In the case of a fractured distal marginal ridge with a large amalgam restoration, what is the recommended treatment?

• A. Replace with composite
• B. Replace with new amalgam
• C. Cast restoration
• D. Leave alone

Answer: (C)

The recommended treatment for a fractured distal marginal ridge with a large amalgam restoration is the use of a cast restoration. This is because a cast restoration, such as a crown, provides superior strength and durability, especially when the tooth structure has been compromised due to the fracture.

In cases where a significant portion of the tooth has been lost or when the integrity of the tooth is at risk, a cast restoration can effectively redistribute occlusal forces and protect the remaining tooth structure. Additionally, cast restorations are more resistant to wear and can provide better marginal adaptation compared to direct restorative materials like amalgam or composite.

While replacing the restoration with either composite or amalgam could be options, these may not offer the same level of reinforcement and longevity as a crown, especially when significant structural integrity is compromised. Leaving the tooth alone is generally not advisable as it does not address the fracture and may lead to further deterioration of the tooth or even potential pulp involvement. Therefore, opting for a cast restoration is the most comprehensive and effective treatment strategy in this scenario.