
Nov
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.
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.
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Mark A Cruz graduated from the UCLA School of Dentistry in 1986 and started a dental practice in Monarch Beach, CA upon graduation. He has lectured nationally and internationally and is a member of various dental organizations. He was a part-time lecturer at UCLA and a member of the faculty group practice and was past assistant director of the UCLA Center for Esthetic Dentistry. He has served on the National Institute of Health/NIDCR (National Institute of Dental & Craniofacial Research) Grant review Committee in Washington D.C. as well as on the editorial board for the Journal of Evidence-Based Dental Practice (Elsevier) and is currently serving on the DSMB (data safety management board) for the NPBRN (national practice-based research network.