Gold Inlays and Onlays
One of the oldest restoration materials for repairing teeth is gold. An "oldie, but a goodie" and "the gold standard" are both apt descriptions for this material. The track record shows that a high noble gold alloy (that describes the elemental makeup of all the different types of metals used where 90% of the metals are precious metals) simply lasts. While we can get good longevity from porcelain, composite, and amalgam restorations, gold is rarely beat. The secret lies in it's ability to be strong, yet flexible. So you can burnish (move on a microscopic level) the margins (that's the transition point from tooth to restoration) to an extremely close fit, but it won't break. It's the only material that is capable of this. Also, since it's so strong, you can use relatively thin amounts allowing you to be more conservative in how much of your tooth needs to be removed. I like it when I can save tooth structure because nothing has been invented that's as good as natural tooth!
But there's more great benefits to gold. It's a naturally occurring noble element. That doesn't mean it's royal, but it does mean it is inert and will not react with other elements. And that means it will never change color or change the color of the surrounding tooth. Since gold can be polished incredibly smooth, plaque and bacteria have a hard time sticking to it--it's cleaner! My favorite part about gold is that it will wear the opposing teeth just about the exact same as natural teeth would. That's one of the big drawbacks of porcelain -- it will abrade other teeth much more quickly.
So why aren't all dentists using gold to fix everything all the time? The first reason is cost. Often you get what you pay for, and this is no exception. These restorations are like jewelry for your teeth, and good jewelry is never cheap. The next reason is time. To prepare the tooth often takes extra skill and patience, then the gold needs to be finished to the tooth and polished with a specific and special technique that not every dentist has the resources or skill to do. And some patients are... well... not patient enough to wait for the work to be done. How long is the extra time? Well every tooth is a little different, but on average it might take 3 hours total split into two different appointments (where as a full crown might take 2 hours total over two different appointments).
Why did I reference the time to do a full crown? Well there are two different types of restorations gold is typically used for: inlays and onlays. You can think of inlays as gold fillings and onlays as conservative crowns. I'll include some pictures of my very own cases on this page.
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