Friday, January 26, 2024

old pt came to replase all old amalgam filling he had sever occlusal attriation the best replacement is.. full crowns

old pt came to replase all old amalgam filling he had sever occlusal attriation the best replacement is:

  • A- composite.
  • B- amalgam.
  • C- cast metal restoration.
  • D- full crowns.
Choosing the best replacement for old amalgam fillings with severe occlusal attrition in an older patient depends on several factors, and there's no single "best" option in every case.
Here's a breakdown of each option considering the specific context:

A. Composite:


  • More aesthetically pleasing, conserves more tooth structure compared to crowns. Can be suitable for small to medium-sized restorations if sufficient tooth structure remains.


  • May wear faster than metal alternatives, especially with severe occlusal attrition. Might not be ideal for large restorations or teeth with significant structural compromise.

B. Amalgam:


  • Durable and wear-resistant, good choice for areas with high biting forces.
  • Less expensive than most other options.


  • Not as aesthetically pleasing as composite or porcelain.
  • Potential concerns about mercury content, though scientific evidence on its health risks in fillings is inconclusive.

C. Cast metal restorations:


  • Very durable and wear-resistant, excellent choice for teeth with severe occlusal attrition.
  • Can restore significant tooth structure loss.


  • Less aesthetically pleasing than composite or porcelain.
  • More expensive than composite or amalgam.
  • Requires more tooth preparation, potentially compromising tooth structure further.

D. Full crowns:


  • Provide maximum protection and support for heavily damaged teeth.
  • Highly durable and wear-resistant, ideal for long-term success.


  • Most expensive option.
  • Requires removal of significant tooth structure.
  • Might not be necessary for every case, especially if sufficient tooth structure remains for other restoration options.

Thorough Evaluation:

Therefore, the best replacement for your patient depends on a thorough evaluation by their dentist, considering factors like:
  • Extent of tooth structure loss due to attrition: If significant, crowns or cast metal restorations might be needed for sufficient strength.
  • Bite forces: Teeth with high biting forces might benefit from the durability of metal options.
  • Patient's aesthetic preferences: If aesthetics are a concern, composite or porcelain restorations might be preferred.

Budgetary considerations:

Cost can be a factor, with amalgam being the most affordable, followed by composite, then cast metal and crowns being the most expensive.

Ultimately, the dentist will collaborate with the patient to determine the most appropriate and individualized treatment plan based on their specific needs and preferences.