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A daily dilemma in Dentistry is deciding when (and HOW) to restore that extensive MODL amalgam restoration that was placed over 30 years ago! We go deep in to this, looking at single-tooth factors but also a full mouth 'bigger picture' view with Dr Andrew Chandrapal who has been trained by world-class clinicians including Dr John Kois and Dr Didier Dietschi, https://youtu.be/lulpENm4swo Check out this full episode on YouTube. Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: How to make sure your equipment doesn't keep getting lost? Use color coded tapes on your own equipment and tell your team that stuff is super important because it belongs to you. https://www.instagram.com/tv/CNUi20EJ9Pk/ “Using things like air abrasion to then try and remove the apical amalgam whatever you can do to try and be gentle in your removal of that material is a good way to go” - Dr Andrew In this episode I ask Dr Andrew Chandrapal,  When to classify the large restoration has failed (12:45)Risk factors of a tooth with large restoration would undergo necrosis (18:33)About restricted anterior restriction or constriction (22:21)How to prevent yellow stains and if you should intervene for a long time restorations? (29:16)Little tip on special burs to use when cutting out caries (31:21)Cutoff point whether to cap the cusp tip or not (33:26)When to decide if you should intervene because of marginal staining and communicating to patients (37:44)What factors to consider moving from direct restoration to indirect restoration? (39:59)Treatment plan to reduce the risks of fracture (42:31) As promised in the episode, if you want to learn more of Composite courses by Dr Andrew Chandrapal - IndigoDent Education If you enjoy this episode, check out this Composite vs Ceramic with Dr Chris Orr Click below for full episode transcript: Opening Snippet: I've shied away many times I've made a treatment plan for a patient for quadrant but I will just work around that upper first molar we've got that behemoth amalgam because I don't want to touch it. Any help you can give me? We should not be responsible for owning the clinical problems that the patient presents with... Jaz's Introduction: Most of my patients are above the age of 60 actually nowadays and when I look into their mouths I see these huge amalgam restorations you know like it's MODB they've got very very thin cusps you can see the amalgam shining through. You can see craze lines, crack lines but they've been there for so many years, they've been there for two three sometimes even four decades i mean you look at these studies about longevity of amalgam and composite and you know my patients are the heavy metal generation patients are a living testament to longevity of amalgam however when things go wrong they can go catastrophically wrong like remember when you find secondary caries around amalgam it can be a huge huge mess and of course, we know that in time cusps can fracture around amalgams and that's like the most common emergency we find which is when someone just broken off a cusp and lo and behold there's a huge amalgam left behind. So when should you look at amalgam and say you know what I’m gonna decide now is a good time to crown this tooth or now is a good time to remove this amalgam because I worry about secondary caries or I worry about microleakage because if they've been like this for 30 years 40 years and I can't really justify enough a good reason to drill into it then why am I drilling into it okay? This kind of debate that I have with myself. So to help answer this as part of this back-to-basics series for August, I’ve got Dr. Andrew Chandrapal from the UK, who is just such a gifted clinician.He's well known throughout the world actually and I think he's done a really good job of covering these basics of you know when do I need to remove the stained composite like is that staining around a margin,