Thars gold in them thar teeth?


After I removed a gold crown from a patients tooth and placed it on my bracket table my patient seemed suddenly interested and said "Let me see that baby!". I gave it to him and I explained to him that  if he could save 10 more of these he might be able to get a gold refiner to give him some money in exchange. Actually Gold, when  used as a dental restorative in the mouth  has a much greater value.

Other than the fact that it is not tooth colored, it is close to an ideal restorative material . There is nothing more "kind" to opposing teeth because when placed in opposition to opposing teeth gold tends to wear instead of the tooth opposing it. It is virtually unbreakable.  If a patient has a prematurity or grinds excessively side side, the occlusal gold surface will continually tend to correct itself.

 Ok, Gold crowns may not last forever. What I have seen over the years, is that under heavy function with high occlusal abrasive forces, gold crowns, even if they were initially 1.5 mm thick at the occlusal surface, can perforate in as little as 9-15 years. This perforation is evidenced by a small hole in the occlusal surface of the patients crown and often can be "plugged" with a minimally invasive amalgam restoration, so that the live span of the crown can be extended. In the same situations, porcelain crowns tend to either experience breakage or cause extensive wear on the opposing dentition.

Maybe I can be a little old fashioned, but even though I make the full gamet of crowns for my patients (Zirconium, Emax, feldspathic porcelain and porcelain fused to meta), my favorite crown for second and third molars is a full cast gold crown, or if my patient prefers a silver colored tooth, a full cast semi-precious crown.

Not every patient agrees with my favorite choice, so I do make some porcelain fused to metal and Zirconium crowns for their most posterior molar teeth, but I do believe these are really the second best choice. In my mind, even though they are quite cosmetic, their tendency to break or possibly cause problems with the teeth opposing them,  make them a much less desirable option.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2019/03/thars-gold-in-them-thar-teeth.html - http://lspindelnycdds.blogspot.com/

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