision and can be difficult. For example, after presenting the patient with a treatment plan for six anterior units of crown and bridge, you don't want to add an additional $500 for the root canal on tooth No. 10. However, if No. 10 is blushed or very close to requiring a root canal, take our advice and do the RCT.
The worst case scenario is to do a beautiful crown, only to have to open the tooth and do a root canal two to three weeks later. Patients seldom appreciate having holes drilled into their new crowns. An even bigger nightmare is if the tooth is part of a six-unit bridge and you break the porcelain or shear off the glass while making your endodontic access. There goes your lab bill!
We have never in our combined 55-plus years of experience had a patient who did not understand why we had to do a RCT to prevent further damage. No one exactly welcomes this treatment; certainly, no one wants to pay an extra $500. Patients do understand. However, they cannot and will not understand if you go through a beautiful new crown to perform a RCT, only to have the porcelain shatter. The way to avoid this nightmare is simple: Do the endo, Dude!
Hopefully, these few examples will make your Endo/Prosth life a little easier. Never forget that endodontics and prosthodontics complement each other. In the meantime, we will continue to give you, "Just the Facts — Nothing but the Facts."
Dr. Dennis Brave is a diplomate of the American Board of Endodontics and was the senior managing partner of a group specialty practice for 27 years. Dr. Kenneth Koch is the founder and past director of the new program in postdoctoral endodontics at the Harvard School of Dental Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic education company. They can be reached at (866) RWE-ENDO, or visit their Web site at RealWorldEndo.com.
