[Second Opinion] I had these root canals done August 23 and Sept 6th. Crowns were done Oct 5th. Does the work look adequate?

Patient Question

Thomas Brown 🇺🇸: Dr. Samuel, I’m seeking a second opinion on root canal treatments I recently had. I had root canals done on two teeth—one on August 23rd and another on September 6th. The permanent crowns were placed on October 5th. I don’t have any pain, but I’m concerned about the quality of the work. How can I tell if the root canals were done properly? Is there anything specific I should look for in the X-rays? Also, was the timing appropriate for placing the crowns after the root canals?

Dr. Rockson Samuel’s Response

Dr. Rockson Samuel: Thank you for reaching out for a second opinion, Thomas. It’s prudent to be proactive about your dental health, and I appreciate your thoughtful questions about the endodontic treatment you received.

Assessing Root Canal Quality

Without seeing your specific radiographs, I can provide you with the key quality indicators that endodontists and general dentists use to evaluate root canal treatment. These are the same criteria I would use if I were examining your X-rays in person:

1. Radiographic Assessment Criteria

a) Obturation (Filling) Length:

• Ideally, the root canal filling material should extend to within 0.5-2mm of the radiographic apex (tip of the root)
• Fillings that are significantly short (>2mm from the apex) may leave untreated space
• Fillings that extend beyond the apex (overfilled) might cause post-operative discomfort, though many heal uneventfully

b) Density and Homogeneity of the Filling:

• The filling should appear dense and uniform throughout the canals
• There should be no significant voids (empty spaces) within the filling material
• The interface between the filling and the canal walls should show good adaptation

c) Canal Preparation Shape:

• Canals should maintain their original anatomy while being sufficiently enlarged
• The preparation should have a consistent taper from crown to apex
• No evidence of transportation (shifting of the canal path) or perforation

d) Number of Canals Treated:

• All canals should be identified and treated
• Depending on the teeth involved, specific numbers of canals are typically expected:
  • Lower molars usually have 3-4 canals
  • Upper molars typically have 3-4 canals
  • Premolars may have 1-2 canals
  • Anterior teeth typically have 1 canal (occasionally 2)

e) Absence of Procedural Errors:

• No visible instrument separations (broken files)
• No perforations (holes) through the root surface
• No significant alteration of the natural root anatomy

2. Clinical Assessment Criteria

While radiographs provide valuable information, they don’t tell the complete story. Clinical factors that would suggest successful treatment include:

a) Absence of Symptoms:

• No pain to percussion (tapping on the tooth)
• No spontaneous pain
• Normal function during chewing
• No swelling or tenderness in the surrounding gums

b) Healing of Any Pre-existing Pathology:

• Resolution of any bone lesions visible on the initial X-rays
• This may take 6-12+ months to be radiographically apparent
• Early follow-up radiographs may not yet show significant healing

Timing of Crown Placement

Regarding your question about the timing between the root canal treatments and crown placements:

1. Industry Standards:

   • The optimal timing for permanent crown placement after root canal therapy varies based on clinical circumstances
   • Historically, dentists often waited 1-4 weeks after root canal completion
   • Modern evidence suggests that delaying crown placement significantly (beyond 1-3 months) increases the risk of tooth fracture and bacterial recontamination

2. Your Specific Timeline:

   • Root canal #1: August 23
   • Root canal #2: September 6
   • Crown placements: October 5
   • This represents approximately 4-6 weeks between your root canal treatments and crown placements, which falls within accepted clinical guidelines

3. Factors That Influence Timing:

   • Presence of pre-operative infection
   • Complexity of the endodontic treatment
   • Need for post placement
   • Patient-specific factors (healing capacity, occlusal forces)
   • Tooth type (molars benefit from more expedient coverage than anterior teeth)

4. Modern Approach:

   • In the absence of signs or symptoms of persistent infection, earlier restoration with a permanent crown is typically preferred
   • The timing in your case (4-6 weeks) is reasonable and aligns with contemporary practice

Getting a Comprehensive Second Opinion

If you’d like a more definitive assessment, I recommend:

1. In-Person Evaluation by an Endodontist:

   • Bring your current radiographs or have them forwarded digitally
   • New radiographs may be taken for comparison
   • A clinical examination will supplement the radiographic findings

2. Consider 3D Imaging (CBCT):

   • If there are specific concerns about missed canals or other issues not visible on traditional X-rays
   • CBCT provides a three-dimensional view that can reveal details not visible on two-dimensional radiographs

3. Documentation to Bring:

   • Pre-operative radiographs (if available)
   • Immediate post-operative radiographs
   • Current radiographs
   • Treatment notes if you can obtain them
   • List of any symptoms or concerns you’ve experienced

Your Absence of Symptoms is Encouraging

It’s worth emphasizing that your report of no pain is a positive clinical indicator. While not a guarantee of success, it suggests that:

• No acute inflammation is present
• No significant pressure is building within the tooth
• The treated teeth are likely functioning as expected

However, some endodontic issues can be asymptomatic initially, which is why radiographic evaluation remains important even in the absence of symptoms.

What to Do If Issues Are Identified

If a thorough second opinion does reveal concerns with your root canal treatment, options might include:

1. Monitoring:

   • If minor imperfections are found but no intervention is immediately needed
   • Periodic radiographs to ensure healing progresses

2. Endodontic Retreatment:

   • Accessing through the crown to improve the root canal filling
   • Modern techniques can often be performed while preserving the existing crown

3. Surgical Endodontics (Apicoectomy):

   • For issues at the root tip that cannot be addressed from the crown
   • Involves accessing the root end surgically through the gum tissue

Would you like me to elaborate on any particular aspect of root canal assessment or treatment sequencing? I’m also happy to discuss what specific questions you should ask during an in-person second opinion consultation.

Further Reading and Resources

For more information on related topics, you might find these resources helpful:

• Root Canal Treatment Myths
• Dental Crowns: Complete Guide
• Retreatment Root Canal: Second Chance
• Apicoectomy: When Root Canal Isn’t Enough