For decades, cast gold has been the material of choice to repair back teeth when large restorations have failed due to recurrent cavities, fractures, sensitivity to hot and cold, or poor function. The benefits of gold restorations have been historically well-documented in dental school curriculum, post-graduate education, and criteria for licensing.
Failing silver filling view of chewing surface
Failing silver filling view from side of tooth cheek side
It should be noted that there is no "perfect material". Each individual restoration has advantages and disadvantages. Dr. Mark Cruz focuses on patient choice by educating each patient about their treatment options. He encourages each patient to make informed decisions and choose the best material for their own individual needs.
In the last 10 to 20 years, there has been an obvious shift away from the use of cast gold. We see this in training curriculum where the public's demand for tooth-colored materials drives educational courses and dental materials research. Unfortunately, the public's awareness and demand for cosmetic restorations is strongly influenced by reality TV make-over shows and magazine advertisements, rather than by solid dental research. Use of these materials by dental professionals, in deference to patients' perception of them as the latest and greatest technologies, has also contributed to the trend away from gold restorations.
Today's dental professional has a responsibility to determine, based on best evidence and clinical expertise, integrated with the patient's values and preferences, the ideal option beyond mere dogma or market influence. This includes fulfillment of cosmetic desires as well as functional longevity, comfort, and biocompatibility. Achieving one of these criteria at the expense of the other, without the patient's true, informed consent, clearly poses as an ethical breach in the doctor/patient relationship.
To avert such a breach, an updated understanding of the behavior of the tooth/restoration complex is essential. These are not novel concepts; however, a re-evaluation of our collective mindset with regard to dental practice philosophy can only be beneficial to the patient-oriented doctor. It is vital to keep in mind that what we are doing in daily practice is never beyond reproach.
We take responsibility for passing the torch to a next generation of clinicians - a generation yet to develop their own expertise and witness long-term clinical outcomes. They will do so in an atmosphere of market influence, self-touted gurus, and financial pressures. This is no small responsibility. Yet the spirit of the Hippocratic Oath makes it a given.