Root to crown in a day: how on-site milling makes it possible

Why the gap matters

Root canal treatment removes infected or inflamed tissue from inside a tooth, cleans and shapes the canals, and seals them. That seal is only as good as what sits on top of it. In most cases a back tooth that has been root treated needs a crown to hold it together and keep bacteria out.

Traditionally there was a wait of weeks between the two, with a temporary filling in place. Temporary fillings are not designed to last. They can wear, leak or come away, and a tooth that has lost its pulp is more brittle than it was. Closing the gap between root canal and crown removes a period in which a good result can be undone. A tooth sealed from the root to the biting surface in one sitting has simply had fewer chances to go wrong.

Under the microscope

My practice is limited to endodontics, and I work under a dental operating microscope for every case. The canals inside a tooth are narrow and often curved, and some are difficult to find without magnification and good light. The microscope lets me see what I am cleaning rather than feeling for it. It also lets me check, at the end, that the canals are sealed to the tip and the floor of the tooth is sound, which is the foundation the crown will sit on.

For some teeth we go further and plan the access with a printed endodontic guide, made in-house from a CBCT scan and an intra-oral scan. The guide directs the instrument to a calcified or hidden canal along a path we have already checked on screen. It is a small piece of plastic that takes much of the guesswork out of a hard case.

The laboratory down the corridor

What makes a single-day appointment possible is that the crown does not leave the building. Once the root canal is complete and the tooth is built up, we scan it with the intra-oral scanner. The crown is designed on screen, milled from a ceramic block on the CEREC, then stained and glazed by the dentist before it is fitted.

That takes a little while rather than a fortnight. While it is being made you can wait with a coffee or go for a walk around Lincoln's Inn Fields. When you return, the crown is tried in, adjusted if needed, and bonded in place. The tooth that arrived in the morning with a problem leaves sealed, restored and ready to use. There is no second impression, no temporary crown to nurse for a fortnight and no return visit to fit the final one.

What the day looks like

The appointment begins, as all of ours do, with a scan. The root canal is done under local anaesthetic with the tooth isolated under a rubber sheet, which keeps it dry and keeps everything else out. Treatment is usually comfortable; the anaesthetic does its work and the microscope keeps the procedure precise and unhurried.

Once the canals are sealed, the restorative stage begins. The tooth is rebuilt, scanned and the crown designed and milled while you take a break. Some cases are completed in one longer visit; others, where a tooth needs time to settle, are better spread over two. We tell you which before the day, so there are no surprises in the chair.

Who it suits

Root to crown in a day suits people who want a tooth dealt with properly in one go: someone with a demanding diary, someone travelling, or simply someone who would rather not live with a temporary filling. It is most often used for back teeth, where a crown is usually the right final restoration.

It is not right for every tooth. Where there is a large infection, severe symptoms or a very complex root system, a staged approach is often the safer choice, and we will say so. We decide together after your consultation and imaging, and the choice is recorded in a written plan, fees included, before any work is done.

The fees

A root canal consultation is £150 and includes the imaging we need to assess the tooth. Root canal treatment itself starts from £1,200, with complex cases from £1,250. A same-day CEREC crown starts from £1,250. These are guide fees; your own figures are confirmed in writing before you decide.

If finance helps, it is available for treatment from £1,000 to £30,000, subject to status, for people over eighteen. Our treatment coordinators can take you through the options and answer anything that comes up between visits, so the clinical decision and the practical one can be made calmly and separately.