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Does every root canal treated tooth have to get a cap? Is it just a way for the dentists to make even more money? Or is there a scientific reasoning behind this practice? We have all the answers.

Root canal treatment — or RCT — is one of the most commonly performed procedures in the dental office. Contrary to popular belief, having root canal treatment is not very painful in the overwhelming majority of cases [1]. It can even be completed in a single sitting if the situation allows it.

While most people consider the filling up of the root canal as the last step of the procedure, scientific evidence collected over a long time has shown that not to be the case. A crown, to protect the root canal treated tooth, and to ensure it returns to full function is the true end of root canal treatment [2].

So why is a crown (also called as a cap) necessary after root canal treatment?

A Cap After Root Canal Treatment

Most teeth that require root canal treatment are suffering from decay or have been fractured in an accident [3]. This means that a significant portion of the tooth is already compromised before the start of the treatment.

The root canal treatment procedure itself also involves drilling into the tooth until all the decay has been removed. The canal also needs to be drilled as they are shaped/prepared to receive the final filling material.

All of this drilling and removal of tooth structure results in weakening the tooth [4].

The tooth literally becomes a shell of itself and is no longer strong enough to withstand the chewing forces that it is going to be subjected to. This is why almost every root canal treated tooth requires a cap after root canal treatment to protect it and ensure its longevity.

What Happens If You Don’t Put A Cap After Root Canal Treatment?

There are several problems that a person might face by avoiding a cap after root canal treatment. The pain, which was probably present before the start of root canal treatment, would have subsided. Some people even find it comfortable to eat with a root canal treated tooth even though it does not have a cap on it.

In a very large percentage of the cases, though, any root canal treated tooth which is not protected by a cap will break [5]. Once it does break or fracture, it can be very difficult to save the tooth and it may have to be extracted.

This would not only mean that all the hard work, money, and time spent in performing the root canal has gone to waste, it would also mean more dental treatment in the future to replace a missing tooth.

A root canal treated tooth also changes color over a period of time [6]. It starts to become darker than its surrounding teeth and become noticeable from afar. This may not be immediately apparent or even a problem in the case of a back tooth but for teeth that are present towards the front of the jaw, this is unacceptable.    

Are There Any Situations Where A Cap After Root Canal Treatment Is Not Necessary?

There are. If your dentist finds that there is not enough tooth remaining to be able to put a cap on it, then the tooth may be left unrestored to last for as long as it may [7]. The advances in material technology have made such situations extremely rare but they do arise from time to time.

Also, if a tooth has been root canal treated due to a reason other than decay and is not fractured then it may be possible to make a very small drilling to gain access to the underlying root [8]. This is usually what happens when treating the front teeth of the jaw.

In such a case, the dentist may simply opt to put a filling material to close the access hole and leave the tooth as it is. Like we mentioned earlier, though, a root canal treated tooth tends to end up changing color after a few years and becomes an esthetic pain.

There was a time in dentistry when root canal treated teeth were not always protected with a cap afterward. It was believed that the expense of a crown as well as the loss of tooth structure that went in fitting that crown was not significantly better than just letting the tooth be.

Now we know that to be false and that it is in the interest of the patient to protect a root canal treated tooth with a cap [9].

Conclusion

A lot of the time, the motivation for treatment is lost when the pain subsides, as it happens after a root canal. Other times, the patient simply becomes lazy and thinks that the crown can be placed any time afterward. The cost involved in getting a crown can almost be as much as the root canal itself, so that also may be a consideration for the patient.

In the long run, though, it is important to remember that root canal treatment is performed in order to "save" the tooth and avoid extraction. By not protecting it with a cap, the tooth remains vulnerable to fracture and thus defeats the initial purpose altogether [10].  

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