I'm Rick buck and I've been a dentist for 15 years and in this video you're about to see how and why this tooth will get a root canal and Crown including all the steps I take and why each step is important so like And subscribe if you have tea [Music] six years ago this patient came in and we let him know about this cavity that you can kind of see on the X-ray that was from them and that you can see as a dark shadow underneath this filling then finally the Decay made it down to this canal where the nerve of the tooth Lies when that happens on a back tooth and in this case it's a premolar to save it it needs a root canal and a crown whether it's causing pain or not the root canal to take out the dying nerve and the crown to prevent it from breaking in the future so this here is the tooth again and at this first appointment we are going to do a root canal to start we put this rubber barrier or Dam on the tooth the rubber barrier is made to isolate the tooth so what is in your mouth doesn't get in the tooth while doing the root canal and what is in your tooth doesn't get in your mouth once the barrier is on the next step is to make an opening in the tooth's upper portion or crown we call this hole an axis opening because this gives us access to the canals we will see in just a moment the axis opening needs to be wide enough to gain access to every canal in the tooth and remove all the Decay if it's too wide the tooth can become excessively weakened by this opening and Fracture if the opening is too broad in fact that is the reason for kneading a crown in the first place after a root canal of the crown you'll see will sit around the tooth and prevent it from breaking in this case this tooth has so much Decay as you will see that opening is quite large for this too however sometimes you just can't avoid it the tooth is going to have an opening that is quite big and the opening for this tooth is pretty big for this size of a tube now something that you might see here is this mushy consistency coming out that mushiness or flakiness is Decay when it comes out when using my slow speed hand piece drill and that's actually kind of how you differentiate between Decay tooth and solitude when it becomes powdery the tooth is solid healthy tooth so you can see we remove a lot of Decay before we get to solid tooth once all the Decay is removed now we look for the canals through that access opening that we made into the Chamber of the two those canals will present themselves as small holes in the tooth's floor we find the holes using a long pointy metal instrument called an endo Explorer when you find a canal this tip will slightly stick in the canal and when you try and pull it out you'll feel that kind of tug back or stickiness finding all the canals can be quite challenging as these canals constrict and calcify and become smaller in time so especially for older patients these canals can become really small sometimes they become so narrow that they actually completely seal off and those become really difficult what's also not straightforward about these canals is how many each tooth will have dentists have a good idea of about how many canals will be in each type of tooth and where they will be but it can vary quite a bit for each individual luckily this tooth has one Canal as I expected and where I expected so now I will start filing in that root canal when healthy this canal has a nerve and blood supply that flows into the tooth if this blood supply in the center of the tooth dies your body has no way to fight infections so infection will easily get into these canals so the reason we're doing a root canal is because infection got into them and now to prevent it from coming back we have to seal off the canals from future bacteria to do this we start by removing the nerve and tissue in these canals with these long rotating mechanical files that you've seen sometimes the nerve from the tooth wraps around the file instead of getting torn into shreds this nerve here we won't be able to see it because it gets torn into shreds while I'm cleaning out the central canal and the nerve in another video I show the nerve getting pulled out of the root canal sometimes we get lucky and the Nerf comes out as a whole and it's one of the joys I guess of being a dentist anyway after removing the nerve we use a series of mechanical and manual files to unclog and shape each Canal nicely so we can fill them this part takes a lot of skill and there are a lot of challenges so here are some of the challenges if a dentist is too aggressive in filing the canals the files can make a hole in the side of the canal called a perforation or it can leave the roots so weak that they break in the future if you're going too fast sometimes the instruments can break inside the canal which could be fine but it also could be a problem that requires future attention either way taking it slow enough to avoid breaking files is best in addition to those these canals can become blocked and unclogging them can become quite a hassle another challenge lastly you must ensure you file these canals within one millimeter from the tip of the root or the root can become reinfected so those are the things that make a root canal challenging once we clean and shape the canal we irrigate it with sodium hypochlorite or bleach if you shape the canal sufficiently this will kill all the bacteria in the canal for some people with significant infections this can even make a burning sensation so after we filed and cleaned all of the bacteria out of the canals we are then ready to seal off the tooth to seal off the canals we use these long rubber-like cones made of gutta-percha which is a natural substance these cones are the same size and taper as the mechanical files we use to shape the canal so they should fit in the canals perfectly just like the files you used before we finish we take a quick x-ray with the cones in the tooth to confirm that they will fill the canal just how we expect them to our x-ray looks good here so we irrigate with bleach one more time to make sure the canals are clean and then we take paper cones which dry the bleach from those canals and then after drying them we mix sealer and coat the canals and also we coat the Gutta percha and put the gutter percher cones back into place and that's what SEALs off these canals after all that we melt off the excess Gutta percha and place cotton and a temporary filling in the tooth and that's pretty much the root canal portion when the numbness wears off you can expect some soreness that will likely differ from any soreness that you may have had before the root canal was done and that soreness is due to inflammation and will probably go away in a few days and ibuprofen normally works best in this case because it helps with the pain and the inflammation you need to be careful chewing on this tooth until the final Crown is made as it is weak and can break until you get that crown on it that leads us to our next appointment where we will start crown and put a post in the tooth to give more strength to this upper portion since we took so much of that tooth away here we are at the next appointment usually between 2 and 14 days later we start by removing the temporary filling from the tooth until we expose the beginning of the filled root canals to give strength to the upper portion of this tooth we need to Anchor it to the stronger root portion of the tooth otherwise the crown would likely break months down the road like I already mentioned so we start by giving the tooth a post if I zoom in here you can see on the screen the top of the root canals and I'm going to go into the canal and remove a lot of that filled canal with this long straight drill so with this drill I'm creating a slot that we will fill with the post and with a resin material now this is probably as good as you can view it of a close-up of what that tooth looks like with the upper portion of the root canal drilled out what we're doing here is I'm taking a fiber post that we will use to fill the move portion of the canal and I'm just kind of sizing it to see what size I want in the canal and upper portion of the tube I use Fiber post because the older metal posts commonly fracture the root over time and these fiber posts are much more common to the tooth so this post fits nice now and we're going to bond it into place to get a strong bond we etch the tooth surface then we place the bond in the tooth with this brush and we kind of scrub it into place then we use a light to set that Bond as well as a chemical we use to set the bond down in the canal where the light can't reach this next material we use is called core paste it fills up the bulk of the tooth and also bonds the posts that we are going to put in now so you see this post fits into the canal and we use this bulk fill which is resin that flows around the post and fills up the majority of the missing portion of the tooth we then just used my little um Dental Explorer to try and open any air bubbles that might have formed while we were filling it up we do find one and maybe you can see here where I put the Explorer and it kind of opens up one of those air bubbles once that air bubble is opened up we fill that void with more of the core paste then we take that curing light and this again will set the post and bulk filling into place in just a few seconds the core Pace will also just kind of set on its own if the light doesn't do all of it but the light is good to kind of get things going because we have a lot of work to do during this appointment now we have a stronger upper Crown portion of the tooth firmly anchored to a post to the lower root portion of the tooth the core of the tooth is now strong so the next step is to drill a millimeter and a half to two millimeters in every direction around the circumference of the tooth we file the tooth down because eventually the crown is going to fill in this space we are drilling out now now I am not aimlessly drilling if you drilled too much to structure away the crown can be come loose from time to time due to the lack of retention from the walls of the stump Left Behind being too steep but then again if you drill too little of the crown away it won't be thick enough and will likely break in time as you chew and bite on the crown also when drilling for the crown you want to make sure the stump or Preparation as we dentists call it is as close to parallel all the way around the circumference of the tooth now to be precise you don't want it to be completely parallel but you want those walls of the circumference of the tooth to converge at about ten to five percent this will ensure a tight fit of the future crown that won't come loose so it likely won't come off or come loose in the future as you chew and use it down the road now you probably all have noticed that the gums are bleeding and that is because on this tooth we need drill below the gum pill we reach we reach Solid 2 . the gums get Nick kind of beat up in the process now rest assured the gums will heal back and they'll heal back tightly around the a future Crown when it is done but it's also important to go down below the gums to hide the margin where the future crown and the natural tooth meet below the gums if this line or this margin is above the gums it would be noticeable when the final Crown is done if it's hidden below the gums it's more Cosmetic in fact you've probably noticed people with crowns and you notice that kind of dark shadow around the gums of the teeth it's this margin that wasn't put below the gums instead it was made above the gum level quickly my favorite toothbrush floss and other Dental products by far are in Amazon affiliate links in the description below this video those Dental products will give you stunning results every time you clean your mouth and you can also watch my video posted at the end of this video to see why they are the best and how to brush and floss your teeth with Immaculate results this gel here that I'm using is called viscostat and it helps to stop bleeding when it is scrubbed onto bleeding gums once we are done with all the drilling now this this gustat tastes terrible so we immediately wash it away and then once the gums are done bleeding the patient bites down to make sure we have enough space between the prep or the stump of the tooth left behind and the opposing teeth it bites up against I also am checking right now to make sure there are no undercuts in the preparation and that the corners of all the preparation are rounded and so as I look at this tooth that's past all my checks and is now ready for an impression so that's what we're doing right here is we're taking an impression of the tooth I like to do this in two steps first we take an impression with a quick setting hard material called Blue Button then we remove the impression when it is hard and then second we add a more detailed impression material layer and we snap that back into place in the mouth this method pushes the material below the gum level to get an extremely accurate impression of the margin below the gum level and then eventually we take that impression out of the mouth and if you know what you're looking at you can see here that it has an accurate impression of the margin next we take the shade of the tooth that we also took before the appointment even started so the we then take this impression and the shade and we send it to the lab and the lab we'll take this and make a stone model of the teeth and take that shade and they'll build a crown on top of this Stone model this will take the lab a few weeks and then we'll get that crown back in the meantime we have to make a temporary crown so that the patient doesn't go with this step of a tooth exposed to do this we use another impression we took before we drilled the tooth down as a template the temporary crown material fills only the impression template of the original tooth in that negative space where we drilled away the original tooth when we snapped this impression back into place the material will fill the void between what the previous tooth was and the stump that is now left behind so this temporary crown will actually be fashioned after the original tooth once we remove the impression you can see there is a lot of excess temporary material that needs to be moved and trimmed away so that we can make this look like an acceptable tooth for those weeks that the patient will be waiting for their final Crown so we take a few minutes to trim it smooth it out and make sure it feels even when biting then we dry the tooth and use temporary cement to secure the temporary crown into place until the next appointment before we let the patient go for the day we then remove the excess adhesive which looks pretty good after we removed it especially for temper and crown hair it will get the job done until the final Crown appointment so let's now fast forward to that next appointment so here we are at the final appointment where we will try in the final Crown so we first have to remove that temporary crown and then clean off all the temporary cement and here we are slipping on the final crown and we're checking for five criteria for an acceptable Crown before we cement it permanently into place we will also make necessary adjustments so the crown will pass all those points first we check how well this Crown contacts with the adjacent tee if floss snaps nicely through the teeth it will also likely prevent food from getting trapped between the teeth when chewing too tight the crown won't sit all the way down so we make sure the floss snaps nicely through second we check the internal of the crown if something is high or off internally the crown will kind of rock and if you don't fix it the crown will loosen in time as you chew it and you'll have to keep cementing the tooth on from time to time third we check the margin where the tooth and Crown meet it needs to be flush and not catch my Explorer when I'm checking it if this is open the lab will need to remake the crown because the margin is the weak point in the crown once again if it's open it will catch food and the K will start here fourth we check the bite the bite is very commonly off and needs to be adjusted you want to make sure this tooth feels like it bites evenly if the bite feels like it hits the crown before the other natural teeth then that crown tooth can become sore over time and even cause jaw problems fifth we check the Cosmetics if the patient is happy with the way it looks and that the crown meets the other four criteria then we're on to cementing the crown so to cement the crown we dry the tooth and then we put permanent cement on the interior or internal of the final crown and have the patient bite that down into place and you'll see that a bunch of excess cement gets expressed out of the crown we remove the excess cement with an Explorer and floss and other materials thank you watch my daily dental care video I have posted now for the best technique tips and product recommendations for a stunningly clean mouth that avoids tooth decay gum disease and gives you fresh breath the best Dental products that I recommend are an Amazon affiliate links in the description below if in Southern California my dental office is in the description as well like And subscribe to my channel if you have tea