Sample Answer
I start by looking at remaining tooth structure and functional demands. For a posterior tooth with a large MOD lesion, if I’m losing more than about 50% of cuspal width or the marginal ridges, I lean toward an indirect onlay or crown to prevent fracture. If I still have strong cusps and can keep the isthmus under roughly one‑third of the intercuspal width, a bonded composite can work well. I also factor in occlusion (bruxism, heavy contacts), isolation, and caries risk. A high‑caries, bruxing patient who’s already lost one cusp is a poor candidate for a big direct; that’s where an indirect with cuspal coverage and possibly a nightguard makes sense. Then I layer in patient factors: budget, insurance, and time. For example, I’ve had students manage costs by doing a well‑designed direct first, then upgrading to an indirect when finances improve, while clearly documenting the higher fracture risk.
Keywords
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