A cusp is broken but the pain is coming from a different crack under the amalgam.
Here we have a tooth with a small amalgam filling and the corner cusp has broken off. It’s a common problem and there are several options on what to do about it. Here we chose to do nothing and leave the tooth broken as there was no pain and no decay. A few months later the patient reported pain when eating certain hard foods. This is a classic symptom of a cracked tooth. The patient then admitted to cracking open mud crabs with his teeth in his younger days!
The crack is outlined in blue in the picture. Note that cracks are not always easy to see, even with Xrays. The plan then became to reinforce the tooth by wrapping up the 2 split portions with a gold crown. This brace helps to hold everything together. Provided the crack has not traumatised the nerve too much, this can give relief when eating. The gold crown is ideal as it can be made as a very thin shell. The thinner the crown material, the less of the tooth needs to be removed to receive the crown. The dentist could have used a porcelain coating over the gold, but more tooth would have been removed to make space for it. The patient was more than happy to have a gold tooth and can now eat comfortably.
Note that if the crack is too far gone, sometimes the pain cannot be relieved with a simple crown. Each case is different and sometimes there is success and sometimes the nerve of the tooth needs to be removed. That is root canal treatment…and that’s another story.