Few restorative decisions are clearly black and white. The patient has a right to choose a cosmetic outcome at the expense of durability, so long as he or she is fully informed and intelligently accepts the risks of that alternative, and the dentist is also comfortable with the decision. No cosmetic restoration, including cast gold technique, is advisable without the patient's understanding of the short- and long-term risks.
Think about the future of gold for a society who may not aware of its benefits - biocompatibility, comfort, longevity, and physiologic wear - and whose focus is solely superficial. Then, consider these indications for use of cast gold in this era of cosmetically-driven treatment alternatives:
In many cases, it eliminates the need to use a reverse bevel when covering a non-functional cusp of a tooth in the upper jaw, since that technique can have an unaesthetic outcome.
Preparation design for cast gold restoration
Impression of preparation
Cast gold restoration prior to cementation onto tooth
Cemented and polished gold casting. Note precise fit
Image of tooth with gold casting and cheek retracted. Note re-establishment of nature tooth color and no display of metal visible.
Cast gold is a long-term alternative when replacing a filling which has failed, rather than waiting until the restoration is so large that it requires either extracoronal protection or a full crown.
Cast gold can be used for the initial restoration of cavities which are somewhat extensive. They remain aesthetic since only a minimal (possibly none) display of gold is visible.
Gold may be used exclusively in maxillary (upper) and mandibular (lower) second molars, where the benefits supersede cosmetic considerations.
Gold restorations for a young patient provide reliable service for decades. And use of gold resolves situations where bacterial reservoirs under failing composites (traditional fillings) are being removed.
Once the underlying cause is defined, cast gold may be used to manage dental erosion, with more favorable wear characteristics and more predictable results than ceramic or composite.
Cast gold should be avoided in areas where the restoration will be obvious, unless the patient is fully-informed and insists.
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