PRACTICE
ALL THAT GLITTERS IS NOT GOLD Is it true all that glitters is not gold? In 1907, a Chicago dentist named W. H. Taggart introduced a casting method for small gold inlays. Then, in 1936, a Danish engineer, Thoger Gronborg Jungersen, filed a patent for a method of manufacturing precision gold objects utilizing the lost wax technique combined with a centrifugal casting machine. This ushered in the modern era of indirect cast gold restorations, including inlays, onlays, ¾, ⅞, and full-coverage crowns. Over the years, many refinements to this process have been introduced that have enhanced control over the size of the casting and have greatly improved the precision nature of the process. Consider how many of these restorations have been utilized since they were first introduced. The number is likely in the tens, or even hundreds of millions. Wow! The ability to reinforce tooth structure in a very conservative way with these restorations was a significant breakthrough. To say that many teeth have been saved by indirect cast gold restorations is, indeed, an understatement. As a witness to the remarkable nature of these restorations, it is likely that many dentists reading this article are sporting at least one, if not more, indirect cast gold restorations in their own mouths. As you well know though, partial coverage is really where gold shines. There is not a less-invasive, longer-lasting restoration in our toolbox. It is not uncommon for many of these restorations to be in service for more than 60 years. With that as a backdrop, according to a 2018 survey of 844 dentists across the United States, less than 3% of all crowns placed were cast metal, let alone cast gold. Currently, worldwide the number of cast gold restorations placed is likely less than 1%. The University of Utah School of Dentistry is one of only a handful of dental schools in the country that still teaches indirect gold restorations, including partial coverage. While visiting recently with a colleague, he indicated that his 2008 graduating class was the last class at his dental school that was taught indirect gold. Is the indirect gold restoration becoming a lost art?
There are several obvious reasons why gold is falling out of favor; but, poor performance is not one of them. Do we give our patients ample opportunity to choose gold? Are we taking the time necessary to educate them regarding the benefits of gold? Are we, as dentists, maintaining our skills with regards to gold, or are we simply taking the path of least resistance and doing what is most expedient? Whatever the reasons for the decline, we still have a responsibility to pursue the best for our patients. I am not advocating that we abandon the myriad of ceramics at our disposal. They are amazing products also. I love using them. They have expanded our ability to provide highly esthetic and durable restorative options for our patients. However, there are still situations wherein indirect gold, especially partial coverage, is the most appropriate restorative option for a patient. That being the case, then I would contend we have a responsibility to make that option available for them. Give our patients the same opportunity to choose gold, like you would for yourself. All that glitters may not be gold, but no one can argue with the fact that for some restorative situations, nothing outshines gold. Mark R. Taylor, D.D.S., UDA Secretary
UDA Action
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