When I received a root canal from my cosmetic dentist in 2018, she wanted to place a porcelain veneer over the toot, but I declined. The tooth is dark now, and I’ve relocated to Burlington, which is 400 miles from my former dentist. My new dentist recommended a crown for the tooth because he said a veneer wouldn’t work anymore. I didn’t realize that he would have to file down the tooth for a crown. I know it’s probably too late, but was my dentist too aggressive in recommending a crown? Elyssa from Burlington, VA

Elyssa,

Dental schools train dentists to restore a tooth with a crown after root canal treatment. Your dentist was likely doing as he was taught. Crowns require shaving your tooth to ensure it fits without negatively affecting your bite.

When Do Cosmetic Dentists Use Crowns After Root Canal?

• Extensive damage – If a tooth has a lot of its structure missing, dentists place a crown. After root canal treatment, a tooth can become brittle, and the risk of fracture increases. A crown protects the tooth.
• Back teeth – Daily, back teeth are subject to the pressure of biting, chewing, and grinding food. If a back tooth is severely damaged, broken, or split, a crown will prevent further damage and withstand the forces of biting and chewing. Less pressure is exerted on the front teeth.

Do Front Teeth Need a Crown?

An impact on your front teeth is usually lateral. So front teeth are most likely to snap off at the gumline. A dental crown removes about a millimeter of structure around the entire tooth and can weaken it.

Although most dentists prepare teeth more aggressively, the photo below shows very conservative preparation for a dental crown. The tooth will be stronger and less likely to break.

What About a Porcelain Veneer After Root Canal Treatment?

After root canal treatment, some cosmetic dentists choose to restore a front tooth with a porcelain veneer whenever possible. Only 0.5 mm of the enamel is removed.

Most general dentists don’t place veneers on front teeth after root canal treatment because it requires more skill. The dentist and the laboratory technician must understand how to conceal the darkness of the tooth and make the veneer look natural. Most general dentists like the skill and artistic ability to provide aesthetic results.

The photos below are an example of the amount of tooth structure that dentists with conservative porcelain crown preparation vs. conservative porcelain veneer preparation.

What Causes Discoloration After Root Canal Treatment?

Rather than darkness from the tooth drying out, root canal filling materials inside the tooth can darken it. Advanced cosmetic dentists prevent premature darkening with the following steps:

• Clean out the filling materials
• Place a white fiberglass post into the root
• Seal the opening with tooth-colored composite

The technique delays discoloration for five or ten years and prevents the need for a veneer until then.

 

Michael Szarek, DMD of Lowell, MA sponsors this post.