Sir, after reading 'The ultimate guide to restoration longevity in England and Wales. Part 5: crowns: time to next intervention and to extraction of the restored tooth'1 in the July issue of the BDJ, I changed a treatment plan in the hope of a better and more minimalist approach.

As shown in Figure 1 15, 16 and 17 all had MOD carious, leaking and fractured amalgams; I had replaced the amalgams with composite cores under rubber dam (Fig. 2) with the intention of crowning or onlays if stable – that is, until I read the latest research indicating the reduced lifespan of teeth restored with crowns.

Figure 1
figure 1

15, 16 and 17: long standing and failing amalgams secondary to caries and fracture

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Figure 2
figure 2

Rubber dam placement & removal of amalgam 16, 17; disto-buccal cusp 16 fractured & to be removed

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I looked again at the pictures after amalgam removal and at the composite cores (incidentally highlighting the benefit of photographing one's work to allow for reflection and discussion with peers). I then concluded that, rather than cutting away tooth out of habit, with the favourable occlusion and guidance, I would polish the composites up instead as permanent restorations (Fig. 3).

Figure 3
figure 3

Finished restorations in 15, 16 and 17

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The patient seemed keen on this change of treatment plan in avoiding further work and potentially having more tooth left to play with in the future. In keeping with the findings of the article, as a young dentist (BDS 2015) I hope my direct restorations will perform well! My only regret is not placing an opaquer to hide the amalgam stained dentine.