Endodontics is a specialized branch of dentistry focused on the intricate structures inside the tooth, primarily the dental pulp and surrounding root tissues. This soft tissue can become infected or inflamed, often requiring root canal therapy to save the tooth. Root canal therapy is an internal cleaning process designed to eliminate infection and pain. The question of whether the endodontist places the final restoration, like a crown, clarifies the distinct roles of specialists and general practitioners in tooth preservation.
The Endodontist’s Primary Role
The endodontist focuses exclusively on the internal anatomy of the tooth, diagnosing and treating the pulp and root canal system. They navigate the complex network of canals using advanced tools like operating microscopes and specialized ultrasonic instruments.
During root canal therapy, the specialist removes the infected pulp tissue through an access opening. After thorough cleaning and disinfection, the endodontist seals the root system with a biocompatible material. This internal work creates a stable foundation but does not address the tooth’s external structural needs. The procedure concludes with placing a temporary seal over the access opening to protect the internal seal until the final restoration.
The Need for Post-Treatment Restoration
Following the root canal procedure, a permanent restoration is necessary for the tooth’s long-term survival. Removing the dental pulp eliminates the tooth’s natural source of hydration, making the remaining structure more brittle. Existing damage from decay or large fillings often further compromises its structural integrity.
This compromised state makes the tooth highly susceptible to fracture under normal chewing forces. Studies show that a root-canaled tooth not protected by a crown is significantly more likely to be lost. The final restoration, typically a crown, acts as a protective helmet, binding the weakened structure to prevent breaks. The crown also provides a complete seal against the oral environment, preventing bacteria from leaking into the treated root canal system and causing reinfection.
Who Places the Final Crown
The final placement of the permanent crown is typically performed by the patient’s general dentist, also known as the restorative dentist. Endodontists concentrate on the internal health of the tooth, while general dentists focus on the external form, function, and aesthetics of the entire mouth. The general dentist’s expertise includes preparing the remaining tooth structure, taking precise impressions, and selecting and fitting the custom-fabricated crown.
The endodontist’s responsibility ends after successfully sealing the root canals and placing a temporary filling over the access site. Although endodontists are trained in restorative procedures, the standard of care involves referring the patient back to their general practitioner for the final crown. In rare instances, the endodontist may place the final core buildup upon request, but crown fabrication and cementation remain the domain of the general dentist.
The Hand-Off Coordinating Care
The transition from the specialist to the general dentist requires clear communication to ensure continuity of care. Immediately after the root canal, the endodontist places a temporary filling to protect the sealed canal system. They promptly send detailed treatment notes and radiographs to the referring general dentist, confirming the successful completion of the internal procedure.
The general dentist assesses the tooth to determine if a post and core buildup is required before placing the final crown. If the remaining tooth structure is insufficient, a post may be placed into the root canal space to anchor a core material. This core buildup reconstructs the foundation needed for the permanent crown. The patient must schedule this final restorative appointment quickly, typically within a few weeks, to avoid fracture or contamination.