broken cusp restoration

[maenos]

About a year ago I cracked the inside cusp of a back molar biting into something hard. This last week, the cusp finally broke off without pain. The tooth has an amalgam filling placed about 20 years ago running the length of the tooth.

My question is, is a direct composite replacement of the cusp at all viable? Especially if it were shaped in a way that avoids much chewing force and helps to shore up the remaining tooth on the same side? The dentist wants to use a partial crown, yet the amalgam filling seems to be offering good support, I have no pain and the rest of the tooth looks healthy, even under x-ray.

I’ve been frustrated that initially 20 years ago so much healthy tooth was carved out for a cavity and don’t want to repeat the same thing here – I want to keep as much healthy tooth as possible.

Thanks!

 

[comfortdentist]

A crown will give the tooth the support it needs while a composite filling may allow for another fracture that could doom the tooth

 

[Gordon]

Big composites don't last in general, the danger in this case apart from what ComfortDentist says, is that it's impossible to get a good seal between the composite and the existing amalgam, so it will probably leak and cause decay deeper in the tooth.

A gold onlay could possibly be done, which would conserve a bit more tooth structure than a crown and still support the rest of the tooth.