Restoration of endodontically treated lower right 1st molar.

Its definitely not the easiest case, but i will go with a full gold crown.
Once the amalgam overhang is removed distally you will have at least 3mm coronal to bone to place the finish line on sound tooth. Crestal bone distally will undergo some kind of resorption later on ( natural crown lengthening ).
Let us know what happens!
Good luck.

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Truly appreciate your kind advice. However, I am a bit skeptical about the " natural crown lengthening" process.

If the bone resorbs further apically, the pocketing will get worse. Furthermore, the margin of the crown will be subgingival which will increase the periodontal risk in the area (as the patient is already to susceptible to periodontal disease).

I could do some laser excision of the gingiva, but that would mean exposing the crown of the tooth at the dentinoenamel junction of the 7.

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What I would do is prep tooth for a crown, It does not really matter what kind of crn, place a temp and re-eval in 2 weeks ,do some bone sounding on the distal area to check the position of the margin, if 3mm or more Good! we take the impression, if less than 3mm crown lengthening or build up the distal area with glass ionomer on that distal margin where the crown will seat.

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Hello Hamad -

Very insightful of you to catch how difficult this case is before preparation! I tend to agree with Juan; it is difficult to know the extend of your distal margin without removing the overhanging amalgam.

A large gold onlay may be the best plan for this case, if the patient is willing to go that route. The patient appears to have very demineralized enamel that would compromise your bonding for a composite or ceramic onlay. I would also recommend full cuspal coverage (buccal and lingual) for your onlay to prevent fracture, since the tooth is already at a higher risk for fracture with the large restoration and missing posterior teeth. This would eliminate your need for ferrule, and allow you to finish your margin in a more occlusal position to avoid the need for crown lengthening.

Thank you for sharing! Sometimes the seemingly smaller cases allow for the best learning opportunities.

Wendy

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I recommend crown elongation (if necessary) and full coverage (preferably gold) crown. Why take and chances with this type of enamel.
Chuck

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