Rebuilding your tooth after its root canal treatment.

- Dental crowns vs. fillings. Which makes the best choice? - success rates | How soon does a final restoration need to be placed?

Crown or
filling?

Link to crown vs. filling section.

Advantages
of crowns.

Link to research about placing a crown after endodontic treatment section.

Every tooth treated will need a final restoration.

After a tooth's root canal therapy has been completed, it will require some type of permanent dental restoration.

This page discusses the different options you have in deciding how your tooth is rebuilt (crown vs. filling), and details that need to be considered when selecting between them.

Considerations:

 

You may also be interested in these additional topics about rebuilding root canalled teeth:

 


A) A crown or a filling after root canal - Which makes the best choice?

For the most part, the two basic options that you have for restoring an endodontically treated tooth are the placement of a dental crown or else a filling.

Here are some of the issues that need to be considered when choosing between the two.

An access cavity tends to weaken a tooth.

Teeth that have had treatment may require strengthening.

1) The tooth may need strengthening.

Teeth that have had root canal therapy can be fragile, possibly significantly so. Here are some reasons why:
Weakening has occurred during their treatment.
When performing root canal therapy, the dentist must create an access cavity (opening) in the tooth through which its work will be performed (see picture). And creating this hole tends to weaken the tooth.
  • When a conservative opening can be made in a virgin tooth (one that did not have a previous dental restoration), the reduction in tooth stiffness that results may just be on the order of 5% or so. (Eliyas)
  • But with many cases, like when the tooth's individual root canals have been difficult to locate, the dentist may need to remove a comparatively greater amount of internal tooth structure, to the point where the tooth may become significantly hollowed out.

 

Previous damage.

Teeth that end up requiring root canal treatment have often already experienced some type of significant event, and as a result, are already in a weakened state.

After its endodontic therapy, this tooth will require a crown.

This tooth is very hollowed out and should have a dental crown placed.

  • It's common that treated teeth have previously suffered levels of trauma that have resulted in crack formation or outright fracture. The loss of tooth structure due to the effects of advanced tooth decay can significantly weaken a tooth.
  • When repairs are made, it's been found that the need for a filling on the chewing surface of a back tooth tends to reduce its stiffness on the order of 20%.

    Larger fillings, like those whose extension is such that they touch neighboring teeth, have been found to result in an over 60% reduction. (Eliyas)

 

Changes in tooth dentin.

The flexural strength of dentin (the hard, calcified tissue that makes up the bulk of a tooth) is likely reduced by the various chemical agents frequently used during the cleaning phase of root canal therapy (Eliyas).

Each of the above suggests that by the time its root canal treatment has been completed a tooth may be at substantial risk for fracture, even when exposed to normal chewing forces.

If so, a dentist will frequently recommend that a crown should be placed. Dental crowns provide a strengthening effect that can help to prevent fracture.

Section references - Eliyas

Coronal leakage - Bacteria seeping past a dental filling.

If contaminants re-enter a tooth, its completed treatment will fail.

2) The tooth will require a proper seal.

If contaminants from the mouth find a way to seep past a tooth's dental restoration (a phenomenon termed "coronal leakage"), its root canal treatment can fail.
A dental crown, more than any other type of restoration, can help to predictably prevent this type of event. (Use the link above for a more detailed explanation.)

3) Restoration longevity / durability is an important factor.

The final restoration that a dentist places must be one they feel can provide lasting service. The specific physical properties that the restoration needs, however, will vary on a case-by-case basis.

Examples.

a) Relatively intact teeth.

It's possible that a tooth that ...

  1. Just has a conservative access cavity ...
  2. And no other history of significant tooth structure loss (such as a previous cavity, filling or breakage)

... might be successfully restored with just the placement of a dental filling.

This approach may be best suited for front teeth (incisors and canines) where the direction of force applied is typically non-axial.

With back teeth (premolars and especially molars), forces are more commonly directed straight down (axially) and for this reason providing for tooth reinforcement (like that created by crown placement) may make the more prudent choice.

Section references - Eliyas

b) More involved cases.

In comparison to teeth that are still in relatively pristine condition, those with large fillings or extensive decay, or teeth that fractured prior to their receiving root canal treatment, are probably best restored with a dental crown.

(If enough of the tooth's original tooth structure is missing, a dental post and core may be required before crown placement.)

This approach may be needed for either front or back teeth. Crown placement is especially appropriate for molars, a type of tooth that must be able to withstand heavy chewing forces.

 
Picture of filling placed in anterior tooth after root canal treatment.

Conservative access openings in front teeth may only require filling placement.

What type of final restoration makes the right choice for your tooth?

  • Placing a dental crown has increasingly become considered to be the appropriate "standard of care" for endodontically treated molars (see next section).

    (Related page: Can a tooth's existing crown be used after its root canal therapy is finished?)

  • For other teeth, especially relatively intact front ones (incisors and canines), and even possibly premolars, the decision to place a dental filling may make a perfectly appropriate choice.
Choosing between the two.

Just to recap, the decision here is basically one of judging if the needs of sealing the tooth (to protect the integrity of its root canal work) can be met by a filling over the long-term.

Issues involved include the quality of seal it creates and its anticipated service performance (strength, durability, longevity). Of course, the restoration must also meet the needs of the tooth in terms of helping to prevent catastrophic failure (i.e. tooth fracture).

Pros and cons.

The advantage of utilizing a filling is that it avoids subjecting the tooth to the aggressiveness of crown placement. This includes much more extensive tooth structure reduction and greater cost. Also important to consider, crown placement still involves duration-of-service factors.

The decision between the two typically boils down to the extent of original tooth structure that still remains (is the tooth still structurally intact) and the degree of wear and tear and level of force the restoration is expected to be subjected to (can it be expected to provide predictable service).

Obviously, your decision will almost always be based on the advice of your dentist. But it's these types of issues and factors that they should have considered, and be able to provide an explanation to you about. There is no cookie-cutter best choice that applies to all cases.

B) Dental research confirms the benefit of dental crowns.

An x-ray showing completed endodontic therapy and a dental crown.

X-ray showing a tooth's completed treatment and dental crown.

Several studies have evaluated the outcomes of teeth that have had root canal treatment and then were, or were not, crowned. Here are the findings of some of those studies.
1) Aquilino (2002) - This study evaluated the track record of 400 endodontically treated teeth and found that those that were not crowned were lost at a rate 6 times greater than teeth that had dental crowns placed.

2) Nagasiri (2004) - This study evaluated 220 molars that did not receive dental crowns after root canal treatment. The survival rates of these teeth at 1, 2 and 5 years were 96%, 88% and 36% respectively.

3) Lynch (2004) - This study evaluated 176 teeth for a6 three-year period following the completion of their root canal treatment. The following survival rates were observed for teeth with the following types of restorations: cast restoration (dental crown) - 92%, amalgam restorations ("silver" filling) - 67%, composite restorations (tooth bonding) - 35%.

Section references - Aquilino, Nagasiri, Lynch

Learn about the different types of dental crowns.

Click image to jump to topic Dental Crowns.


C) How soon does the permanent restoration need to be placed?

Your dentist will make a recommendation about the time frame that is appropriate for placing your tooth's final restoration (dental crown or filling).

The phrase "as soon as is reasonably convenient" (meaning not an emergency but definitely a priority), often applies to this situation.

Why the rush?

In general, the temporary restoration that has been placed is just that. Here's why:

  • It can't be relied upon to provide adequate protection or strengthening for the tooth over the long term, thus leaving it at risk for fracture.
  • When compared to a permanent restoration, the seal that a temporary creates isn't as lasting, thus placing the tooth at risk for recontamination.

 

 
 
search

 Page references sources: 

Aquilino S, et al. Relationship between crown placement and the survival of endodontically treated teeth.

Eliyas S, et al. Restoration of the root canal treated tooth.

Lynch C, et al. The influence of coronal restoration type on the survival of endodontically treated teeth.

Nagasiri R, et al. Long-term survival of endodontically treated molars without crown coverage: A restrospective cohort study.

All reference sources for topic Root Canals.

Comments

Is crown necessary?

My tooth that's just had root canal had a filling in it for years and it did just fine. My dentist said we should now place a crown. Is that really necessary? It's a big added expense. I'd rather have another filling placed.

Heather

We're not going to have enough information about your tooth and situation to know what's needed. Your dentist is in a position to have an idea, and evidently they think that crown placement makes the best plan.

There are two important factors that you should keep in mind:
1) The restoration that's placed needs to be able to create a seal that prevents bacteria and such from seeping back into the interior of your tooth (see coronal leakage link above). Crowns are very good at preventing this.
2) Your tooth probably isn't as strong and fracture resistant as it was previously. (For example, it's been substantially hollowed out during your root canal treatment.)

It's not so much that a filling can't provide a seal and serve as a strong restoration, it's just that crowns do this so much more reliably and predictably. Evidence of this is found in the studies mentioned above. Teeth that have had crowns placed after their root canal treatment tend to have a higher survival rate.

That doesn't mean that all teeth require a crown. It in part depends on how much tooth structure has been lost. In your case, we're assuming that the filling that existed previously was somewhat sizable (a repair large or involved enough that root canal treatment was ultimately needed).

If instead the hole in the tooth is just a small one (and really only your dentist would be able to make this judgment), a filling might suffice just fine.

Ideally the crown (or whatever permanent restoration is chosen) would be placed promptly after the completion of your tooth's endodontic work. If finances or such make that difficult, bring the issue up with your dentist and see if they can offer any solutions/alternative plans (payment plan, placing the crown as soon as your next insurance cycle allows, etc...). Good luck.

Composite filling in root canalled tooth one year before crown?

I need to have a root canal in a molar tooth, since there is a cavity under the old silver filling on the chewing surface. From two other root canalled molars I know the tooth needs a crown and that it takes some time for the lab to create the crown. But I don’t have the time waiting for that, as I am expatriated to Asia very soon. Therefore I will ask my dentist to prepare a regular composite filling in my root canalled molar tooth, hoping that such a filling will last a year or so (as a temporary one-year solution), then I will have the crown once I return from Asia. Is that a suitable solution for a root canalled molar? Don’t know if one year is too long to wait for a crown on a weakened root canalled molar tooth even though it has a composite filling or whether it will break during that year. Alternative is to get a crown while I am in Asia

Flemming

In regard to the timing of the crown placement, we'll defer to your dentist's opinion. There is no question that a 1 year delay in placing the crown isn't usually ideal. But for some teeth (possibly even a molar) some type of conventional filling might provide an adequate final restoration. Just ask your dentist what they would do for their own tooth (wait until you return, or have the crown placed in Asia).

In regard to making a go of a dental filling. The quality of the coronal seal of the restoration can be improved by the dentist extending the filling down into the opening of each of the canals just a few millimeters.

(Here's a link to a paper that discusses exactly that, and mentions that dental composite creates the superior seal as compared to other restorative materials. But also mentions that all groups showed some leakage, so that might be your answer right there.
An assessment of coronal leakage of permanent filling materials in endodontically treated teeth: An in vitro study.)

In regard to filling placement and protecting a potentially fragile tooth, your dentist would probably make the occlusion on the tooth as passive as possible (meaning it doesn't get much pressure when you bite down or slide your teeth around when touching). And then of course, you would want to favor the tooth as much as possible.

While it would mean utilizing a different dentist, same-day crown placement is a possibility in some dental offices. Probably the most durable type of crown they would have to offer is (monolithic) IPS e.max. You might ask your dentist about suggestions with this option.

And finally, if you'll Google "best dental schools in the world" (and consider that a proxy for the type of dentistry practiced in that country), several seem to be in Asia.

Thanks a lot for a very

Thanks a lot for a very informative and detailed answer. I had my root canal done yesterday. My dentist was clearly in his opinion that I should have the crown very soon and that 1 year delay is far too long. But he accepted my wish and made a composite filling (don’t know if he extended it down the canals as you mention). But he shaped the tooth/filling so it will not have the hard pressure for chewing and of course I will try to favor the tooth as well. He also mentioned that dentists should be quite good in Asia, so maybe I should consider have the crown while staying there.

Restoration After Root Canal

I had a root canal performed on my #2 molar. I would be OK with only a filling as the tooth is not visible and the repair would be less expensive than a crown.

* Comment notes.

Ramond

The issue isn't about appearance. Instead it's (always) about how well the restoration seals the tooth (so to prevent coronal leakage) and possibly a restoration is needed that can strengthen your tooth.

If you haven't already, you should read this page about final restorations for root canalled teeth. (Make sure to read the statistics section.)

Possibly just placing a filling is satisfactory for your situation. But only your dentist can advise you on this issue.

Hi, thank you for the great

Hi, thank you for the great site, it's very informative!

I had a root canal done for my upper first molar 12 years ago. I remember the dentist at the time mentioning that the tooth might become brittle over time and break at some point but no crown placement was offered. Since then I've seen a number of different dentists and while they have remarked that the root canal is quite extensive, no-one has suggested getting a crown, this includes an endodontist that I saw for an unrelated issue earlier this year.

However, reading information on your site and other sources it seems that crowns are the current standard of care for root canal aftercare. So should I be getting one? Does the fact that the tooth has been OK for the last 12 years means it's a good sign and a prediction that it might last or has the tooth been getting brittler and I am at ever greater risk of splitting it as the time passes?

I'm a bit worried about getting a crown because it comes with its own fair share of possible complications and difficulties. Also it seems that with a crown it is not recommended to eat hard food such as nuts and popcorn and I imagine those would be the likely culprits for why a root canal tooth with a filling might break too. If so, could I just stop eating hard food now and not get the crown? Even now I consciously chew nuts and seeds with my wisdom teeth (of which I have all 4), to take the pressure off of the first molars, is that a good thing to do?

Thank you so much!

Toothy

A dentist not suggesting work vs. you specifically asking them about the need for treatment really are two different things. So if you haven't recently, you should bring up the subject with yours, pretty much the way you have here and let them advise you.
---
Here's an article titled: Are full cast crowns mandatory after endodontic treatment in posterior teeth?. It seems to take the same general stance on issues as we've discussed them here on this page but provides greater detail.

You'll note there is a section that addresses the issue of tooth structure changes after endodontic treatment.

And it mentions how the size/extent of the filling in the tooth significantly affects the tooth's strength, and therefore whether or not a crown should be placed. (Here's our similar page: Choosing between a crown and filling.)
---
You're right that there can be possible complications with crowning a tooth. So one should only be placed for good reason. But if placed, the type should be one where concerns about breakage are non-existant or minimal.

The linked article above discusses "full cast crowns," meaning all-metal ones. But there are other, more aesthetic appropriate crown options for molars too (scroll down on that page just a bit).
---
Forces directed to teeth can cause cumulative effects. Generally, small initial cracks can grow in size due to continued exposure to heavy forces. So, in regard to your root canalled tooth and/or its neighbors, you should keep that in mind.

Like stated initially, you should bring up this issue with your dentist, the person that can evaluate your specific situation, so they can advise you one way or the other. Good luck.

Crown question

5 years ago I had a root canal done on canine #11. It died because my or orthodontist turned it too quickly. My dentist at the time placed a post in the tooth but never mentioned needing a crown. This year I went to a new dentist who recommended getting a crown done as the post is exposed on the back of the tooth. SHould you crown a front canine that from the outside looks okay? Thank you

HR

Your question is hard to answer because it depends on how much of the tooth is original tooth structure vs. dental materials.
--
It's usually considered that a post is only required if it is needed to help anchor the dental materials that are used to rebuild the tooth. (Our post and cores page explains.)

So if a large portion of your tooth was missing after the completion of the root canal work (possibly just on the backside), it would be expected that post placement was indicated. And it's very common that related to the substantial rebuild job needed that crown placement often makes the preferred way to rebuild a tooth.

Following that scenario, that fact that your post is now exposed implies that the filling material originally placed has deteriorated (or at least substantially worn down) in just a few years. If so, a crown typically provides a more lasting, better sealing, restoration and probably therefore is indicated.

--
One can't help but to notice that you state that your tooth required root canal treatment related to orthodontic trauma (as opposed to structural damage caused by advanced decay or tooth fracture).

It's sometimes possible that with this situation (structurally pristine front teeth) the access cavity made can be quite conservative, and following the root canal procedure just placing a filling suffices. (A post isn't needed because the filling needs no aid in retention.)

So consider the situation where just placing a filling can be considered an adequate final restoration for the root canal work, and (for whatever reasons) a post just happens to have been placed. And now the post is exposed.

Is it exposed because it wasn't trimmed short enough originally and had just a thin layer filling material over it that has since worn down? With a possible solution being trimming the post shorter so a more adequate thickness of restorative can cover it?

----
So as you can see, only a dentist who has seen your tooth can answer these questions and make an appropriate treatment recommendation. So just ask again. But as they explain your situation, it would be expected that the issues described above might be mentioned.
---
It should be pointed out that, at least in theory, the exposed post places you at risk for the complication of coronal leakage, so you need to pursue a remedy of some fashion in a timely manner.

Crown on tooth a partial will hook to

Good idea or pull the tooth

Cn

Your question is phrased in the future tense, as in:
You have a broken tooth. And if it is rebuilt with a crown, a partial you plan to have made will clasp (hook on) to it.

Crowned teeth are routinely used as "abutments" (clasping teeth) for removable partial dentures. In suggesting it, your dentist must feel that your tooth makes a reasonable candidate (a crown with good retention can be made). If so, a successful, lasting outcome can be expected.

The other question is how important the damaged tooth is in providing a situation where the partial that's made will have good support and retention. The positioning of the teeth a partial clasps onto is an important factor in creating this. Losing a tooth may leave you with a less than idea situation (like absolutely no tooth to clasp to in the very back of your mouth). Your dentist would have to explain.

If a successful partial can be made with or without the tooth, although it is most ideal to save any teeth possible, from a practical standpoint a tooth is sometimes sacrificed. Having one additional tooth on your partial often adds no additional expense (or just very minimal cost). And doing that saves you the expense of having a crown made, which as you no doubt know can be substantial.

Root canal failure

Molar had root canal treatment and was filled. No discussion or mention of type of restorative treatment eg crown filling post and core and I was until now not aware of these as options. Cannot now remember why root canal was carried out apart from to try and save tooth. Definitely did not have external decay. Had excruciating pain for week after treatment emergency appointment and given antibiotics. After 14 months knew some type of infection as unpleasant taste when sucking and slight tenderness when pressed on one corner of tooth. Dentist xrayed and stated tooth had cracked (not visible externally) and would have to be extracted. Asked for further explanation just said unlucky and said had been difficult due to adjacent molar. Not happy to have extraction as not causing pain and already lost 2 upper molars opposite side so would mean loss of lower molar this side and possibly previously filled molar adjacent although not causing any probs at present. Appointment made for 4 weeks for extraction... no antibiotics given. 2 days ago, 1 week before due appointment, eating chicken pieces and small corner of RC treated molar cracked off and within 15 minutes large chunk of metal filler fell out leaving huge hole mainly to one half of tooth so I still have half of the tooth remaining. No pain but very sharp edges and huge hole. Emergency apptmt made with dentists same practice who stated unsavable and would need extraction so put temp dressing on to stop food becoming trapped. Showed me last xray which showed infection at base of tooth root which said could be healing infection?! Also stated that adjacent molar giving no probs is dead (root) and needs to come out. Meaning 2 lower molars forward of wisdom will be extracted leaving huge gap and consequential problems? Dental dam not used when root canal treatment carried out. Due to see dentist in 5 days very unhappy about situation and tooth having been left vulnerable after treatment and, also over last 3 weeks resulting in massive failure. Still no pain so cannot understand why dentist states extraction only? Help please!

Aclt

"pain for week after treatment"
"After 14 months knew some type of infection"
Possibly your dentist was never convinced about you tooth's long-term successful outcome, and was hesitant to recommend the expense of crown placement. This would be a judgment call.

"xrayed and stated tooth had cracked (not visible externally)"
Whether the crack had existed originally (and not detected or detectable) and was the reason for the continued problems with the tooth, or whether the tooth cracked, or the crack progressed in size, later on (would have benefited from the protection of a crown) probably can never be known.

If the crack extends below the gum line (into the root, which likely seems the case here), there is no possible repair, hence extraction is indicated.

If, per chance, the crack is confined to just one root, possibly "root amputation" could provide a solution. But even knowing that the crack was confined to a single root and didn't extend into other portions of the tooth would be difficult to definitively ascertain. This route isn't chosen very often.

"unlucky and said had been difficult due to adjacent molar"
Unlucky, yes. A crown might have made the difference. But like mentioned above, it's not always a easy recommendation to make. Also, if the tooth had been cracked originally (before its root canal treatment), having a crown may not have changed your outcome.

It's unclear/difficult to understand what the "difficult due to adjacent molar" refers to in regard to performing conventional root canal therapy.

"no antibiotics given"
Dentists have an obligation not to prescribe antibiotics if they don't think they are medically indicated.

"corner of RC treated molar cracked off and within 15 minutes large chunk of metal filler fell out"
Metal fillings are usually held in place by mechanical retention. If its corner was lost, evidently the shape of the tooth could no longer confined/retain its filling.

"apptmt made with dentists same practice who stated unsavable and would need extraction"
Possibly this could be considered a second opinion.

"showed infection at base of tooth root which said could be healing infection"
An x-ray doesn't provide an explanation for what is seen. In some cases, current problematic and historic non-problematic (healed) conditions might look similar on a film.
In your case, you have a history of symptoms with your tooth, suggesting that what is seen is infection-related.

"adjacent molar giving no probs is dead (root)"
An x-ray can be used to diagnose a dead tooth (when confirmed via other testing).
It does seem strange that your dentist hadn't noticed this.

"and needs to come out"
Generally, an extraction is the only recourse if: 1) The tooth has an advance gum disease condition that can't be remedied. 2) Something about the tooth makes it obvious that performing root canal treatment is unlikely to be successful. 3) The tooth is so damaged (decay, fracture) that it can't be rebuilt.

Extraction is sometimes discussed because not performing an expensive series of procedures for a single tooth might provide funds for other reconstructive procedures (like making a lower partial denture that would replace both molars for one fee). That's not to say that that is necessarily a good plan (and there are better (more ideal) ways to replace teeth). Just a possible option.

"Dental dam not used when root canal treatment carried out."
Here are our comments about not using a rubber dam during conventional endodontic procedures where it is possible to apply one.

After further discussion with your dentist, you may find that it just seems that its extraction is the only practical option left. In regard to your most recently diagnosed tooth, they need to provide you with further explanation. Good luck.

Crown

About thirty years ago I damaged the nerve in one of my front teeth at this time I had a root canal done. In June when visiting my dentist he remarked how black me front tooth had become. He said that I should consider having a crown fitted, I maid an appointment for this to be done, after a week I went back and he created a post from the damaged front tooth. He fixed a temporary crown and told me it would be about two weeks to get a new crown, when the crown arrived it was the wrong colour so had to be re maid. After another week or so the temporary crown came off, so I went back to the dentist to have it replaced. A lady dentist replaced it with what I can only say is a substance which was expelled from a gun and moulded to shape. A few days later I went back to the male dentist to have the new crown fitted.
The dentist had a hard job to pull off the temporary moulded crown so much so that I felt a cracking sound and feeling, I asked it my tooth was ok and was told it’s fine, after fitting the new crown I left. About two weeks later wile getting in my car the crown fell off including the post maid from my tooth. I returned to the dentist the lady dentist replaced the crown with what she called a flexible post how ever this was very flexible. I did complain but was told that if it came off, she would fit a new crown with a steel post. By December I returned and she agreed that she would fit a new crown an steel post the new post was fitted three days ago and despite telling her that it was still very loose she said it was fine. However this morning Saturday it dropped out I contacted the helpline but they was unable to help, it appeared to me that there were no adhesive on the post but only around the tooth. What would advise me to do now

jb

In case you haven't found it already, here's our page that explains post and cores.

Generally, a core is placed to idealize the shape of the tooth (replace portions of missing tooth structure) so the trimmed-down nub of tooth the crown fits over is ideal in shape (this aids with crown retention). The purpose of a post is to anchor the core.

Posts can be made out of flexible (fiber) or rigid (metal, ceramic) materials. Each type has its own advantages. Neither type is best for all considerations.

The important question here is why three attempts at anchoring a post have failed.

It could be a failure with the materials used (cement, bonding), kind of like you explain. But a post should not be held in just by the grip of its "cement." Its Resistance Form (resistance to being dislodged due to its shape and fit inside the tooth) is a more important factor.

"Adhesive" cements have only been available in dentistry over the last 30 years or so. For many many decades prior to that, dentists were able to place successful post and cores just with cements that acted as "fillers" between the cemented parts. They worked due to the mechanical design of the post/tooth relationship.

Having said that, for future attempts, probably your dentist will choose a cement known to bond to both tooth structure and metal. That can certainly be an aid.
--
Repeated failure could also be due to the fact that something is amiss with the "bite" of your crown(s). If it is too prominent in some aspect (like possibly just when you slide your teeth a certain way) and the tooth receives excessive forces, the post might get dislodged.

In your case, it seems you have had multiple crowns on your tooth. It seems unlikely that each one would have been crafted with the same "bite" discrepancy.
--
Another issue that may be playing a role is the lack of a crown/crown preparation ferrule effect. Go to Google images and type in "crown ferrule" and look at the pictures for an explanation.

A crown ferrule has to do with the way the edges of a crown rest on the tooth. This effect helps to direct forces to the tooth itself. A short, incomplete or nonexistent ferrule would allow a higher level of force to be directed to the post and core complex (thus dislodging it).

The cure in this case would be to replace the post and core, then re-prepare the tooth (reshape it so a more substantial ferrule design exists). A new impression would then need to be taken and a new crown made (to fit the new shape of the tooth).
---
Only your dentist can determine what is going on and what solution is needed. Good luck.
Other than being successful with the post and core, there's no other avenue for rebuilding your tooth as it exists.
Conceivable some type of design could be contrived where a neighboring tooth shares in receiving some of the force directed to the tooth (like making a 2-unit bridge or such) but that wouldn't typically be considered a first-choice approach like getting the post anchored successfully would.

Crown

Hi thanks very much for you very comprehensive reply, do you think this was just bad luck or possibly poor practice? The dentist has agreed to try again tomorrow 5/2/20 to cement a new steel post and refit the crown, I believe she is a good dentist but I do think there was a degree of negligence.

jb

Sometime performing procedures for teeth are simply troublesome/difficult and seem to take on a life of their own, despite any dentist's best efforts.

If I was sitting in the dental chair, I would feel most assured if the dentist mentioned using a cement that forms a bond with both tooth structure and the type of post being used. Discussed using pins or divots to help anchor the core. And mentioned that after the new post and core they plan to reevaluate the preparation, especially in the area of the crown margins, to insure that a proper ferrule effect will exist. Then take a new impression and have a new crown made.

Probably your dentist already plans to do all of these things.

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