yeah, that does look crummy. but to play devil’s advocate for just a minute…. perhaps a resin cement like variolink or infinity was used to fill in any voids in the resto. personally, when i see margins like that radiographically (i take BW or periapical before i cement to double check the margins) i usually send that back to the lab. but it can be done with some success. that may be why the referring dentist hasn’t said anything.

and why doesn’t the 7 have a crown??? hmm, HMMM???? composite resins are heinously notorious for microleakage, and i’m assuming that a rubber dam was not used when that was placed (hence what looks like recurrent caries at the mesial, that was probably pretty sub-g)

good question, i just ran a search on radiopaque/radiolucent cements. the older variolink does had a lucent formulation, however the newer generation of dual-cure resin cements (variolink II and infinity, which are what i have in my office) are in fact radiopaque. so my bad there.

the resin reinforced glass ionomer cements are radiolucent and have pretty good resistance to microleakage. in additio, some of them now have sustained fluoride release, such as Rely-X luting (another thing i have in my office) and Fuji.

this crown looks like it may be older, though, right? maybe zinc phosphate was used, and that stuff washes away like dish detergent. who knows what was used. probably not a resin-reinforced cement if you can explore the distal margin – they give you a little bit more leeway with margins. again, not something that i would take a gamble with but i’ve seen it happen. how about that 7, though? that won’t hold up forever with that restoration.

I don’t worry too much about the dentists that I work with now–only the good ones keep referring to me (how this came about is another story). But back at the office I was at before this current one I had arguments with dentists who thought they knew more about endo than me because of a weekend course they took and believed every word that was told to them. Eg. If you’re not using Resilon you’re behind the times and doing endo in the dark ages.

Here’s how a conversation about the 6 would go between the referring dentist and the patient:

P: I’m having a lot of pain on this tooth. I don’t understand why because it has had a root canal! I remember the Endodontist saying something about the crown that you made for this tooth having a problem? Could it be that?

D: Hmm. Looks like the root canal is failing.

P: What!?! I spent a lot of money and time on the root canal and the crown on this tooth, and now it has a problem again?!? I thought root canals were forever!

D: Well they usually are, but this one is infected again. We’ll have to send you to a specialist again to look at it.

P: Oh…I’m so pissed, when I see that guy again, I’m gonna let him have it.

D: I think I’ll send you to a different endodontist this time. You might have better success with them.

And so the referral slip to the endotechnician is written up. The endotechnician is the guy who does the root canal or surgery or extraction that you ask them to do without any care about diagnosis or prognosis. They also don’t care about periodontally or restoratively unsound teeth because “it’s not their concern”.

Oh, the stories that could be told. Dentistry (as in any profession where your clients trust you and have no real way of evaluating the quality of your work) brings greed to the surface too often.

See you this weekend! We’re looking forward to playing Twister with you guys.