Crown or onlay.

[EugeneOl]

Hello. I have been experiencing a heartbeat in one of my molar teeth. Some time ago there was a large filling put into this tooth  and from he onset I could say I could feel this tooth. I would not hurt, sometimes I would experience discomfort and heartbeat under it especially while exercising. I told that to my dentist who took a number of X-rays and could see some blurred spots but could not say for sure that it reached the root. Anyways, he referred me to other dentist for root canal procedure and advised that a crown would be needed after root canal procedure. I had a pre-determination done by my insurance and saw that also a post and core procedure would be done along with root canal. I had another dentist look at my tooth and she could not say for sure either whether I would need a root canal or not. She said a Cat Scan of my tooth (not covered by my insurance) will tell me exactly if i need root canal done or not. She also said that i could go with onlay procedure if so I decide. So now I do not know what to do.  In case I need a root canal done, would a crown or onlay be a better option ? would I need post and core if I decide to go with onlay ? If cat Scan determines that I do not need root canal , what can I then do about heartbeat? I read about pulp capping, would that be an option?

[Jerome Tsang, DDS]

Its a tough call.  If you decide to do an onlay and later on need a root canal, they may need to put a crown on it later on anyways.  I suppose a CAT scan can determine how deep the cavity is, if there is on, but I don't think they can predict whether or not the tooth will heal and respond positively after being drilled on.  I would suggest you either do the root canal because it is symptomatic or you can try to remove the old filling and remove any decay and put a temporary filling in there to see if the tooth will give you any problems for a few weeks.  If no problems, then you can try to place an onlay on it and hope that it never becomes symptomatic although if you do that, it may still need a root canal and I don't think anyone can predict how long it will be before a root canal is needed.  It could be a week, it could be years.

[Jerome Tsang, DDS]

If you decide to do a root canal, an onlay may not be the most ideal treatment.  A crown may be a more ideal option.  As for the post/core, a core is necessary but a post is dependent upon how much tooth structure is left after the root canal.

[EugeneOl]

Thanks for your response.

[EugeneOl]

Thanks for your answer. If I do the root canal and decide to go with onlay, would the post and core be necessary? and is onlay a better option after root canal or a crown? Thanks