Is it necessary to put a cap or crown after root canal treatment?

Advising a dental patient on the treatment to be performed is, in many cases, straightforward, because the dental professional sees innumerable advantages to one technique over another, and points out to the patient that this is what should be done.

In other cases, it is more complex because there are several alternatives to choose from, and it is up to the patient to decide which one to opt for, advised by their trusted dental professional, based on the advantages and disadvantages of each procedure.

One of the most frequently asked questions in recent times in the field of restorative dentistry has been whether it is necessary to place a 'sheath' or 'crown ceramic on the tooth after root canal treatment, which is popularly known as 'killing the nerve'.

Patients in Murcia often ask: why? Placing a sheath is a means of 'protecting' a tooth that, after root canal treatment, is weakened by the amount of tooth that was previously decayed and the tooth that had to be removed to reach the nerve.

In these cases, after a normal filling, a fracture of one of the weakened walls of the tooth would occur after some time, forcing the tooth to be extracted and losing a tooth that both the dentist and the patient wanted to keep in place.

At the bottom left, we can see a cover
At the bottom left, we can see a cover

For this reason, the use of 'caps' or 'crowns' became widespread, which avoided this problem by covering the entire tooth with a rigid structure that is difficult to fracture. However, over the years, 'microleakage' can occur between the tooth and the crown so that saliva and food can enter the tooth, causing decay and in some cases causing the tooth to be extracted.

A leak has caused the tooth to decay and the crown to fall off (bottom left).
A leak has caused the tooth to decay and the crown to fall off (bottom left).

This is something that has been studied in depth and that, in many cases, is currently solved by performing a filling with a 'cuspid protection', consisting of 'filing' part of the cusps of the teeth and also covering them with 'filling' material in a safe way and avoiding filtrations.

If the sheath falls off and it takes a long time, the root is usually below the gum and the root has to be extracted and the tooth is lost.
If the sheath falls off and it takes a long time, the root is usually below the gum and the root has to be extracted and the tooth is lost.

In this way, a reinforced structure can be achieved by 'filing down' as little tooth as possible and without the need for a veneer, which is now reserved for cases where there is hardly any tooth tissue left and one of these is combined with an intraradicular pin to give greater strength, which is more difficult to achieve with a 'filling'.

This is why, when faced with a complex situation, it is essential to have the advice and confidence of experienced professionals in restorative dentistry solutions that know how to provide the best solution to our problems, and communicate to us the alternatives available to us, with the advantages and disadvantages that each one of them presents.

Despite the retention elements, the cover may come off.
Despite the retention elements, the cover may come off.