I wanted to expand on the original article about prophylactic RCT by sharing a realistic case. Take #14 from the x-ray, which was initially treatment-planned for just a crown. But once the amalgam is removed, you can see that very little coronal tooth structure remains. At that point, you really have two main options:

For this patient, an implant wasn’t a good option because Medicaid would cover the RCT and crown, but not the implant, which would have been entirely out of pocket. In a dental school setting, it might make sense to attempt the crown first and only do the RCT later if needed. But in the real world, that approach often fails. Why? Because you’d eventually have to explain to the patient that you’ll need to drill through their brand-new, expensive crown, and possibly replace it—or worse, that the tooth may be unrestorable due to lack of coronal structure.

Recommending root canal therapy up front may sound daunting, but patients generally understand the logic when it’s explained clearly. What they won’t understand is why, after paying $700 for a crown, they’re suddenly told that the tooth still needs a root canal, another crown, or may even need extraction.