Cast gold – is newer always better?

Many individuals believe that developing technology is synonymous with better outcomes. The dental profession, as a whole, exhibits a will to constantly improve on established standards. Sadly, the idea that technology must be better simply because it is newer and is often mistaken. No area in dentistry better demonstrates this than the development of tooth-colored materials.

Consider this example of the profession’s collective emotional (and at times irrational) mindset regarding novel ideas. Michael Buonocore is deemed an innovator in dental research. His influential efforts beginning in 1955 at the Eastman Dental Center were introduced in his 1967 paper on acid-etch technique.

The controversy this development stimulated within the dental community is often compared to the firestorm created within the medical profession when Florence Nightingale suggested statistical tracking of post-operative infection. Both represented a paradigm shift (a change in basic assumptions) difficult for the respective professions to accept as a necessary change in clinical practice.

Since Dr. Buonocore’s scientific contribution, the evolution of bonded and un-bonded tooth-colored materials has continued, albeit with some argument. The debate exists primarily because of a conflict in values between cosmetic worth and predictable longevity, statistically measured in decades rather than mere months.

Silver filling and decay removed Today it is not so much a question of if tooth-colored restorative material is viable, so much as when it serves the patient’s best interest. A more balanced approach is beneficial in deciding which technique will fulfill the patient’s expectations, values, and preferences.

Both mindsets – metal-free dentistry and the inflexible use of gold – characterize two sides of the same coin. Although cast gold technique represents a standard for long-term durability, function, and comfort, it is not an overall solution for today’s dental practice. Tooth-colored options fulfill the requirements of many scenarios, yet many of these novel materials are still experimental in nature. A conscientious clinician will explain this to the patient as part of informed consent.

• Flawed dental beliefs.
• Misunderstanding of how tooth structure and dental materials function.
• Development of cosmetic tooth-colored materials.
• Market pressures (cosmetic influence in restorative choice).