MANAGEMENT OF FRACTURED FUNCTIONAL CUSP OF MAXILLARY FIRST MOLAR: A CASE REPORT

using cast metal restorations like inlay.

Loss of tooth structure has been a common mishap, occurring due to various reasons like fracture, caries or mechanical preparation. Maxillary and mandibular molars have been the most common teethexperiencing a major amount of masticatory load, therefore facingincreased risk of fracture. The most commonly fractured cusps have been the functional cusps as the load bearing has always been high. Loss of such areas may not be restorable with direct techniques and restorative materials like amalgam or composite. Therefore, a need to replace the functional cusps require replacement through indirect restorative procedures using cast metal restorations like inlay.

…………………………………………………………………………………………………….... Introduction:-
Inlay in dentistry was first introduced by Dr.Philbrook, in 1897. This followed theintroduction of cast gold restoration technique, given by Taggart. 1 The amount of tooth structure that remains, dictates the choice of restoration. Such teeth with extensive loss of tooth structure cannot be restored by direct restoration due to its inability to provide the required resistance and retention form. Therefore, indirect restorations such as inlay, onlay, overlay are the solution to such teeth. These restorations provide sufficient resistance and retention form for the overall function and form of the debilitated tooth. 2 The indirect restorations can be considered in the following case scenarios: 1 1. Extensive tooth involvement 2. Restoration of endodontically treated teeth 3. Occlusal correction 4. Subgingival restoration 5. For better control over contact and contour 6. Teeth with risk of fracture 1087 history were non-contributory. Past dental history revealedrestoration of 27 and 28. On general examination patient was conscious and well oriented in terms of time, place and person. Extra oral examination revealed no abnormality. Intra oral examination showed fractured cusp with respect to 26, cervical abrasion 25, 26, root caries with respect to 27,28. Pulp sensibility test showed 26 as vital which responded normally to EPT (Electric Pulp Test). The diagnosis was given as cusp fracture of 26 involving enamel and dentin.
The suggested treatment options give to the patient were as following:

Discussion:-
Silver amalgam being the oldest restorative material, has been time tested for its good compressive strength but it has the disadvantage of getting fractured due to weak marginal strength. Composite restoration despite being esthetic and operator friendly, undergoes unavoidable polymerization shrinkage leading to hypersensitivity. 2 Therefore, these options were surpassed. Porcelain fused to metal or full ceramic crown can be considered for large and extensive cavities, such as the present case but the only disadvantage being, requirement of excessive tooth cutting for accommodating the ceramic. 3 Cast metal inlay is considered as one of the best possible restoration in cases such as the present one. This is attributed to the good compressive strength and marginal integrity, providing the ability to withstand heavy masticatory forces. 4 In the present case, the same was required for the restoration of 26 that had undergone fracture. Few other added advantages of cast metal inlay are enumerated as following: 1. Cost effective 2. Patient' compatibility and preference 3. Longevity 4. Better margin visualization 5. Better control and production of contact and contours The maintenance of gingival and periodontal health is important for the long run survival ofthe restoration and for the functional purpose. Care should be taken to avoid over or under contouring, since it is injurious to gingival health. Opting for the indirect method allows better control over the contact and contour hence, maintaining the gingival and periodontal health. For the same reasons, margins were kept supragingival, as they are best suited for adaptation and gingival health.

Conclusion:-
Cast metal inlay provides remarkable restoration that might be overlooked and under used in dentistry. The technique definitely requires multiple patient visits and good laboratory support but results in a highly durable and long-lasting restoration. In the present case, cast metal inlaywas preferred as the choice of treatment since, clinical situations such as this, were beyond the capability of amalgam or composite restorations. Cast metal restorations 1088 also provides a source for restoring an ideal occlusal anatomy, including contact and contours, keeping them in service for years.