When replacing a restoration in a defective tooth that is 3/4 amalgam, what is the treatment of choice?

When replacing a restoration in a defective tooth that is 3/4 amalgam, opting for a porcelain-fused-to-metal (PFM) crown is often the most suitable treatment choice due to several reasons. A tooth that has already undergone significant restoration indicates that it may have compromised structural integrity and requires a more robust solution to ensure longevity and strength.

A PFM crown offers the benefits of both metal and porcelain. The metal base provides excellent strength and resistance to occlusal forces, making it an ideal choice for posterior teeth that typically endure more chewing pressure. The porcelain layer allows for aesthetic considerations, enabling the restoration to blend more naturally with surrounding teeth.

Additionally, when a tooth has a substantial amount of existing amalgam, it may be challenging to gain adequate retention and resistance with simpler forms of restoration, such as a direct composite or a veneer. These options may not adequately support the structure of the remaining tooth or effectively seal the restoration, particularly in a tooth that is already significantly restored.

In contrast, other options such as a composite veneer or direct composite restoration may not offer the same level of durability or protection, especially given the history of the tooth and its previous restoration. A full gold crown, while strong, may not offer the desired aesthetics for