Steven Gray Hey any West coasters, late night people or early risers... I had meant to get this case posted earlier in the day or week, but hadn't. I'm presenting an onlay case to some other docs and wondered if anyone out there had thoughts on the prep, the design and pros/cons of the way I treated the tooth. Note - I am pretty much an A1 block guy, so don't harass me too much about the shade of the block! I have been doing these onlays since 2002 with very high success, but am training some other docs and want to see how many in the community would do an onlay type prep as I did here, or something LESS invasive, like a composite, or more of a full coverage crown.
Initial presentation: 
Removed the Amalgam and recognized the mesial crack was extending onto the pulpal floor: 
After shaping around the mesial fracture, noted the pulpal fracture on the DB cusp, but since the crack was on the floor only, decided not to hood the entire molar: 
THoughts on this? Better to hood the entire buccal?
After shaping down, preparing with very slow speeds and finishing the margin, didn't like the 2nd dentin and the high MB pulp horn: 
So placed some CaOH: 
And after cementing and comparing the final occlusion, thought we looked pretty good on this restoration: 
I have a tendancy on molars that have had heavy occlusion with large amalgams to reduce the overall bite so from the initial biocopy, you can see the reduction of the heavy bite and I'm wondering how others would have managed this case. Original biocopy: 
Adjusted occlusion: 
Thanks for any thoughts! Curious how many would have just done a composite here... how many like the onlay.... and how many think this should have been full coverage- or MORE coverage than what I did here. Appreciate the feedback!
Steve
