Many many years ago, one of my prosthodontic instructors shared a story about how one of her referring endodontists had worked on one of her crown-prepped walls.
I didn’t think anything of it.
What’s the big deal? [being endo]
If there was any decay on that wall, it should have been removed anyways. [again, being endo, I do see prepped walls with decay]
Obviously, if there’s decay and the final temporary impression has not been taken, it is time to rectify the crown prep and communicate with the referring dentist.
However, oftentimes, as we know in life, ideal circumstances and timing are not always aligned.
With respect to my [endo] office, we rely heavily on the referral and PREPARATION. We ask for Xrays. We ask for the referral. We read those BEFORE the patient arrives so that we know what to expect. We rely on our referring docs to share that a tooth has been crown-prepped – does not always happen, but we appreciate the information.
When a tooth has been crown prepped, we then call the referring office. Has the final impression been taken? I would say that about 15% of the time, it has. Yes, not the majority, but still potentially enough to make >1 referring doc upset.
In my Endo office, if a crown-prepped tooth has already had the final impression, I try my very best to AVOID “touching” the walls with my bur.
I had a beautiful prep last week – all four walls were intact (rare for a crown prep) and the occlusal table was plentiful. This pearl occured to me then, but I forgot to take the pic. My access was perfectly centered (not always the case) and I didn’t get near the occlusal or any side-prepped walls. My temp was flush with the occlusal table and all was perfect – LOVE THIS SO MUCH.
Because I forgot to take the picture, I thank Greg and Dino – thank you Dino for sharing your beautiful crown preps. Gorgeous.
[learn more from Dr. Napoletano here: https://www.facebook.com/DonatoDentalSystems?mibextid=LQQJ4d]
Imagine my access on either of these pics – perfectly centered, small and totally flush with the occlusal prepped surface. SO IDEAL.
However, the access also cannot always be centered…. in the past several years I have been utilizing CBCT-guided accesses. To elaborate, I use my cbct for very, very guided access, and also to avoid touching the prepped walls. Meaning, based on how I outline (through segmentation of my WLs with the ruler function on the 3D software – akin to tracing the IAN) my canals to the occlusal table, I might have to modify my access so that I don’t touch the prepped walls, when possible. Otherwise, the final impression will have to be retaken!!!! What if the crown has already been made! That will surely upset a RD.
Always, the ideal outcome and goal for both endodontics and dentist is to save the tooth (with endo) and place the crown.
As endodontists, we should be mindful (and demure) to PLAN and adjust our access – hopefully just a little bit, without compromising the Endo – to honoring the prep when the final impression has been already taken.
That is a win for everyone!!!
