Can you do an onlay instead?
Jorge Bonilla DMD

Hello! I'm a dental student and I'd like to ask a few questions to the
kind dentists around, I have a rough sketch diagram of a tooth (2nd
molar of the 4th Quadrant) attached below that I'm about to work on,
it's a Class I cavity and soon to be a Class II cavity as there's
caries on the distal. From what I've learnt, pins with amalgam
restoration would be one of the options but the surrounding walls of
the tooth are very thin as the amalgam filling has occupied about 85%
of the tooth and since I have to re-do the restoration, there'll be a
good chance that the walls will be even thinner and weaker (flexing of
the tooth) as I remove the amalgam plus the wall on the distal will be
gone as well. It's about 3-4mm deep. So, will amalgam restoration with
pins be the best choice? Is it possible to do cuspal protection with
composite + GIC as the filling? There's no opposing teeth as the
patient is requesting for a prosthesis, by the way. Any suggestion
would be much appreciated! Thank you so much! :D I'm still new in the
clinics and have a loooong way to go, don't go too hard on me.. ;)
Thank you!

Rough Sketch:
http://img99.imageshack.us/img99/8370/roughsketch9fu.jpg
(Sorry about the diagram, it's a bit too kiddy-ish.)
____________________

dentaldoc replies:

If the walls of the tooth are as thin as the diagram indicates, they
are very weak and subject to possible fracture under function.

Generally an onlay or a crown would be needed to protect what remains
of the cusps. No filling can be considered adequate to protect
remaining outer enamel if the tooth structure is that thin.

I would hope that your dental school's course of instruction would
cover the indications for fillings vs. onlays or crowns.

Good luck,
- dentaldoc

I am not sure pins are held in high esteem anymore. I heard they tend
to split or fracture the tooth structure. A sensible alternative is
intentional
root cnaal therapy, post and crown.

Joel

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