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!

[Jerome Tsang, DDS]

Judging by your description, I probably would do the same thing and recommend a partial coverage crown,  Its more durable and would probably last longer than a white composite restoration.  Its the fact that the white composite material is placed in layers in your mouth whereas the partial coverage crown is made with a harder material (I'm assuming porcelain) and placed immediately at once.  

[Jerome Tsang, DDS]

You can do that but there's a fracture risk.  If the composite breaks off, that's not a big deal compared to the composite breaking off and taking more of the tooth with it.  Also, you may want to discuss the actual procedure of the composite.  Sometimes working near the gumline, the area is wet with saliva and is hard to keep dry.  Because of that, doing the composite in the mouth can be difficult and can leak later on due to the wetness.  The moisture basically prevents the composite from bonding to the tooth

[maenos]

Thanks for the help. If there's no serious threat to the tooth with a composite restoration, only a question of longevity of the fix, I think I'd rather start with the composite option and see how it goes. It would save a lot of money and retain healthy tooth.