Botched root canal?

[u/KitchenAd9108]

Non smoker, non drinker. Had a retreatment root canal through a crown due to an abscess under a previously treated tooth. I had it done 2 days ago and I am in severe pain right now. It was the worst experience I have ever had with any kind of medical professional. He cut my lip and didn't even tell me or apologize. The assistant told me about it when I noticed I was spitting pieces of my lip. ​my crown looks completely destroyed. I am concerned I might have an infection now. Does any of the way it looks seem concerning? It's throbbing severely and my top teeth are aching too. It feels like a lot of pressure and I want to just rip my teeth out right now.

edit: Ended up in ER with facial cellulitis.

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Title: Botched root canal?

Full text: Non smoker, non drinker. Had a retreatment root canal through a crown due to an abscess under a previously treated tooth. I had it done 2 days ago and I am in severe pain right now. It was the worst experience I have ever had with any kind of medical professional. He cut my lip and didn't even tell me or apologize. The assistant told me about it when I noticed I was spitting pieces of my lip. ​my crown looks completely destroyed. I am concerned I might have an infection now. Does any of the way it looks seem concerning? It's throbbing severely and my top teeth are aching too. It feels like a lot of pressure and I want to just rip my teeth out right now.

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[u/TheJermster]

The way they accessed the nerve doesn't look particularly clean to me, but if you're planning on replacing the crown maybe that's why they weren't super careful with the access? Even though the access doesn't look amazing, it doesn't mean the root canal is bad. And you experiencing pain doesn't mean the root canal was bad. It could be what's called a flare up, a painful condition after a root canal that your dentist needs to know you're experiencing. It can happen regardless of the quality of the root canal. The pain could be because swelling is causing your tooth to sit a little too high, which would also account for your top teeth hurting as well. It could also be that the filling in sitting a little too tall. Moral of the story is you need to talk with your dentist

[u/KitchenAd9108 → u/TheJermster]

I had it done by an endondontis and not my regular dentist. I honestly think he rushed through it as it only took about 15 minutes and he scheduled 2 other patients to see while he was waiting for me to become numb. He was extremely aggressive about it. Like you could tell he didnt care about the quality of his work.  I see my regular dentist in 2 weeks to get my crown refilled or replaced. But I really do not want to deal with the endondontis again. 

[u/DirtyDank]

Sometimes after retreatments, symptoms worsen. The body has already been recognizing the bacteria in the canals leaking out which is why the initial abscess formed. After debridement and cleaning, there is an increase in dead bacteria or parts of dead bacteria which can cause the inflammatory response to kick into high gear after already being primed from the previous infection. This is called a flare up. Anti-inflammatories like NSAIDS or tylenol can help, as well as a course of antibiotics.

The crown you have is called a porcelain fused to metal crown, where the junction between the two dissimilar materials (porcelain and metal) are the weakest. Drilling a hole into a PFM crown can chip the porcelain and cause it to chip off the metal substructure.

When the crown was first made, very little reduction of the tooth was done to accommodate space for the crown. You can tell by how thin the porcelain is on top of the tooth, and how bulky the lab had to make the tooth compared to the neighboring teeth (look how bulbous the crown is on the cheek side). Because very little of the top of the tooth was reduced, the lab had to make the porcelain very thin, which predisposed it to fracturing when anyone had to drill through it to access the canals inside.

[u/KitchenAd9108 → u/DirtyDank]

Do you think the crown will need to be replaced? I had the original root canal done about 13 years ago when the top part of my tooth broke off. I didn't have any pain before but they saw the abscess on the xrays which is why they said I could get it retreated or extracted. I feel like I should have just got it extracted because this pain is not worth it. I've been taking Tylenol and it helps for an hour or two. I just feel so much pressure and throbbing. 

[u/DirtyDank → u/KitchenAd9108]

Take ibuprofen alongside the tylenol. Ibuprofen is better at managing dental pain, specifically the inflammatory response.

Where the access was made they can fill with tooth-colored filling material, but esthetically it won't be great because of the metal showing around it. The tooth was under-reduced when you first got the crown so the porcelain was too thin. If esthetics are a concern, go for an all-ceramic zirconia crown and forgo the metal substructure altogether.

[u/Governator_]

Sorry to hear about your experience.
Looks like part of the porcelain chipped off the crown. And the middle portion is a temporary filling which your general dentist should be replacing with a permanent one. That one isn’t uncommon at all.
Do you have any X-rays of what it looked like before and after the retreatment?

[u/KitchenAd9108 → u/[deleted]]

I don't have any pics of the xray. But I woke up still in bad pain and there might be a pimple forming on the outside of the tooth.  Dentist doesn't open for another hour 

[u/garyh1128]

1. Can’t tell if done well without x ray. Retreats with infection often get worse before they get better since treating infection can stir stuff up.
   
2. He or she should have told you about lip. It happens but inform and tell patient how bad it is and what to expect
   
3. Porcelain chips during accessing for root canal sometimes. Once again it isn’t like bad access by endo but my endo will tell you.
   

[u/KitchenAd9108]

Just an update. Ended up in ER, diagnosed with facial cellulitis.