Apart from filling materials like amalgam, Glass Ionomer cement, composites, gold fillings have gained much importance in the field of conservative dentistry. The importance of gold lies in its strength and shelf life. A gold filling once placed can last as long as 15 to 30 years.
You might be thinking that gold, being too malleable, would not be suitable for filling. But let me tell you that gold isn’t used in its pure form. Some impurities are added to it to making it an alloy.
The steps of preparation of gold filling are similar to that of amalgam filling. The only difference lies in the precision and detail required for filling the tooth with gold.
Three things that should be taken care of while preparing direct gold filling are:
Resistance Form: To achieve the resistance form, the pulpal floor is made perpendicular to occlusal floor. Walls should be supported by a sound dentin. Take care to make walls smooth and flat.
Retention Form: To achiever retention form, facial and lingual walls are made slightly convergent. The internal line angles should be sharp and the cavity should be 0.5 mm deep into the dentin.
Convenience Form: It is achieved by keeping the field dry and gaining comfortable access. In case of class III cavities, separators can be used.
Direct gold filling comes with endless advantages. Few to be named are:
1. It has got good strength.
2. It is the most durable restorative material available for dental fillings.
3. Because gold is a Nobel metal therefore it is not subjected to corrosion in the oral cavity.
4. Unlike amalgam fillings, gold fillings doesn’t show expansion post filling. It adapts good to the cavity walls. It has excellent marginal integrity.
5. There is no accumulation of plaque over direct gold fillings
6. The shelf life to direct gold filling is quite large and range from 15-30 years.
In dentistry, no material is perfect. So is the case with direct gold fillings too. Here are some of the side-effects associated with direct gold fillings.
1. The first and prime disadvantage of gold is its cost. It is ten times more expansive than other dental filling materials.
2. Due to its high thermal conductivity, great amount of pulp protection is required underneath the direct gold filling.
3. From endodontist point of view, direct gold filling is quiet a tedious job and requires great amount of time and concentration. Even a small amount of saliva contamination can spoil the whole lengthy procedure. So, its manipulation requires a great mastery over the subject.
4. Gold filling, due to its yellow color, isn’t esthetically compatible with anterior teeth.
5. If you already have amalgam filling, then getting gold filling placed adjacent or opposite to it can cause galvanic shock.
There are many conditions when direct gold fillings are not advised or may not be suitable for the patient.
Posterior Teeth: Direct gold filling can’t withstand heavy occlusal forces and hence are not indicated in case of posterior teeth with large carious defects.
Esthetic Considerations: Direct gold fillings, due to their color, aren’t indicated for anterior teeth.
Periodontal Problems: Due to poor prognosis, gold is not the material for filling if the patient is suffering from periodontal diseases.
Children: Due to the large pulp chamber in young patients, the pressure applied while placing gold over the tooth might not be bearable by the pulp and thus can cause damage. Therefore gold is not indicated in case of young patients.
Inaccessible Areas: Placement of gold requires complete isolation of the tooth. The tooth where complete isolation can’t be achieved is ruled out to get direct gold filling.
Due to high precision and hard work required, direct gold fillings are six to ten times more costly as compared to the normal tooth fillings. The starting range may vary from $800 per tooth.
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