Douglas Decker, DDS

A competent GP or pediatric dentist can make the call. My guess is that the radiograph(x-ray) showed fracturing thru the pulp chamber and that is why you  they told you root canal therapy was needed. Good call Leonard! Mauricio, a second opinion is not a bad idea--but why a board certified endodontist? Why not a board eligible endodontist or a competent GP or Pedo? Good explanation of the follow-up!

All general dentist do cosmetic dentistry-for example,fixing a chipped or decayed front tooth,etc.  "Cosmetic dentists"-there is no official standard/accreditation for "cosmetic  dentist"-it is a self-proclaimed title- often over treatment plan patients for cosmetic procedures. Dr. Gordon Christiansen, one of the most highly respected voices of dentistry, has written frequently of the overtreatment of patients for cosmetics and the lack of  informed consent about the procedures.

The most ideal approach would probably be extractions,implants and fixed bridges/prostheses. This can be very expensive and insurance typically does not cover much of it.You could try to find a dentist who understands a wide array of options and could set up a treatment plan to save some strategic teeth and make you removable partial dentures . Having the saved teeth would give you a lot more stability and comfort with the partial dentures than full dentures and would be a lot less expensive than the implant option.

In the hands of a skilled and competent dentist, CEREC crowns and onlays/inlays work well. However, I see alot of people coming in with poorly done CEREC restorations. It seems as though there is a steep and long/tall learning curve. Some dentists do not seem to ever get thru the learning curve. Quite often they are poorly cemented with gaps at the margins or excess cement that cannot be cleaned off. I also believe there is tendency of dentists to overprescribe CEREC crowns when a direct composite filling would work fine. Typically the patients insurance will pay 80% of $150-$330 for a filling vs. 50% of $600-$1200 for a CEREC restoration. This is a huge difference in the out of pocket expense for the patient. The dentist  has $100,000 invested in the CEREC system and has to pay that overhead so it seems like CEREC is being over-utilized. The old saying..."if all you have is an (expensive) hammer, everything looks like a nail ! "

Using a laser or high intensity "white" light to whiten teeth with a bleaching gel has become very popular. ZOOM and BRITESMILE are two very popular products/techniques. I have had both in my office. I gave the BriteSmile machine back. The Zoom machine sits in the corner of my storeroom. Gordon Christianson and Clinical Research Associates( a highly respected , independent, non-profit research group) came to the conclusion that laser/light assisted bleaching did not work any better than doing it with no light or laser.  It appeared impressive due to a temporary and transitory dehydration of the teeth. We now use tray bleaching only and prvide it for our patients at no charge once they have completed treatment.

Titanium implants should be no problem with an MRI. An MRI uses a powerful magnet to scan the human body. It is a problem with things containing ferrous metals(i.e. iron and steel). Implants and the restorative materials on them typically contain non-ferrous materials only( titanium,gold,platinum, etc.) The one possible area might be if you have a removable prosthesis that uses magnets for retention. It is probably a good idea to take out any removable prostheses(dentures,bridges,etc.) before an MRI and leave them outside the MRI room.