Sameer Puri I hear this a lot from patients. "My dentist told me that my teeth are cracked and I need crowns."
I go into the mouth expecting to see a severely bombed out tooth with an extensive amalgam. What I typically see is what is below. Some old amalgams? Yes. Some visible cracks? Yes. But is this something that requires a crown? In my opinion, no. In the case below, treatment can vary significantly depending on the severity of the size and wear of the amalgam but in my opinion, as a professional, we are doing too many crowns. You can be more conservative and can leave more tooth structure behind which benefits the health of the patient. Simply removing the amalgams and removing the cracks will reveal a tremendous amount of healthy tooth structure behind. As you can see from the initial clean out of the amalgams, the teeth do not need crowns but well functioning inlays and onlays. A few tips if you prepare your teeth this way- no undercuts whatsoever in the preps- especially with the Omnicam. If you have undercuts, you will spend a tremendous amount of time fitting and adjusting your restorations and you will not have the ability to properly seat your restoration. You also want to make sure you leave cusps behind that are "thick enough." My general rule of thumb is that I prefer that my functional cusp is at least 2mm thick and the non functional cusp is 1.5 mm. Any less than this, we will have a potential problem of having thick and strong enough porcelain but a weak substructure behind. The preps below just need simple refinement from this point. You do not need to cover all the cusps and for sure we do not need to remove any additional tooth structure other than cleaning up the stained cracks that are present. So next time you see old beat up amalgams, instead of just cutting the teeth down completely, take the time and effort to properly evaluate what the teeth need and save tooth structure. No matter how good your restoration, at some point, it will need to be replaced and the more healthy tooth structure you can leave behind for the next guy, the better it is for the patient.
