Usually, when you get a toothache, it is because the tooth is

badly decayed or very heavily restored (filled). When a

toothache is bad enough, the nerve inside it is dead or
dying, and in order to relieve the toothache or abscess, it is
necessary to either extract the tooth, or to remove the nerve
from the tooth. The latter choice saves the tooth, and the
procedure is called a root canal. When a root canal has
been performed on a tooth, we say that the tooth has been
"endodonticly treated". ndodonticly treated teeth have a
number of characteristics that ma!es them different than
normal "vital" teeth (teeth with live nerves inside them).


ndodonticly treated teeth tend to be badly damaged above
the gum line due to decay and old fillings. They also are more
brittle than vital teeth, something li!e a dead tree branch in
comparison to one that is alive. "or these reasons, once the
root canal has been performed, these teeth need special
treatment, or they tend to brea! a few years down the line.
This is especially true of bac! teeth that have broad biting
surfaces. They are li!ely to shear off because of biting forces.
"or this reason, simple fillings do not usually restore them for
very long. These teeth need to have crowns placed in order to
protect the investment in the root canal treatment.
#ut unfortunately, because of the very poor condition these teeth have been
left in as a result of the original decay, there is often not very much tooth left
above the gum line to "hang" the crown on. "or this reason, we need to do a
special !ind of filling on the tooth that will be so firmly embedded in what
does remain of the tooth that it will not dislodge later when it is prepared as a
core for the crown. ($ core is that part of the tooth and the fillings in it that
are left over after the tooth has been prepared to receive a crown.)
The first step is to remove some of the gutta percha that
was used to seal one or more of the root canals in the
tooth. Then, using a series of graduated rasps, the inside of
the canals are enlarged and shaped to receive a specially
made metal "post" that exactly fits the hole made by the
last rasp. These posts are usually pre%manufactured and
come in many different shapes. The post is then cemented
in the hole so that it is firmly embedded in the root of the
tooth, and pro&ects up above the level of the gums in order
to help retain a filling that will be placed over it.


The filling is now retained on the tooth by whatever
undercuts are available on the inside of the remaining
tooth stump as well as the post which is firmly anchored in
the root. This filling is meant to be prepared as a core for a
crown, but it may remain temporarily as a finished
restoration

"inally, the tooth and filling are prepared to receive a
crown. This is done by grinding down the filling and what
remains of the tooth above gum line to a form similar to the
one in the schematic on the right. The "margins" of the
crown preparation are usually prepared slightly below the
gum line, and on tooth structure, rather than on the core
material. This ensures a tight, waterproof seal around the
finished crown. The prepared part of the tooth above the
gum line is called a core.


'nce the tooth has
been prepared, a
rubber impression is
ta!en (shown at the
left) and this is sent to
the lab. $t the lab, the
impression is poured
with plaster creating a
plaster model which is
a duplicate of the
prepared tooth above
the gum line. Using this model the lab fabricates a custom
crown which is then sent bac! to the dentist for
cementation on the prepared tooth.