In dental school, we’re taught to place MO’s, DO’s, MOD’s with precision – restoring to the tooth to pre-caries state.
But what about the structural integrity of the teeth? Often, caries has progressed so far that there is little amounts of tooth remaining.
Obviously, in an ideal world, patients like this would choose to have a crown or onlay – but the reality is that they often cannot afford it.
Capping the cusps is the second best thing to having a crown, and will prevent catastrophic fracture of the tooth, compared to if it had been restored the traditional route. Think of it like doing an Onlay intraorally.
I’d recommend performing this if there is less 2mm of tooth available in either a Mesial – Distal, or Buccal-Palatal direction.
In such instances, I’d recommend preparing the tooth occlusally 2mm, prior to restoring the occlusal surface with composite.
I know, many of you will scream – that is TOO destructive, but clinically, you will find it impossible to add only 2mm of composite thickness alone. Often, if you haven’t reduced the cusp enough, you will spend lots of time reducing the height and therefore removing any potential cuspal coverage that could be provided.
Apart from being able to keep the tooth viable, your patients will be happier. They won’t be returning to your office in a few short weeks or months when the tooth has fractured to the point of needing extraction.
Do this and your patients will stay with you for life.