Destabilizing large amalgam removed to reveal large mesial-distal fracture underneath

Amalgam was cracked in buccal-lingual direction, exhibited peripheral rim fracturing of enamel, greater than 1/3rd intercuspal width, and radiographically appeared to have deep base place underneath

Upon removal it appeared the “soft” poorly bonded base was the epicenter of a large mesial-distal fracture - this makes sense from a biomechanic standpoint as it represents a huge transition from very high to very low modulus of elasticity with ids well known to exacerbate mechanical stresses

Due to the size of the crack, the inability to completely remove it, and the complete mesial-distal-vertical direction I preferred to overlay both cusps with a bonded stiff ceramic - crack dissections in the PFZ were attempted but stopped when I started pushing beyond my comfort zone

Immediate Dentin Sealing with Clearfil SE PROTECT performed - resin coat over the remaining crack was performed with EverX Flow and Resin Coating over dentin with Majesty Flow

Ribbond placed over remaining crack.

E. Max A1 HT bonded with Warm Clearfil AP-X & Clearfil SE Protect

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