There is a great divide in philosophy among dentists who seek to preserve biology as to what is the most important biology to save.
Procedures using direct composite resin or amalgam have been suggested to cost the patient less.
Procedures using direct dentistry require more time, skill, care and judgement. It has been suggested it costs the patient more.
But that reality is only in one time frame. If one plots out the cost/benefit curve for indirect dentistry done well with proper protocols vs. direct dentistry done too fast because of poor insurance reimbursement over time, the result is direct dentistry costs the most.
So in the process of minimizing cost and preserving enamel and dentin in the short run, many times direct dentistry sacrifices the biology that really matters in the long run…pulp, soft tissue and bone.
Such was the result in the case posted here. Had the amalgam been replaced with an onlay years earlier there would have been no need to extract this tooth and place an implant.
I suggested to the patient years earlier to replace the amalgam with a gold onlay but he chose not to do so.
I do not fault any patient, or dentist for that matter, who makes such a choice.
Were this my tooth I would have wanted it restored properly with a gold casting years before this catastrophic failure occurred.
