Tucker Manual

CONTENTS
Preface
Course Schedule
4

6

9
Course Survival Tips

Inlay Cavity Preparation for Posterior Teeth

Richard V. Tucker, DDS
10
Temporaries
11

Laboratory Notes for Cast Gold Restorations

14

A Technique for Finishing Gold Castings

16

Conservative Cast Gold Restorations


Dennis M. Miya, DDS
41

All About Pins in Gold Castings

Richard D. Tucker, DDS

44

Cast Gold Clinical Instrument and Supply List

46

Laboratory Instruments and Supplies

47
Suppliers
48
Educational Materials
49
Map
50

Rubber Dam Placement

Dennis M. Miya, DDS
Impression Technique
PREFACE

A few years ago, Dick Tucker and I were having lunch at the
Meany Hotel and we talked about creating a clinical course in
Seattle where dentists could learn about conservative gold castings. There seemed to be a need for such a course since the only
way a dentist could learn a good technique at that time was through
participation in a study club. Dick had taught a five day clinical course for many years at the
University of British Columbia. The ideal scenario would be to provide courses for dentists and
laboratory technicians in a private teaching facility. Hence, the concept of the Tucker Institute
was conceived.

There is no private facility yet, but this course and others like it, marks the beginning of
our journey. I hope that the information in this syllabus and your experience in the course will be
of assistance for your journey toward perfection and enjoyment of gold castings.
Dennis M. Miya, DDS

Director
Tucker Institute
lunch
tooth prep B
12:30
2:00
tooth prep D

lunch
tooth prep C
1:30
12:00
9:30
tooth prep A
1:30
12:00
9:30
10:00
lab
lunch
lab
lecture
8:00-9:15
8:00-9:15 lecture
Wednesday
Tuesday
Monday

8:00-9:30 lecture
Tucker Institute Course Schedule
Thursday
1:30
12:00
9:30
seat casting
lunch
seat casting
8:00-9:15 lecture
Friday
1:30
12:00
9:30
closing dinner
seat casting
lunch
seat casting
8:00-9:15 lecture
Course Survival Tips

Preparation
You are coming to learn Richard V. Tuckers technique for gold restorations. You put
yourself at a disadvantage if you do not have all of the exact instruments and supplies that are listed
for the technique. You will spend precious time borrowing items from your fellow students. Or you
might substitute instruments or supplies that dont work as well for the technique. Based on our
experience from previous courses, a blind faith approach seems to work the best.
If you chose to maximize your experience with Dr. Tucker, I would recommend the
following preparation: read the syllabus; watch Dr. Tuckers DVD with the The Gold Inlay, Variations in Cavity Design, and The Laboratory: get the models of Dr. Tuckers preparations and then
practice cutting preparations on ivoreen teeth, trying to duplicate the models exactly as far as outline
form, proportion and preciseness.
Treatment Planning
Create a situation where you have the best chance of having a positive learning experience. Choose
a patient that is easy to work on. Choose teeth that are ideal for the restorations that you want to
learn how to do. Teeth with incipient lesions or small restorations are ideal. Try to stay away from
teeth with large restorations, poor quality tooth structure, potential carious exposures, and teeth
with access problems. It is better to take your time and do one restoration well rather than multiple
restores at a mediocre level.
Study Club Format
When someone is finished with his preparation or seat, the mentor will ask for permission to announce that the procedure has been completed. All participants of the group can then look at the
completed procedure. You can learn a lot from observing what others have done. It is also a form of
support for your fellow participants to take the time to look at their procedure.
Mastery
In a book called Mastery, George Leonard talks about succeeding at any task. He says that mastery is not perfection, but rather a journey, and the true master must be willing to try and fail and try
again. Perhaps some of his thoughts on mastery will assist you on your journey toward becoming a
Master Dentist.
The Five Master Keys:
1. Instruction
2. Practice
3. Surrender
4. Intentionality
5. The Edge

Instruction
Find the right teacher. Why re-invent the wheel? Begin with a good
foundation. Look for those who themselves have had great teachers. Look for patients and empathy.
Look for those who interact, who praise at least as much as they critique.
Practice
Practice can be used as a verb. We practice to get to Carnegie Hall. For the masters journey, practice is not something you do but something you are. Practice is the path upon which you travel. A
practice (as a noun) can be anything you practice on a regular basis as an integral part of your lifenot to gain something else, but for its own sake.
Surrender
The courage of a master is measured by his or her willingness to surrender. This means surrender to
your teacher and to the demands of your discipline. Perhaps the best you can hope for on the masters journey is to cultivate the mind and heart of the beginning at every stage along the way. For the
master, surrender means there are no experts. There are only learners.
Intentionality
Apply full consciousness to an activity, dont just go through the motions.
The Edge
A master is one who not only pursues the refinements of a skill; he eventually pushes the edge of the
envelope.
Inlay Cavity Preparation for Posterior Teeth

Richard V. Tucker, D.D.S.

The steps required in the placement of a cast gold restoration are as follows: diagnosis, tooth
preparation, impressions, models, wax up, investing, casting, cementation and finishing. A flaw in
any of these steps or lack of attention to the finest detail would result in failure or an unsatisfactory
result.

The single step which contributes to a large number of failures, and that which
requires a special effort from the operating dentist is the cavity preparation.. A well prepared cavity
not only meets the standard criteria of a satisfactory outline form, resistance form, retention form and
the other requirements established years ago by G.V. Black, it also must be smooth and precise in both
its internal and external form. It is this precise, smooth, properly tapered cavity with sharp margins
and internal angles that make it possible to carry out each of the other steps with precision2 .

Consider these steps mentioned above in relation to the cavity preparation. The proper diagnosis
and treatment plan is of little value if the treatment is not adequately carried out while preparing the
tooth. The preparation should encompass that which was considered when it was determined that the
cast gold restoration was indicated. It involves occlusal coverage, esthetic considerations and preventive concepts.

A good impression is more easily obtained if the cavity is smooth and sharp, and without this
sharpness it is difficult to evaluate the impression. The models are enhanced also by the fine definition
of a good cavity and fewer fragile areas result. A satisfactory wax pattern is more easily obtained from
the model of a smooth cavity preparation with a proper taper and well defined margins. As a result the
casting, which can be no better than the wax pattern, is likely to have fewer flaws and discrepancies
than if the preparation of the tooth were rough and irregular.

The last consideration would be that a properly extended cavity with sharp smooth margins
make it possible to finish the restoration on the tooth and to produce a more perfectly adapted gold
inlay.

Dr. George Ellsperman, an outstanding teacher and critic of operative dentistry,invariably
speaks of his concern with cavity detail, cavity design and fine margins3 . Considering the importance
ascribed to the cavity preparation, which is the theme of this paper, a short discussion of the sometimes
mundane subject of cavity instrumentation will be presented. The following steps in procedure will
involve the posterior Class II cavity.
1. The rubber dam should be placed to give visibility, tissue retraction, and for ease of operation.
When it is apparent that some procedure can be done better with the dam removed, such as discing of
a margin on the distal surface of the most posterior tooth, then the preparation should be completed
as nearly as possible before removing the dam for final completion.
2. The tooth opened with a high speed diamond stone then either a #56 carbide bur for a bicuspid
tooth or a #57 carbide bur for a molar would be substituted. Care is used to avoid over cutting. The
flat occlusal and gingival walls are placed at the same time as establishing the axial wall and the occlusal pulpal wall. The roughed out cavo-surface margin is cut at the same time. All of this is done
while maintaining a slight taper away for the occlusal surface.
3. The double ended off angle chisel #42S (15-10-16) is used to plane the distal buccal wall with the
one blade, then down the distal lingual wall with the other,while maintaining a slight divergence to
allow for draw of the wax pattern. The same instrument of the Ferrier enamel hatchet #15 and #16
(15-8-14) is then placed on the edge of the occlusal wall and with two or three slices toward the gingival, the axial wall is planed. The chisel meets the proximal walls to establish the bucco-axial and
the linguo-axial line angles. The bucco-gingival and linguo-gingival line angles are coincidentally
formed by the chisel chopping to the gingival wall. The 42S chisel also should smooth any flaws or
discrepancies on the occlusal wall and gingival wall while it is in hand. The same procedure isused
on the mesial areas of the tooth with the off angle chisel #43S (15-10-16) and or the enamel hatchet
#15 or #16. On both the mesial and distal areas of the tooth, the proximal walls should be planed first
so the effect of gouging the line angles with the edge of the chisel would be removed as the axial wall
is planed along this angle.
4. The gingival margins are beveled with double ended marginal trimmers #232 (10-95-19-16) for
the distal; then # 233 (10-80-10-16) for the mesial areas of the tooth. The double ended instruments
would be used for ease of operation. The marginal trimmers should be sharpened to acute angles so
the bevel on the gingival margins will be longer than that which would be produced with the more
flattened marginal trimmers. The gingival bevel should be made smooth and even with the trimmers
planing toward the proximal walls.
5. There is some difference of opinion regarding the use of a bevel on the occlusal margins4 . When
the tooth being prepared is very sound, with occlusal enamel that has not been bruised or crazed, it
may be justifiedthat just a faint contouring should be done with a medium sand disc. There would be
less concern of future breakdown of the occlusal margin however, if a bevel of approximately twenty
degrees were placed with a #56 carbide bur. The disc does serve to polish the proximal walls if they
have not been planed sharp and straight with chisels.
6. When it is necessary to cover a cusp or cusps with gold it can be accomplished
effectively with a #7404 or #7406 twelve fluted bur producing a hollow ground relief and bevel. This
finishing bur is used in almost a painting motion to establish a smooth, well defined flowing outline
to the extended cavity5 . This technique would not be used for coverage of maxillary buccal cusps as
it would display an unnecessary amount of gold and the inclined planes of the occluding teeth do not
require such coverage. In such cases after occlusal reduction has been done with the hollow grinding
bur, only a sleight discing is necessary to remove the acuteness of the margin.

It has been demonstrated that there is a relationship between surface roughness of the cavity
or the casting and consequent retention6 . It would seem unreasonable to apply this fact to posterior
inlays which present little or no retentive problems.
However, it should give cause to avoid polishing with discs the bulk of three quarter crown or full
crown preparations. It has been shown that properly placed pins serve well to increase the retentive
quality of a casting. If a tooth is destroyed to the extent that retention should be a problem the placement of the pins is the simple solution.

In view of the fundamental necessity to prepare a fine cavity to accomplish a satisfactory gold inlay, it is hoped that this paper and the technique that has been described will be of some assistance.
References
1. Brown, Milton H., Impression Procedures for Restorative Dentistry. Dental
Clinics of North America, Philadelphia, W.B. Saunders Co., 1967, p.149.
2. Bassett, Ingraham and Koser, An Atlas of Cast Gold Procedures, Uni-tro
College Press, Buena Park, Califronia, p.14.
3. Ellsperman, George E., Bellingham, Washinton, Personal Consultation.
4. Frates, F..E., Inlays, Dental Clinics of North America, Philadelphia,W.B.
Saunders Co., 1967, p. 163.
5. Tucker, R.V., Variation of Inlay Cavity Design, JADA 84: March 1972, p.
616.
6. Charbaneau, G.T., Some Effects of Caity Roughness On Adaptation of Gold
Castings. J. Dent Res. 37:95 Feb. 1958.
7. Lore, R. E. and Myers, G. E., Retentive Qualities of Bridge Retainers,
JADA 76: p. 571 March 1968.
Impression Technique
1. For one or two crowns or perhaps a quadrant of inlays, the quadrant check bite is a proven technique.
2. The metal Coe tray is used most often. When the back of the Coe tray does not allow the
patient to bite into centric occlusion comfortably, the smaller wire Emery tray is used.
3. For gingival retraction, a bulky, non-braided cord (Gingivi-Pak #3, Surgident) is pre

ferred. This cord provides good retraction depth below the preparation and good width

of the sulcus. The popular braided cord, double pack method where the first chord

remains in the sulcus during the impression generally does not provide the depth and

width desired for good impressions. Invariably the tissue seems to bleed if both chords

are removed. A 25% aluminum chloride solution (Hemodent) is used for hemorrhage

control. It seems to be kind to the tissue and leaves no film on the preparation. Ferric sulfate is

not recommended for a hemostatic agent for inlay preparations.
4. One or two cords are placed around the preparation. Two cords seem to work well

interproximally. They should be left in place for about 3 4 minutes. Prior to taking the

impression, check the fit of the tray and have the patient practice getting the feel of

biting into centric occlusion with the tray in place. Note the occlusion on the
contralateral side as a guide so you know when the patient is biting into centric
occlusion.
5. Light body polyvinyl siloxane impression material is used for the entire impression to avoid
folds that can occur at the interface of light and heavy body mixes. The potential set inhibition
due to the rubber dam or latex gloves can be counteracted by cleaning the preparation and
adjacent teeth with a cotton pellet saturated with diluted hydrogen peroxide, followed by

a thorough rinse. Hydrogen gas evolution is a by-product of the polymerization of polyvinyl
siloxane impression materials. Small voids in the stone model will result if the impression is
poured too soon. Model pour ups should be delayed 30 minutes to 2 hours depending on
the brand of material.
6. Before the impression material is mixed, the operating field should be spray washed and

dried and the cord is slowly removed. It is checked for adequate retraction and that
there is no hemorrhage. If retraction is not adequate or if there is hemorrhage, repack.
If it is satisfactory, it must be maintained dry and the impression material is mixed.
Syringe impression material into the preparation, place the check bite tray and have the
patient bite into centric occlusion. Be prepared to assist the patient into the proper jaw
position with gentle pressure on the chin. Continue to monitor and support the patient
for a few minutes to make sure that there is no distortion in the impression due to
patient movement.
7. Check the set of the material with the tip of the cotton pliers. When the material seems to be set,
allow one more minute of set time.
8. Remove the impression with a fast movement in a vertical direction to minimize
distortion and tearing.
9. If there is a question that the patient was biting in centric occlusion, a supplemental bite of BluMousse material can be taken. A new impression is generally not necessary.
DuraSeal Temporary
Armamentarium
DuraSeal acrylic
Temporary stopping (gutta percha)
Large straight brush
Woodsen hand instrument
2 dappen dishes
lighter (flame)
Indication
DuraSeal is a semi-soft acrylic that is ideal for inlays and onlays. It is easy and quick to place and
to remove.
1. A piece of temporary stopping large enough to cover the gingival 2/3 of each box form is heated
with a lighter and taken to place with a Woodsen instrument (packer/plugger combination). It
acts like a dam so that the acrylic does not touch the tissue so the stopping must be placed against
the adjacent tooth as well.
2. The stopping should not extend above the contacts to allow the acrylic to be locked in at the
contacts of the adjacent teeth. Excess stopping can be contoured and removed with a heated
instrument.
3. The DuraSeal acrylic is placed with the liquid/powder method using a fairly large brush. Build
acrylic to contour, be sure to cover all margins of the preparation. Work quickly because the
patient must bite and go through excursive movements while the acrylic is still fairly soft. The
acrylic can be molded with moistened finger-tips. No attempt is made to refine the occlusion if it
is not grossly excessive. Excess flash can be
removed with a cleoid or a heated instrument.
4. Multiple preparations can be connected with a single layer of acrylic.
5. Tell the patient they will not be able to floss.
6. There are more sophisticated methods to temporize inlays and onlays but this method is very easy
and fast both during placement and removal since no temporary cement is used. Patients seem to
tolerate this temporary well. The gingival tissue response is generally surprisingly good.
11
Laboratory Notes For Cast Gold Restorations


Impression Pour-up
1. Rinse and clean impression with room temperature water.
2. Spray the impression with surfactant.
3. Pour the impression immediately.
4. Use a die material with minimum expansion. Fuji Rock (golden brown).
5. Weigh the die material and measure the distilled water to manufacturers

specifications. Proportion of 20 ml water/100 g of stone.
6. Line up the pins so dies can be withdrawn.
Articulating
1. Pour the opposing cast .
2. Cut keyway on each side of dowel pins.
3. Paint around dowel pins with separating medium.
4. Fit impression to articulator.
5. Pour 1/2 at a time.
6. Remove impression from the casts.
7. Immediately pour a back-up die.
8. Allow the die material to set at least five hours.
Dies
1. Separate dies with coping saw and thin blade. Treat dies very carefully.
2. Trim dies with sharp knives and chisel, not with a bur.
3. Do not use cyanoacrylate (super glue) on the dies.
4. Do not wet or wash dies.
5. Do not soak dies in lubricant.
Waxing
1. Brush on wax separator sparingly. (Ney Die Lube)
2. Paint opposing and adjacent teeth with die lube.
3. Apply wax (Yeti grey) evenly, flowing into all line and point angles.
4. Flow wax with sweeping motion over the entire surface of the die before allowing it to
harden in order to avoid lines and voids in the pattern.
5. Build wax to excess.
6. Establish contacts.
7. Melt occlusion with hot spatula and close articulator to register bite.
8. Carve and finish the wax pattern immediately after the wax is built up.
9. Avoid scraping the die margins with carving instruments.
10. Avoid reapplying wax over a once carved margin.
11. Be sure wax is cool before removing wax pattern (may refrigerate ).
12. Avoid repeated removal of wax pattern.
11
How to sprue
1. Sprue pattern on the die.
2. Using #12 shapes, cut approximately 1/8 in. long blind sprues and attach to all gingival margins.
3. Place main sprue on heaviest part.
4. On contact opposite main sprue, place 1/8 in. wax sprue. Run a wax sprue from base to this
sprue.
5. Do not distort wax pattern on removal.
6. Apply surface tension remover. (Wax It)
Investing

1. Invest immediately. Do not allow it to set on the sprue former.
2. Line the ring with asbestos or asbestos substitute.
3. Allow a few millimeters of the end of the ring to be free of liner.
4. Soak ring in water and shake off excess.
5. Use room temperature distilled water with investment.
6. Measure both water and powder accurately.
7. Spatulate 10 seconds for a thick mix and 20 seconds for a thin mix.
8. Use vacuum investor. Novocast Investment (Whip Mix) 50 grams of powder. No water
bath. Paint investment on the pattern. Fill the ring.

Water/Powder (cc) TemperatureF Ring Liner

Crown

15.5

1175

2
3/4, 7/8 Cr
18 1150

2
MODBL
18

1150

2
MOD

18.5

1150

2
DO, MO, Occ
15

1175

2

Burn Out
1. Allow the investment to set at least 1 hour.
2. Carve off end of investment in the ring.
3. Place in cool furnace.
4. Be sure furnace is calibrated.
5. Run furnace to temperature, heat rate at 3 takes about 1 hour.
Casting
1. Cast within 20 minutes.
2. Use air and gas flame ( no oxygen).
3. Do not over heat gold. Dust with flux, cast as soon as the gold rolls together.
4. Kerr broken arm casting machine is good.
5. Use a Type II gold with Brinell hardness of 95-110 with approximately 80 % gold alloy.
6. Let gold cool in ring before breaking out.
7. Brush casting clean and place in an ultrasonic cleaner. Do not touch inside with an instrument.
8. Boil in reducing solution (Prevox).
13
Finishing
1. Cut casting off sprue with separating disc.
2. Try casting on die carefully checking for open margins and proper expansion.
3. Keep a log of each casting with variables noted. e.g. water/powder ratio, casting temperature, and time of furnace temperature build-up.
4. Adjust contacts and bite.
5. Adjust contact with rubber wheel.
6. Finish casting with #.5 round bur over all occlusal fissures.
7. Use Robertson #11 standard stiff bristle brush with Tripoli over occlusal also end brush
mandrels that have been sharpened.
8. All other surfaces are finished with discs in the following order: medium garnet, fine sand
and fine cuttle.
9. Robertson soft bristle brush with rouge over the occlusal.
10. Felt wheel on mandrel with Tripoli.
11. Chamois wheel on mandrel with rouge. Do not let Tripoli get on chamois.
12. Wash polish off casting with hot water and all purpose cleaner.

(May use ultrasonic).
13. *Note: While waxing, remove as much bulk from the inside as possible with a sharp
cleoid or discoid instrument.
14. *Note: Do not finish on the die, and avoid finishing the margins.
13
A Technique For Finishing Gold Castings


After all procedures necessary to produce a gold inlay, onlay, or other type of casting have been
completed with care and understanding; the last step, the finishing of the gold if done properly will
make the difference between a serviceable restoration and that of a fine, beautiful case.

The procedures described below are predicated on the fact that the casting fits the tooth cavity,
because without a good casting no finishing technique will produce a fine case, nor even a serviceable
restoration.

The initial procedure of finishing involves the laboratory, as it is here that the difficult access
areas on the occlusal portion of the restoration are refined and polished; and the final contours are placed
on the casting To avoid destruction of the detailed anatomy in the casting, the following procedures
are suggested. All accessible surfaces, except contact areas and margins are smoothed with 1/2 inch
garnet medium, and 1/2 inch sand fine discs in that order. Then 1/2 inch cuttle fine discs are used over
all surfaces of the casting, including margins and inter proximal contact points..

All pits and fissures are smoothed lightly with a No. 3 carbide bur, contacts corrected, occlusion
corrected, then all occlusal anatomy is polished with a No. 11 standard stiff brush wheel and tripoli. If
needed the end brush mandrel may be used with tripoli in the deep areas of the casting. Finally the no.
11 soft brush wheel is used with a high polishing compound over all surfaces of the casting.

Since the restoration is finished except for the margins before cementation, the dentist confines
his efforts in the operatory to the margins only.

Following the administration of an anesthetic and proper isolation with the rubber dam, the
cavity is cleaned and then cavity varnish is applied to the dentin walls, using care not to apply it on the
margins. The restoration is tried to insure proper contact. It is not necessary to drive the restoration
to place prior to cementation. Usually it can be left a half millimeter from being completely seated, we
can be sure of proper expansion of the casting, do any necessary adjustment of the contact point, and
avoid the difficult task of removing a hard seating casting that could damage the tooth or the restoration.
A slow setting mix of zinc phosphate cement should be made on a cool glass slab. This is accomplished
by slow introduction of the powder to the liquid and powder would be added only to the point that it
would drop freely from the spatula. This is important as the casting would not have been
finished on the tooth prior to this time and the margins should be smoothed with the most coarse of the
three discs, prior to the hardening of the cement.

The interior surfaces of the casting are first covered with cement which would also be applied
to the cavity in the tooth. After having placed the casting in the tooth it would be seated hard by applying considerable pressure on an orange wood stick while being gently mallotted. The casting should
be held with pressure for a short period of time to allow
release of hydraulic pressure, which could cause the casting to lift.

With a slowly rotating mandrel in a straight handpiece, a medium grit garnet disc should be
rolled over the margins from the casting toward the tooth surface, creating a single plane between the
gold and the tooth. This also accomplishes a slight burnishing of the gold at the margin.

All margins of the gold can be operated with the straight hand piece except the
mesio-lingual margin and the gingival margins of all posterior teeth in both the mandible and the maxilla, with some unusual exception. After all other margins have been smoothed with this type disc on
the straight hand piece, the contra-angle would be used to smooth the mesio-lingual aspect. This is
accomplished with the grit side of the disc in facing the handpiece. Finishing to this point should be
done before the cement has hardened.
15

The next procedure requires little time because it is merely to polish the gold and the tooth at
the margins, not reduce them. The 1/2 inch fine sand grit disc would be used with the same handpiece
procedures as discussed above to accomplish a reduction in the size of scratches left by the medium
garnet discs.

Attention is next given to the gingival margins. The casting should fit accurately, with no excess
gold over the margin. A narrow eighteen inch finishing strip, with medium garnet grit, sharpened to
allow passage, would be passed interproximally. This is aided, as is the entire finishing of the gingival
margins, by the assistant retracting the tissue as the inter proximal rubber dam is held up, on both the
buccal and lingual aspects. A little Vaseline lubricant also is an aid to avoid catching the rubber with
the strip as it is passed over the margins.

The use of the strip smoothes the gingival gold and tooth structure to the same plane, as well as
the gingival third of the buccal and lingual cavosurface margins, which cannot be reached with discs.
Usually two or three swipes over the margin accomplishes this purpose, and care should be given to
avoid over use of the strip on the relatively soft cementum. It is observed that if gold is in excess, it
seldom can be finished properly to the tooth, since the strip seems to remove tooth structure faster than
the gold.

After use of the medium garnet strip, a similar fine cuttle strip is use in the same
manner. Again only two or three passes with the strip should suffice. This is only to remove fine
scratches and polish where it is not possible to use a disc.

If there are inaccessible areas such as in grooves or fissures, a fine white stone may be used in
those specific areas of the tooth.

A fine cuttle disc is then used to polish all accessible margins in the manner described above.
This seems to close the joint as well as polish the surfaces.

Final polishing can be done, after the proper discing with very little effort. First a slurry of
pumice in a rubber cup on a contra-angle would be used, to be followed by flushing and irrigation.
After drying the field of operation, dry tin oxide or similar polishing agent would be lightly used over
all accessible surfaces.

It should be noted that air coolant be used during all discing and during use of the strip, as well
as polishing, to avoid over-heating the tooth.
15
Conservative Cast Gold Restorations

Dennis M. Miya, DDS
Introduction
Historically, the use of gold for restorations in dentistry has declined with the development of composite and porcelain restorations.
However, conservative cast gold restorations
continue to be the treatment of choice to restore
posterior teeth and distal of cuspids for many
clinicians (Fig 1). The primary advantage of a
gold casting is its permanence (Fig 2). This type
of restoration can last a lifetime. A cast-gold resFig 1 Conservative gold inlays
toration maintains the beauty of a natural tooth
in most cases when cavity design is thoughtfully
nearly reproduced with a casting.
considered, and when care is given to perfection
8. A gold inlay or onlay does not
of the casting and its finishing. Typical cast gold
become worn to produce a sub-marrestorations are shown in Figs 3a to 3f.
ginal surface, nor does it chip and
The advantages of gold castings are:
fracture at the cavosurface margins.
9. Gold castings have a favorable
1. Gold alloys do not oxidize and discoefficient of expansion with tooth
color the teeth.
structure.
2. Fragile areas of teeth can be protected by covering them with a thin layer
of gold.
3. The gold restoration itself will not
fracture in the isthmus or other areas.
4. The margins of the tooth and gold
are nearly imperceptible if handled
properly. This is not so likely to harbor plaque and consequently should
contribute to better tissue health.
5. The cast gold inlay can be finished to
be a highly polished and smooth surface, which is pleasant to the tongue
and compatible with the oral tissues.
This also is more plaque resistant
than a more roughened surface.
6. Gold castings such as 3/4, 7/8 or full
crowns can bind the tooth together to
prevent fracture or relieve sensitivity
when tiny fractures are present.
Fig 2 Longevity. The DO inlay on #28 has been in ser7. The dental anatomy can be more
vice for more than 60.
17
Typical Cast Gold Restorations

Figs 3a to 3f
Inlay, onlays, gold foil 3a
Inlays 3b
Onlay with buccal bale 3c
7/8 Crowns 3d
Full Crown 3e
Distal of Cuspid 3f
17
Fig 4 Outline without composite build-up (A) and with

build-up (B).
Rubber dam
Placement of a rubber dam is standard
procedure for this technique. It allows the operator to have the best field possible to work in.
The teeth are isolated, gingival tissue is slightly
retracted and saliva is eliminated. The tongue,
cheek and lips are eliminated from the operating
field. The patient is not concerned about swallowing any preparation debris. The quality and
quantity of restorations are enhanced.1-3
Remove previous restoration and caries
The entire existing restoration is expeditiously removed. Care should be taken not to
extend the outline beyond the existing restoration. Remove all remaining caries. The operator
should not be concerned about the preparation
taper at this stage. The remaining tooth structure
is then evaluated and the appropriate restoration
is treatment planned. It is helpful to transilluminate with a fiber optic light during the evaluation of the remaining tooth structure. Some
important treatment planning considerations are:
amount and quality of remaining tooth structure,
occlusion, significant fracture lines or enamel
crazing, parafunctional habits and gold display.
Similar to other restorative materials, gold

castings also have their disadvantages. Some of
the disadvantages are:
1. The procedures for restoring teeth with
castings are more time consuming than
most other materials.
2. Typically the gold casting is more expensive for the patient than for most
other types of restorations.
3. A gold casting is somewhat technique
sensitive, and if it is not done with a
real concern for excellence, it probable
is not as satisfactory as other types.
4. Gold can be esthetically unacceptable
if placed in certain areas of the mouth,
particularly the anterior teeth and the Calcium hydroxide base
A thin film of calcium hydroxide (Dycal) is
buccal areas of the maxillary posteplaced
on the internal of the preparation with
riors.
a small cotton pellet. It acts as a separator for
easy removal of the composite buildup prior to
Preparation
cementation. Retentive pits for retention of the

Cavity Preparation Sequence
composite can be placed with a #2 round bur

Place rubber dam
after the base is set.

Removal of previous restoration and

caries
Composite buildup

Calcium hydroxide base
The use of a composite buildup conserves

Composite buildup
tooth structure because the operator can control

Occlusal preparation
the depth of the occlusal and axial walls (Fig 4

Proximal box form
). It allows the operator to cut a precise cavity

Hand instrumentation
preparation that has ideal taper, smoothness and

Occlusal bevel
proportions. A nice preparation will facilitate

Disking of proximal walls
subsequent procedures of impression taking,
casting fabrication and seating.
19
Fig 5 Ideal bur inclination.
An auto-cure composite can be placed with a

packing instrument or a syringe. A matrix band
may be used to contain the buildup composite.
The buildup is usually totally removed prior
to cementing the casting. The casting often seats
to place more completely because of the absence
of the composite pulpal wall.
Occlusal preparation
The preparation is cut with a #56 fissure bur
for bicuspids and a #57 fissure bur for molars.
The occlusal outline and pulpal floor are placed
to a depth of 1.5-2 mm and a uniform inclination of the walls of 3-5 degrees (Fig 5). This
results in an ideal preparation taper of 6-10
degrees ( Fig 6). The #56 and #57 fissure burs
are 4 mm in length and can be used to determine
proper depth.
Fig 7 Proximal wall enamel rods.
Fig 6 Wall Inclination/preparation taper (draw).
Proximal box form

The proximal box form is established next
and is blended with the occlusal preparation.
The box form is cut with the same overall taper
as the occlusal. The width of the gingival floor
is slightly larger than the diameter of the #56
bur for bicuspids and the #57 bur for molars.
The buccal and lingual walls must be extended
far enough (1 mm) beyond the adjacent tooth to
finish the casting. A smaller bur (169L) is sometimes convenient to establish the proximal wall
extensions without damaging the adjacent tooth.
The proximal walls have a slight flare (~45)
that eliminate unsupported enamel
Fig 8 Ideal preparation with uniform inclination

of walls and taper. No reverse curve.
19
Fig 9 Instrumentation Sequence:

( A) Pulpal & gingival walls
(B) Proximal line angles
(C) Axial wall
(D) Gingival bevel
rods (Fig 7). Maximizing the use of the bur to

cut most of the preparation results in smooth
uniform walls and line angles and therefore very
little effort with hand instruments is necessary
(Fig 8).
D. Gingival bevel
It is a small bevel that is .5-.75 mm wide. The
bevel should be definitive and smooth but not
too wide ( Fig. 10). There is no advantage in cutting a large bevel.
The bevel is created in thirds to prevent get Hand instrumentation sequence
ting a swale in the middle where it is easiest to
Smooth, precise preparations can be created cut. Start by cutting the buccal and lingual 1/3
with minimum effort with very sharp instruby planing toward the proximal wall. Then join
ments. Instruments should be sharpened before
the buccal and lingual segments by cutting the
each procedure. The sequence is illustrated in
middle 1/3 of the bevel last.
(Fig 9).
Gingival margin trimmers that are pre-sharpA. Pulpal and gingival walls are smoothedened by the manufacturer (Suter) at a more acute
with a 42 S off angle chisel.
angle than normal (30) are marked Tucker.
The #232 Tucker gingival margin trimmer is
B. Proximal axial line angle
used on the distal. The #233 Tucker gingival
Ideally, this line angle can be formed with one margin trimmer is used on the mesial.
or two strokes. The mesial proximal
axial line angles are placed with the 42S chisel.
Distal proximal axial line angles are placed with
the 43S chisel.
C. Axial wall
Begin by removing the little gouge on the
axial wall formed from creating the proximal
axial line angle and then smooth the rest of the
axial wall as needed. The distal axial wall is
smoothed with a 42S chisel. The mesial axial
wall is smoothed with a 43S chisel.
Fig 10 Gingival bevel too large (A), ideal bevel (B).
21
Fig 11 Occlusal bevel is only a few degrees more than the

occlusal wall. It can include 1/2-2/3 of the occlusal wall.
Occlusal bevel
The function of the occlusal bevel is to remove fragile enamel rods and any irregularities
in the cavosurface margin. It gives the operator
an opportunity to prepare a smooth, flowing,
esthetically pleasing outline. This bevel should
be placed with the same straight fissure bur ( #56
or #57) used for the rest of the preparation. The
bevel is placed with the bur incline of only a few
degrees more than the occlusal wall (Fig 11).
Where the existing outline is already adequate,
no bevel is needed since there are no undermined
enamel rods (Fig 12).
Disk proximal walls
A 1/2 inch garnet disk is used to straighten
the proximal walls. A #42S or#43S chisel is used
to plane the proximal walls if space is insufficient for the disk. The single plane of the proximal wall is maintained since a two plane wall is
not desirable. The disk can also be used to blend
Fig 14 DO bicuspid dovetail and

internal bevel.
Fig 12 No undermined enamel

rods on the occlusal.
the box form and the occlusal outline, removing

any remnants of a reverse curve.

A synopsis of the entire preparation sequence is shown in Figs 13a to 13l.
DO and MO Bicuspid Inlays
A dovetail is cut on the occlusal for retention
and resistance form. A dovetail is the portion of
the occlusal that is made wider than the isthmus
to prevent displacement of the casting proximally (Fig 14).
For most bicuspids, an internal bevel is recommended for added resistance and retention
form (Fig 14, Fig 15). The bevel
also acts as a seating guide for these smaller
castings during cementation (Fig 16). Without
this bevel, the cement tends to force the casting
away from the axial wall during seating. The
entire gingival wall is cut to meet the axial wall
at an acute angle utilizing a non-Tucker #232 or
#233 gingival margin trimmer.
Fig 15 Gingival wall.
21
Inlay Preparation Sequence

Figs 13a to 13l
Fig 13a Occlusal preparation.

Fig 13b Proximal preparation. Fig 13c Preparation completed
#57 fissure bur for molars, #56
with bur.
fissure bur for bicuspids.

Fig 13d Instrument pulpal floor

with enamel hatchet.

Fig 13g Instrument axial wall.

Fig 13e Instrument gingival wall.

Fig 13f Instrument proximal

line angle.

Fig 13h Gingival bevel cut with Fig 13i Medium garnet disk on
Tucker
gingival margin trimmers. proximal
and occlusal walls.

Fig 13j Occlusal bevel with Fig 13k Occlusal view of

fissure bur.
completed preparation.

Fig 13l Proximal view of

completed preparation.
23
Seating
Function
Fig 16 Internal bevel fuctions as a seating guide

and gives added retention and resistance form.
The bevels on these instruments are less acute

(45) than the ones marked Tucker (30)(Fig 17).
The axial wall is instrumented next to insure that
it is not under cut or irregular at the gingivoaxial line angle. The gingival floor must be cut
approximately .5 mm wider than usual to accommodate an internal bevel
MOD Inlay
MODs are probably the most common
preparations made. The opposing mesial buccal/distal lingual proximal walls and the mesial
lingual/distal buccal proximal walls are cut approximately parallel to each other. These walls
are then retentive against each
other and give the preparation a nice symmetry
(Fig 18). The two axial walls are also nearly parallel to add retentive form to the cavity.10
Fig 18 Opposing proximal walls of mesial and distal box

forms ( MB/DL & ML/DB) are parallel and retentive with
each other. Note the nice symetry of the preparation.
Fig 17 The Tucker margin trimmers 30(top)

for gingival bevel. Non-Tucker margin trimmers
45(bottom) for internal bevel.
Impression
For one or two crowns or perhaps a quadrant

of inlays, the quadrant checkbite is a clinically
proven technique.11. A metal check bite tray
(Coe) is recommended. When the back of this
tray does not allow the patient to bite into centric
occlusion comfortably, a smaller wire tray (Emery) is used (Fig 19). The impression is taken
as the patient bites into centric occlusion. The
advantage of this procedure is that the impression registers the occlusion as the teeth are in
function there by allowing a more perfect occlusion of the opposing arches. In turn this usually
allows the castings to be placed without need to
relieve the occlusion. This more accurate occlusion registration is probaly due to the small
amount of movement in the periodontal membrane that allows
Fig 19 Coe and Emery checkbite trays.
23
Fig 20 Quadrant model with hinge articulator.
Fig 21 Dura Seal acrylic and temporary stopping.
the teeth to more completely interdigitate as the

impression registers their position in function.
The resulting quadrant models mounted from
the centric occlusion bite of the impression on a
simple hinge articulator is shown in Fig 20.
For gingival retraction, a bulky, non-braided
cord (Gingivi-Pak #3, Surgident) is preferred.
This cord provides good retraction depth below
the preparation and good width of the sulcus.
The popular braided cord, double pack method
where the first chord remains in the sulcus during the impression generally does not provide the
depth and width desired for good impressions.
Invariably the tissue seems to bleed if both
chords are removed. A 25% aluminum chloride
solution (Hemodent) is used for
hemorrhage control. It seems to be kind to the
tissue and leaves no film on the preparation.
One or two cords are placed around the
preparation. Two cords seem to work well interproximally. They should be left in place for
about 3 4 minutes. Prior to taking the impression, check the fit of the tray and have the patient
practice getting the feel of biting into centric
occlusion with the tray in place. Note the occlusion on the contralateral side as a guide so
you know when the patient is biting into centric
occlusion.

If the operator chooses to use a polyvinyl
siloxane impression material, it is advisable to
use only the light body material for the entire impression because folds can occur at the interface
of the light and heavy body that are unacceptable
for inlay impressions. The potential set inhibi-
tion due to the rubber dam or latex gloves can

be counteracted by cleaning the preparation and
adjacent teeth with a cotton pellet saturated with
hydrogen peroxide after the cord is removed.
Rinse thoroughly before taking the impression.
Before the impression material is mixed, the
operating field should be spray washed and dried
and the cord is slowly removed. It is checked for
adequate retraction and that there is no hemorrhage. If retraction is not adequate or if there is
hemorrhage, repack. If it is satisfactory, it must
be maintained dry and the impression material
is mixed. Syringe impression material into the
preparation, place the check bite tray and have
the patient bite into centric occlusion. Be prepared to assist the patient into the proper jaw
position with gentle pressure on the chin. Continue to monitor and support the patient for a few
minutes to make sure that there is no distortion
in the impression due to patient movement.
Fig 22 Temporary stopping placed.
25
Fig 23 Dura Seal placed.

Check the set of the material with the tip of
the cotton pliers. When the material seems to be
set, allow one more minute of set time. Remove
the impression with a fast movement in a vertical
direction to minimize distortion and tearing.
Temporization

Armamentarium
Soft, fast set acrylic (Dura Seal)
Temporary stopping (gutta percha)
Large straight brush
Woodsen hand instrument
2 dappen dishes
Lighter (flame)
A semi-soft acrylic (Dura Seal, Reliance) is

ideal for temporizing inlays and onlays (Fig 21).
It is easy and quick to place. No cement is used
so it is easily remove and there is no clean up.
A piece of temporary stopping large enough to
cover the gingival 2/3 of each box form is heated
with a disposable lighter and placed with a plastic instrument (packer/plugger combination). It
acts like a dam so that the acrylic does not touch
the tissue, to accomplish this, the stopping must
be placed against the adjacent tooth as well. The
stopping should not extend above the contacts to
allow the acrylic to be locked in at the contacts
of the adjacent teeth (Fig 22). Excess stopping
can be contoured and removed with a heated
instrument.
Fig 24 Inadequate expansion: inlay loose with

marginal gaps, crown will not completely seat.
The acrylic is placed with the liquid/powder

method using a fairly large brush. Build acrylic
to contour, be sure to cover all margins of the
preparation. Work quickly so that the patient
can bite and go through excursive movements
while the acrylic is still fairly soft (Fig 23 ). The
acrylic can be molded with moistened fingertips.
No attempt is made to refine the occlusion unless
there is a gross excess of acrylic. Excess flash
can be removed with a cleoid or a heated instrument. Multiple preparations can be connected
with a single layer of acrylic. Be sure to tell the
patient they will not be able to floss.
Fig. 25 Inlay without proper expansion. Note

marginal gaps and cement margins.
25

Water/Powder (cc) TemperatureF Ring Liner

Crown

15.5

1175

2
3/4, 7/8 Cr
18 1150

2
MODBL
18

1150

2
MOD

18.5

1150

2
DO, MO, Occ
15

1175

2
Fig 26 Expansion recommendations for Novocast

There are more sophisticated methods to
temporize inlays and onlays but this method is
very fast and easy during both placement and
removal since no temporary cement is used. Patients seem to tolerate this temporary well. The
gingival tissue response is generally surprisingly
good.
Lab

The skill in which an operator can prepare
teeth and seat castings is a very important part
of this technique but unless quality castings are
fabricated in the laboratory, it is impossible to
create consistently excellent restorations for our
patients. A basic understanding of the laboratory
procedures is essential to be able to critique castings and to communicate with your lab if refinements are necessary. It is not within the scope
of this chapter to discuss lab procedures in detail
but casting expansion will be covered because it
is an important concept to understand.

Gold shrinks approximately 2.4% of its
mass as it is cast and goes from a liquid to a
solid.15 If nothing is done to compensate for
this gold shrinkage, inlays will fit loosely with
marginal gaps and crowns will not seat to place
(Fig 24). The term expansion is used to describe
methods used to compensate for gold shrinkage.

Is the gold shrinkage clinically significant?
The occlusal inlay in (Fig 25 ) is an example
of an inlay that is too small for the preparation
resulting in marginal gaps that cannot be closed

during finishing.
The investment procedures are where the
compensation for gold shrinkage takes place.
The methods to increase expansion by manipulating the investment are to decrease the water in
the water/powder ratio; increase oven temperature; increase the number of ring liners; hydroscopic expansion in water bath (100F).

As many variables as possible should be
eliminated. Only water/powder ratio and oven
temperature should be varied to give maximum
accuracy to each type of casting. It is important
to realize that each type of casting has its own
requirement as regards to expansion. It might be
noted that the double ring liner accounts for the
necessity of fifty degrees less furnace temperature. This allows the casting temperature to be
below that which causes breakdown of
the investment.

Dr. Richard V. Tuckers recommendations for expansion with Novocast investment
are shown in Fig 26.
Seating
Castings should be seated with anesthetic.

The temporary is removed and a rubber dam
is placed. The fit of the casting is verified on
the preparation and the contacts are adjusted if
necessary.
27
Fig 27 Moore 1/2 inch disks.

Just prior to cementation, all of the composite buildup should be removed. A high speed #2
round bur can be used to section it. The preparation is cleaned and a desensitizing agent like
Gluma 3 is placed on the dentin.
A slow setting mix of zinc phosphate cement
is prepared by adding small increments of powder slowly to the liquid over a period of about
two minutes until the mixture will just drop
freely from the spatula. Cement is placed both
in the casting and the preparation. The casting
is seated and then considerable pressure is placed
with a pointed orange wood stick. The orange
wood stick is lightly mallet and held for several
seconds until the hydraulic pressure of the cement has dissipated. Excess cement can now be
removed.

The Finishing Sequence
Disks (1/2): medium garnet, fine
sand, fine cuttle (Fig 27).
Powders: slurry of flour pumice,

aluminum oxide with alcohol (15

micron), aluminum oxide dry (1
micron)(Fig 28).
Note: Continuous air should be blown
on the casting during disking to dissipate
the heat generated in the gold.16
Enamel and gold are reduced to the same
plane and the margins are burnished with medium garnet disks prior to hardening of the cement. The disks should always be rotated from
Fig 28 Polishing powders.
gold toward the tooth. The garnet disk is the

workhorse of the finishing process and usually
several disks are used. All margins can usually
be finished with a straight hand piece except
the mesial lingual area, where a contra-angle is
used with the grit of the disk toward the mandrel.
After completion with garnet disks, most of
the work will have been done so the gold and
tooth are merely finished so that the scratches
are smaller. The fine sand disks are used next.
The gingival one third of the casting and
gingival margins can be finished with finishing
strips. After completion with fine sand disks, a
narrow eighteen-inch medium garnet finishing
strip that has been cut to a point is passed under
the contact. Usually two or three swipes with
the strip will adequately finish this area. Care
must be taken not to over cut the relatively soft
cementum. A fine cuttle stip should be used next
in the same manner.
Fine cuttle disks are used next to remove
any remaining scratches and polish the gold.
The key to fine finishing seems to be good use
of cuttle disks. As disks become used and worn,
the scratches they leave become smaller. It has
been said that disks have three lives: new, used
and worn. When gold is finished to a third life
worn cuttle disk, it can then be polished with
powders to a mirror-like high finish. This
27
Fig 29 Slight reflection at functional margins of gold

inlay. Opening and gap formation at functional margins
of both porcelain inlays..
can be accomplished by finishing the casting a

section at a time with all three lives of the same
cuttle disk. The life of a disk can be accelerated
to a more worn stage by rotating it on the mirror
handle.
Difficult access areas might be finished with
the smaller 3/8 inch disks. Small finishing diamonds followed by brownie, greenie and super
greenie points work well for grooves and fissures
that are not accessible with disks.
The casting is then ready to polish with
powders. Care must be taken because the powders cut the tooth and gold at different rates and
can open up a margin or cause a reflection. This
is especially true with flour pumice. Each of the
powders should be used with a clean, ribbed rubber cup on a contra-angle. A slurry of pumice is
used to give the gold a uniform finish after the
disks. 15 micron aluminum oxide with alcohol
is used next. The final powder, 1 micron aluminum oxide, is used dry while the assistant blows
continuous air and suctions.

After the rubber dam is removed, the occlusion is checked with articulating paper.
Adjustments are made with a high speed green
stone and polished with high speed brownie and
greenie points.

The longevity of conservative gold castings
is largely due to our ability to create castings
that fit well and are nicely finished with marginal
gaps of less than 50 microns.17 Keenan18 suggests
that a well finished gold surface accumulates less
plaque.
Fig 30 Esthetically pleasing restoration of maxillary

posterior teeth with conservative outlines allowing
preservation of the buccal enamel.
Occlusion and marginal integrity
Based on results, the marginal integrity

of the enamel/gold cavosurface margin holds
up well under occlusal stress. The gold and
tooth wear at a similar rate and the coefficient
of expansion is similar. Therefore, preparation
cavosurface margins can be placed without too
much concern for the opposing occlusion. The
gold margin exhibits only a slight reflection even
after many years of function where as functional
margins of amalgam, composite and porcelain
will eventually open (Fig 29).
Esthetics

If conservative gold restorations are
properly designed and finished, gold display can
be minimal or nonexistent. A tooth can be functionally restored for a lifetime while the esthetics
of the original tooth can be maintained
Fig 31 Slight gold display at occlusal of 7/8 crown #4.
29
Fig 32 Color discrepancy of a porcelain crown as natural teeth darken with age.
(Figs 30, 31). If a tooth cannot be restored esthetically with a conservative gold restoration,
then a porcelain restoration might be the best
treatment of choice. Keep in mind, however, that
the color of a porcelain restoration will eventually not match the rest of the dentition as teeth age
and become darker (Fig 32). So a conservative
gold restoration is often the ideal long-term
Fig 33 Magnification.
esthetic treatment.
Magnification

The use of magnification for this type of
dentistry is very helpful. Our ability to deliver
quality restorations is enhanced with the use of
some type of magnification. A range of 2 - 3.5
diopters is recommended (Fig 33).
VARIATIONS OF CAVITY DESIGN

Inlay vs onlay
The restoration of choice for a posterior tooth
is an inlay because it preserves more functional
tooth structure and can be predictably fitted and
finished. It is often very esthetic because most of
the enamel can be preserved. It is the experience
of the authors that cusp fracture of an inlay is
rare. An onlay restores the strength of a tooth but
destroys more tooth structure and the gold display
can be unesthetic.
remaining tooth structure might support an inlay,

generally it is advisable to onlay the tooth since
predictable longevity is our goal. If there is sufficient tooth structure, only the weakened portion
of the tooth can be onlayed. However, in most
cases both buccal and lingual cusps are onlayed
to distribute the occlusal forces over a broader
surface. An onlayed tooth can be stronger than
the original non-restored tooth. Cusp reduction for a functional cusp is about 1.5-2 mm.
Non-functional cusps can be reduced less. The
Onlay
An onlay is indicated when there is not enough appropriate bevels are placed with a 7404 bur.
The resulting hollow grind bevel gives bulk of
sound tooth structure remaining to support an
gold at the bevel and provides a very nice margin
inlay. The basic technique is to always cut the
mod preparation first and then onlay the cusps as to wax and finish to. Step-by step procedures for
the final step. In questionable situations where the onlays are shown on Figs 33a to 33L.
29
Lower onlay
Invisible Onlay
Both cusps have been reduced and counter beveled. The counter bevel on the buccal functional
cusp is larger than the non-func
tional lingual cusp.
Upper onlay
Proper reduction of the cusps is shown for an
upper onlay. A counter bevel is placed only on
the functional lingual cusp to minimize gold
display.

Indication
This preparation is a modification of the
traditional onlay preparation to minimize
gold display on the occlusal buccal margin
of upper bicuspids.

Armamentarium
1. #56 fissure bur
2. Brasseler 7404 bur
3. Fine cuttle disk
Preparation synopsis
1. The lingual incline of the buccal cusp
is reduced steeply from the cusp tip

to the level of the pulpal floor.
2. The increased thickness of gold

protects the cusp and allows the gold
to be thinned on the buccal so it

cannot be seen.
3. More of the labial portion of the buccal cusp
remains when compared to the traditional upper onlay.
Preparation sequence
1. The lingual incline reduction of the

buccal cusp is done with a #56 bur.
2. A fine cuttle disk is used to place a
microscopic counter bevel on the

buccal cusp.
3. The lingual cusp reduction and

counter bevel are cut in the typical

manner.
31
Onlays
Fig 34a to 34l
Lower Onlay
Fig 34a Cut MOD first.
Fig 34b Occlusal reduction with Fig 34c Occlusal reduction

completed.
#57 fissure bur.
Upper Onlay
Fig. 34d Counter bevel on

both buccal and lingual with
7404 bur.
Fig 34e Onlay preparation Fig 34f Occlusal reduction

completed.
#56 fissure bur.
Fig 34g Lingual counter bevel Fig 34h Micro-bevel buccal cusp Fig 34i Upper onlay completed.
with 7404 bur.
with fine cuttle disk.

Esthetic Onlay
Fig 34j Buccal occlusal Fig 34k Micro-bevel buccal cusp Fig 34l Esthetic onlay completed.
reduction to pulpal floor.

with fine cuttle disk.
31

Molar 7/8 Crown

Indication
This preparation is indication when the tooth
needs to be bound together or when the tooth
is badly destroyed but there is still a good
mesial buccal cusp.
Armamentarium
1. 57 fissure bur
2. 860-012 diamond
3. 860-014 diamond
4. 42 S and 43 S off angle chisels
5. Medium garnet disk
6. Fine cuttle disk

1. A definitive occlusal center line angle
is created as the occlusal is reduced.
2. A minimal taper of the preparation
results in parallel walls.
3. The mesial hollow grind is cut to
draw slightly to the lingual. It allows
this wall to have more length,

increasing retention.
4. The buccal wall is cut relatively

straight across and the distal buccal

angle of the tooth is left relatively

square for added retention. This

results in a small irregular triangle at
the distal buccal finish line.
5. The distal buccal wall of the prepara

tion is cut to function in concert with
the mesial hollow grind.
6. A definitive distal buccal line angle is
created with enamel hatchets.
1. A 57 bur is used for the occlusal

reduction. There is a definitive
occlusal line angle in the middle.
2. The small 860-012 diamond may be

used to break through the interproxi

mal contacts.
3. The larger 860-014 is used to cut the
rest of the preparation. First, a hol

low ground wall is cut on the mesial.
By cutting this area with a slight

lingual draw the mesial buccal wall
of the preparation can be longer for

additional retention. The lingual and
distal walls are cut next.
4. The buccal wall is cut fairly straight

across and the distal buccal line angle
is quite square to try and maintain an
actual buccal wall. This results in a
little triangle or irregularity on the

distal buccal finish line. This is left
since smoothing this area would

result in an undercut.
5. The 42 S off angle chisel creates a

sharp line angle in the back of the

mesial buccal cusp. The 43 S is then
used to slide down the buccal wall to
complete the line angle. This angle

should be about 90.
6. The medium garnet disk is placed on
the distal buccal wall to sharpen the

outline of the preparation.

33
7. The fine cuttle disk is placed on the

occlusal edge of the buccal cusp to dull
and smooth the margin.
Hollow Grind Crown
Premolar 7/8 Crown
Difference from the molar preparation:

The small 860-012 diamond is always
used for the initial proximal reduction.
Over cutting or damage to the adjacent
tooth might result from using a larger bur
initially.
The distal wall has a slight hollow grind
curve that seems to increase resistance
form enough to allow a more conservative reduction of the buccal wall to minimize gold display.
Full Gold Crown Variations
The variations allow the buccal margin to be
kept well above the gingiva for better tissue
health. Each variation has a feature that adds retention and resistance form to the preparation to
allow a high buccal margin. The buccal margin
is finished like an onlay.
Indications
Lower molar full crown preparations where old
restorations or caries would require proximal
margins that are deep gingivally.
1. A gentle buccal to lingual hollow grind curve
on both mesial and distal walls provide ad
equate resistance form.
2. Retention is enhanced by the long mesial
and distal walls of the hollow grind that
resulted from the increased gingival depth of
the preparation. They are also cut quite
parallel.
Armamentarium
1. 57 fissure bur
2. 860-012 diamond
33
3. 860-014 diamond
5. Fine cuttle disk
1. The occlusal reduction is done with a 57
bur. A sharp line angle is created in the
center of the occlusal.
2. The 860-012 diamond may be used to
break the contacts initially.
3. The larger 860-014 is used to cut the bulk
of the preparation.
4. The 7404 bur is used to finish the buccal
margin to provide a sharp smooth finish
line that provides adequate bulk of gold
for casting and finishing.
5. A fine cuttle disk is used to smooth the
occlusal line angles.
Crown with Shoulder
Indication
Lower molar full crown preparations without
extensive proximal involvement where a deep
hollow grind would be inappropriate.
Armamentarium
1. 57 fissure bur
2. 860-012 diamond
3. 860-014 diamond
4. Fine cuttle disk
Additional retention and resistance

form is created by making a buccal wall
more parallel to the other walls by plac
ing a buccal shoulder.
1. The preparation is cut in the typical manner for a traditional full crown except for
the buccal wall.
2. The shoulder is cut with a 57 bur and
blended into the interproximal with the
860-014 diamond.
Brasseler 7404 Bur Preparation Variations
This bullet shaped bur produces a very smooth
hollow ground margin that allows good definition and bulk of gold at the margins.19
Hollow Grind Marginal Ridge
Indication
Thin, weakened distal marginal
35
ridge, usually on second molar.
OL Upper Molar
Synopsis
The marginal ridge can be expediently
included into the preparation without a
distal box or hand instrumentation.
Buccal Extension (Bale)

Indication
The finger-like extension on the buccal of
molars is placed when there is extensive
breakdown of the lingual cusp. It allows
the casting to engage the stronger buccal
tooth structure, reducing the stress on the
lingual.
Preparation Synopsis
1. The extension must have adequate
length and should not taper too much
to the lingual.
2. Adequate depth is necessary for
enough bulk of gold to prevent the
casting from bending and distorting.
Indication
OL groove on upper molars.
Preparation Synopsis
1. The entire cavity is cut with the 7404.
2. This simple preparation will have
a rounded pulpal floor and no line
angles.
3. Draw is created by the shape of the
bur only.
Midwest 7404 Pot Holes

Indication
Wide open cavity needing additional

retention and resistance form.The typical

situation is a large cavity with a compos

ite buildup.
35
1. A Midwest 7404 is used because it has
the ideal shape of more taper.
2. The depth of the pot hole is at least 2
mm. It is often more since we like to cut
through the entire depth of the buildup to
dentin.
3. The entire composite buildup is removed
prior to cementation.
Impression
1. Break off the end of an anesthetic needle
to remove the bevel with out closing the
lumen.
2. Place the needle in the pot hole and inject
impression material.
3. The needle allows air to escape and thus
decreases voids.
Slot Inlay

Indication
Restoration of the distal of a cuspid
with a small lesion or a small existing
restoration.20
1. Hand instrumentation results in sharp
internal line angles.
2. Two plane labial and lingual walls enhance retention.
3. An internal bevel adds retention and aids
in seating of the casting during cementation.
4. A small definitive gingival bevel is
placed.
1. Open the cavity with the 169L bur and
establish the labial and lingual extensions
and the gingival wall. The cavity looks
like a crescent at this time.
2. Use the 169L bur to enhance the axial
line angles labially and lingually for retention. This creates the two-plane labial
and lingual walls.
3. Use the narrow 45 S off angle chisel
to place the proximal axial line angles,
which create sharp retentive walls.
4. Using the #233 margin trimmer place an
internal bevel on the gingival wall . Slide
down both the labial and lingual walls
to define the line angles and sharpen the
point angles.
5. Smooth the axial wall with the 44 S off
angle chisel since it will be rough from
instrumenting the internal bevel.
6. Place a small definitive gingival bevel
with the 232 Tucker margin trimmer.
7. A 55 fissure bur is used for the occlusal bevel which removes unsupported
enamel, smoothes the outline, and creates
a funnel which aids in seating.
Armamentarium
1. 169L fissure bur
2. 44 S and 45 S off angle chisels
3. 232 and 233 gingival margin trimmers
4. Tucker 232 and 233 gingival margin
trimmer
5. 55 fissure bur
37
Distal Hollow Grind
Distal Hollow Grind with a Pin
Indication
Restoration of a large carious lesion or large
existing restoration with a lingual dove tail.20
Indication
Large cavity needing additional
retention and resistance form.20
Armamentarium
1. 56 fissure bur
1. No hand instruments are used for this
preparation.
2. The preparation consists of a lingual
dovetail and a distal hollow grind.
3. It has an easy draw to the lingual because
there are no sharp internal angles.
1. Place the lingual dovetail with a 56 fissure bur. It draws perpendicular to the
lingual cavosurface with equal depth in
all aspects.
2. The Brasseler 7404 is used to place the
distal hollow grind. The hollow grind is
parallel to the labial surface. The axial
wall taper is kept to a minimum.
3. Place a light occlusal bevel with the
7404.
Armamentarium
1. #6 round bur
2. 169 L fissure bur
1. 50% of distal hollow grind preparations
need a pin.
2. The pin is placed as far away from the
primary retention of the dove tail as possible.
1. A counter sink is placed with a high
speed #6 round bur.
2. The pin hole is placed with a 169 L bur to
a depth of about 1.5 mm and is parallel to
the lingual draw of cavity.
Conclusion
Although gold castings are relatively technique sensitive, and demanding on the operator,
when this type restoration is well done it offers
a great satisfaction to the patient in the form of
comfort and permanence. It is the desire of the
authors that more students and dentists acquire
the knowledge required to perform this type
service for their patients and perform this type of
dentistry routinely.
37
Pit Gold Foil

Indication

Often appropriate where a casting has been placed to restore the tooth and a

small buccal or lingual lesion remains that can be restored separately.

Armamentarium
Preparation
1. 55 fissure bur
2. 35 inverted cone
3. 7404 bur
Condensation
1. Powdered gold (Easy Gold)
2.. 5 foil condenser
3.. 7 foil condenser
4. Gold foil mallet
5. Gold foil carrier
6. Woodbury-Myer holder
7. Gold knife
8. Varney foot condenser
9. Cohesive gold pellets
Finishing
1. Disks: medium garnet, fine sand, fine cuttle
2. Cleoid
3. Beaver tail burnisher
4. Ribbed rubber cups
5. Polishing powders: #4 flour pumice, 15 and 1 micron aluminum oxide.

A small circular preparation with axial retention cut with a 35 inverted

one and a small occlusal bevel placed with a 7404 bur.

1. Use a 55 fissure bur to outline the cavity. An ideal depth is 1.5 mm.
2. Use a 35 inverted cone to give the axial wall a little retention.
3. The 7404 bur is used to smooth the outline form and place a little

bevel on the cavosurface margin.

Foil placement
1. Use a .5 or .7 condenser. Use the largest condenser that the cavity will

accommodate. The bulk of the restoration is filled with powdered
gold because it is quicker and easier.
2. Anneal the powdered gold
over a flame using a foil carrier.
39
3. Hold the gold in the cavity with the Woodbury-Myer holder and con

dense with the direction of force directly into the cavity. Condense

each pellet initially with hand pressure and then condense using the

mallet.
4. Fill the cavity to the bevel with powdered gold so that there is only

about .5 mm left to fill.
5. The rest of the cavity is now filled with cohesive gold because it is
denser and will have less porosity. The condensation force is now

directed toward the enamel bevel. This will make the gold tight to the

walls as well as protect the fragile enamel during condensation.
6. As the gold is added to build up the contour, excess gold is removed beyond the margin with
a gold knife. It can be difficult to remove later and we may lose the relationship of where the
margin actually exists.
7. Verify if the cavity is filled by using an explorer from gold toward the tooth. If we do not
feel an edge of tooth, the cavity is filled.
8. Use a Varney foot condenser to finalize the condensation. It takes out the hills and valleys a
bit and smoothes the gold to one plane a little more.

Finishing
1. Always blow air when finishing gold with disks because the heat generated can damage the
pulp.
2. Remove the bulk of gold with a medium garnet. Care should be taken around the margins
with this disk because the enamel is quite friable and we do not want to bruise the enamel
with too coarse of a disk.
3. Next use the fine sand disks. Use a cleoid to remove any surplus flecks of gold since the
disks will continue to carry the gold over the margin.
4. Use a beaver tail burnisher to burnish and work harden the gold a bit.
5. Follow with the fine sand again to remove any irregularities produced as the gold was work
hardened.
6. The last disk is the fine cuttle. It does not require much effort because of the step-by-step
finishing sequence we have used.

Polish
1. Using a ribbed rubber cup, begin polishing with #4 pumice. Do not use pumice too long
because it removes tooth structure and gold at different rates.
2. We now use aluminum oxide 15 microns. The final finish is with the 1 micron aluminum
oxide.
39
References
1. Gergely EJ. Rubber dam acceptance. Br Dent J 1989;167:249-252.
2. Reuter JE. The isolation of teeth and the protection of the patient during endodontic treatment.
Int Endod J 1983;16:173-181.
3. Christensen GJ. Using rubber dams to boost quality, quantity of restorative services. JAm Dent
Assoc 1994;125:81-82.
4. Tucker RV. Class 2 inlay cavity procedures. Oper Dent 1982;7:50-4.
5. Jorgensen KD. The relationship between retention and convergence angle in cemented veneer
crowns. Acta Odontol Scand 1955; 13:35-40.
6. Kaufman EG, Coelho DH, Colin L. Factors influencing the retention of cemented gold castings. J
Prosthet Dent 1961;11:487-502.
7. Dykema RW, Goodacre CJ, Phillips RW. Johnstons Modern Practice in Crown and Bridge
Prosthodontics, ed 4. Philadelphia, WB Saunders Co, 1986, p 24.
8. Shillingburg HT, Hobo S, Fisher DW. Preparations for Cast Gold Restorations. Chicago, Quintessence Publ Co, 1974, p 16.
9. Tylman SD, Malone WFP. Tylmans Theory and Practice of Fixed Prosthodontics, ed 7. St Louis,
CV Mosby Co, 1978, p 103.
10. El-Ebrashi MK, Craig RG, Peyton FA. Experimental stress analysis of dental restorations. Part
IV. The concept of parallelism of axial walls. J Prosthet Dent 1969; 22:346-353.
11. Parker MH, Cameron SM, Hughbanks JC, Reid DE. Comparison of occlusal contacts in maximum intercuspation for two impression techniques. J Prosthet Dent 1997; 78:255-259.
12. Noonan JE, Goldfogel MH, Lamber RL. Inhibited set of the surface of addition silicones in contact with rubber dam. Oper Dent 1985; 10:46-48.
13. Cook WD, Thomasz F. Rubber gloves and addition silicone materials. Current note no. 64. Aust
Dent J 1986; 31:140.
14. Kahn RL, Donovan TE, Chee WWL. Interaction of gloves and rubber dam with poly(vinyl siloxane) impression material: A screening test. Int J Prosthodont 1989; 2:342-346.
15. Hollenback GM, Skinner EW. Shrinkage during casting of gold and gold alloys. J Am Dent Assoc 1946; 33:1391-1399.
16. Cooly RL, et al.Heat generation during polishing of restorations. Quintessence Int 1978 Dec;
9(12):77-80
17. Skinner EW, Phillips RW. The science of dental materials. 6th ed. Philadelphia: WB Saunders;
1967.p.473-74.
18. Keenan MP, et al. Effects of cast gold surface finishing on plaque retention. J Prosthet Dent
1980 Feb; 43(2):168-173.
19. Tucker RV.Variation of inlay cavity design. J Am Dent Assoc 1972 Mar; 84(3):616- 620.
20. Tucker RV. Gold restorations of the distal aspect of cuspid teeth. Signature 1996:4-9.
41
All About Pins in Gold Castings

Richard D. Tucker, DDS

Inlays are so much fun to design and finish, and they are so beautiful. A simple MO, DO, or
perhaps an MOD gives such exceptional service to the patient. However, sometimes there is insufficient tooth structure remaining to provide enough retention or resistance form to retain the simple
casting we would like to place. Rather than a preparation for a more extensive casting requiring
the removal of more of the patients healthy tooth structure, we can gain the resistance form and/or
retention needed through the addition of one or more cast gold pins to our gold casting. There are 4
types of pins available to satisfy our needs for more resistance form and retention. The Shooshan
pin, the 700 tapered fissure pin, a variation on this called the 700 tapered fissure slot, and the
Tucker pin.

The Shooshan pin technique was developed by Dr. David Shooshan, a noted dentist in
southern California. The position of the pin hole is first marked with a #4 round bur to half the depth
of the bur head. This forms the countersink around the pin hole opening which will give the pin
more strength where it joins the casting. The pin hole is made two to three millimeters deep with a
.027 inch twist drill, used in the slow speed contra-angle handpiece. The position of the pin hole
having already been determined and marked with the #4 round bur, the operator simply places the
twist drill in the countersink and aligns it with the preparation for proper draw. The pin hole is then
drilled, being careful to not move your finger rest until the final depth has been reached. If more
than one pin hole is to be made, the positions of all pin holes are first marked with the #4 round bur
countersink. The .027 inch twist drill is placed in the first countersink and aligned with the preparation draw, but no pin hole is made. Without changing the finger rest, or the angle of the twist drill,
the twist drill is now placed in the next countersink checked for alignment, and adjusted if required.
This procedure is continued for all the countersinks until a common path is determined that will accommodate all pin holes and draw with the preparation. Then without changing the finger rest, each
pin hole is drilled. The finger rest and drill function like a surveyor, allowing the operator to place
as many pin holes as required knowing they will all be parallel. The key to this technique is to not
change the finger rest until all the pin holes have been made.

The impression of these pin holes is easily made by placing a short length of .025 inch nylon
bristle with a flat nailhead on the end, in each of the pin holes. Theimpression material subsequently injected into the preparation locks onto the heads of the bristles, and they are all withdrawn
in perfect alignment when the set impression is removed from the mouth. The impression is inspected for completeness, with at least 1mm of impression material extending beyond all margins,
gently washed with room temperature water, and poured in a low expansion stone. Once the die has
been removed from the impression, an .024 inch nylon bristle is inserted into each pin hole. This
size differential will allow the pins to seat easier when the casting is placed in the tooth, and provide
room for cement. The wax is flowed around the .024 inch nylon bristles and the wax up is carried to
completion. The nylon bristles will burn out completely, but may require a longer soak time if the
final burnout temperature is less than 950 Fahrenheit. The advantage of the Shooshan pins is they
may be easily placed in relatively restricted areas.
41

The Shooshan pins provide sufficient retention for an extensive inlay such as a large distal
lingual inlay on a maxillary cuspid. However, if the casting will rely entirely on its pins for resistance and retention, then a larger pin type may be desirable. In this case, the pin hole locations are
marked with a #6 round bur countersink. The pin holes are then made with the same constant finger
rest technique, substituting a 169-L or 170-L (depending on size)tapered fissure bur for the twist
drill.

The impression of these pin holes is made directly with the impression material, using the
air vent technique, as follows. The tip of a dry 27 gauge anesthetic needle is broken off with a small
plier insuring that the lumen remains open. One such needle is prepared for each pin hole. The
needles are placed to the depth of the pin holes, and as the impression material is forced along side
the needles, the air in the bottom of the pin hole will flow out the hollow needle allowing the impression material to completely fill the pin hole. The needle is then slowly withdrawn as more impression material is injected beside it. After all needle air vents have been removed, the remainder of the
preparation is injected with impression material and the impression is completed.

During the wax up, a size 700 tapered plastic pin* is placed into each pin hole. The wax is
then carefully flowed around the protruding end of each plastic pin and down into the counter sink
area. This technique will give a more substantial pin for use in higher stress applications.

There are times when even the 700 tapered fissure pin is not substantial enough, so a variation called the 700 tapered fissure slot is used. There are various applications but it might be used
in a distal occlusal inlay where there is insufficient tooth remaining in the isthmus area to provide
a good dovetail. Rather than cut an approximal box in the untouched tooth structure of the mesial
surface to keep the casting from being displaced distally, a 169-L or170-L (depending on size) bur is
used to place a slot in the pulpal wall just inside the mesial marginal ridge. This slot should extend
buccal lingually about 2-3 millimeters depending on the size of the preparation, and to a depth of 2.5
millimeters. This will provide ample resistance and retention form as well as allowing us to leave
the mesial surface of the tooth untouched. The slot thus formed is of relatively large dimension, and
can easily be reproduced by placing the tip of the impression syringe in the bottom of the slot as the
impression material is injected, or the needle technique could be used. After the die is recovered
from the impression, trimmed, and lubricated, wax can be flowed directly into the slot with a small
instrument during the fabrication of the wax pattern. The larger crossectional area of the slot should
allow the wax pattern to be removed without breakage or distortion of the slot portion. The finished
castings provide sufficient strength and retention without involving the remaining good approximal
surface.

The fourth pin type, the Tucker pin, was developed by Dr. Richard V. Tucker in Ferndale,
Washington. In order to understand its use, one must first visualize a tooth which has suffered a
great amount of destruction of the pulpal wall. This great void inside the tooth is filled with composite to provide a buildup yielding optimum dimension to the internal of the casting.
*Mfg. by N.W. Dental Supply, 590 Clearwater Suite C, Post Falls Idaho 83854
Concept by Dr. Maurice Chechik, Vancouver, British Columbia, Canada
43

If the final preparation needs more resistance and retention form, a 7404 bur is used to place
a pin hole to the full depth of the composite buildup. The 7404 bur which is manufactured with a
fairly straight, rather than rounded profile**, works well for making this pin hole. When the impression is made, the syringe needle air vent technique described previously, may be required to avoid
trapping an air bubble in the depth of the pin hole. The pin is waxed directly on the die as in the
case of the 700 tapered fissure slot. Before the casting is cemented in the tooth, the entire composite
buildup is completely removed. This large internal void is then filled with zinc phosphate cement
and the casting, which also is covered on the internal surface with cement, is seated. The cement
locks into the internal of the tooth and at the same time, locks around the 7404 pin. In this way we
are able to get additional resistance and retention without sacrificing any
additional tooth structure. Because of its large size, the Tucker pin is only placed in the buildup material, and never in tooth structure.

This completes some options for increasing resistance and retention form through the incorporation of pins in our gold castings. A first choice would be the Shooshan pin because of its
conservative nature. Secondly, the 700 tapered fissure pin would be chosen if additional strength is
required. Thirdly, the 700 tapered fissure slot would be indicated where there are great demands to
resist mesial or distal displacement, and finally, the Tucker pin could be used when more resistance
and retention form is required and there is a buildup of sufficient volume to contain the pin.

Incorporating these pin types in your castings will allow you to place more
conservative and longer lasting cast gold restorations.

Richard D. Tucker DDS private practice 1800 C st suite 226

Bellingham WA
Richard V. Tucker DDS private practice PO Box 1146 Ferndale WA

** Mfg. by Midwest Dental Products Corp. 901 W Oakton St., DesPlaines, IL 60018-1884
43
Clinical Instruments and Supplies

Richard V. Tucker
Hand Instruments (for one setup)
*2 setups for the Institute course.
Front surface mirror
Cotton pliers
#5 explorer (Sutter)
42S off angle chisel (Sutter)
232 Tucker gingival margin trimmer (Sutter) 233
Tucker gingival margin trimmer (Sutter)
Chord packing instruments (2)
Crown and bridge scissors
Goldstein 1 composite inst.(Hufriedy) place
temporary stopping
*Only for internal bevel
232 gingival margin trimmer (Sutter)
233 gingival margin trimmer (Sutter)
*Only for small bicuspids or cuspids
*One set each of the above two sets is probably
adequate for the Institute course.

Rubber Dam
Dam holder (Youngs frame or Wizard)
Dam (extra heavy 6x6 dark)
Lubricant (shaving cream)
Dam punch, clamp holder
Clamps: Ivory with wings: 14, 56, 8A, 2
See Rubber Dam Application p.51
Handpieces
High speed
Low speed - straight & contra-angle attachments
Burs (Brasseler)
56, 57 straight fissure
7404 finishing bur
2,4, 6 round bur
35 inverted cone
860-012 course diamond
860-014 course diamond

7404 Midwest potholes
Heatless stone (Mizzy)
169L tapered fissure
Buildup material
CompCore (chemical cure core paste, white)
Dycal
Impression
Gingivi-Pak #3 -not braided (Surgident)
Hemodent 25% Aluminum Chloride (Pre
mier)
Light body polyvinylsiloxaine at least 4
cartridges for Institute
Check bite trays (5): Coe 72 (3) and Emery (2)
Mixing pad, mixing spatula, impression
tips, syringe
Temporaries
Dura Seal (Reliance)
Temporary stopping (Hygienic)
Temporaries (crowns)
Temporary cement
Seating
Moore discs (1/2): med. garnet, fine sand, fine
cuttle
Moore discs (3/8) for small restorations
Moore disc mandrels - straight & contra
Ribbed rubber cups #100-5559 Henry Shein

800-372-4346
Flour pumice #4 (Dixon)
Aluminum oxide -15 &1 micron (Micro
Abrasives)
Flecks Cement - yellow (Mizzy)
Cement slab & spatula
Gluma 3
1/4 diameter seating sticks (orange wood
or chop sticks)
Seating mallet

45
Basic Items
Bibs & clip
Suction tips
Saliva tips
Topical anesthetic

Anesthetic syringe, needles
Anesthetic carpules
Cotton swabs
Dental floss
2x2s
Cotton rolls
Cotton pellets
Cotton roll holders
Articulating paper
Autoclave bags
Patient hand mirror
45
Laboratory Instruments and Supplies

By Richard V. Tucker, DDS
*measuring vial for water
Models
*4 simple hinge articulators

*distilled water
*straight pins
*porcelain crucible
*debubblizer (Delar surfactant)
*Gold (type B)
*small brush
*dowel pins
Finishing
*mixing bowl
*Prevox
*spatula
Tripoli
*Fugi Rock die stone (golden brown)
jewelers rouge
*separating medium (Ney Die Lube)
bristle brushes (Buffalo #11, stiff & soft)
*coping saw and fine blades
ultra thin Joe dandy discs
*Parker knife (#25 blades)
heatless stones
*die relief (Tru-fit,Geo. Taub.)
disc mandrels (Moore)
*microfilm (Kerr)
medium garnet disc (Moore)

sand fine discs (Moore)
inlay wax (Yeti grey)
cuttle fine discs (Moore)

felt wheel & chamois wheel & mandrel
wax spatula (Clevedent #7)
tooth brush
Roach carver (SS White)
bunsen burner or alcohol lamp
Hollenback carver
matches
Waxing
waxing instrument (P.K.Thomas 3)
169 taper fissure bur
*undercut wax
#.5 round bur (straight hp)
Investing & Casting
*Items provided at the course
*plastic sprues (Williams #10)

*short nosed pliers
*Kleenex
**sticky wax
*casting rings & sprue formers
*wax ready made round shapes (Kerr #14)
*asbestos liner
*investment (Novocast)
47
Suppliers
Accubite Dental Supply
WOW articulators
800-248-2746
GC America
Fugirock die stone
800-323-7063
Acculab
Scales (.01 g)
800-656-4400
Jensen Industries
Casting gold, gold foil, DVD
800-243-2000
The Argen Corporation

Casting gold
800-544-5525
MDL Dental Products

Waxes
206-824-3449
Belle de St. Claire

Electric waxer, die spacer
800-322-6666
E.C. Moore Co
Disks and madrels
1-800-331-3548
Blue Dolphin Products

Dowel pins
800-448-8855
Micro Abrasives
Polishing powders (aluminum oxide)
1-800-426-6046
Brasseler
Burs
1-880-841-4522
Moyco
Polishing strips
1-800-221-1344
CT Enterprises
Pin kits
360-676-0305
Northwest Dental Supply

700-701 Plastic pins
800-842-2787
Carolina Biological Supply

AICl crystal, sodium nitrite,
Scales, glassware
800-334-5551
Pepper Dental
Micropol (rubber polishing points)
888-4189
Columbia Dentoform
Ivoreen teeth
718-482-1569
Pfingst
Twits drills (.6 &.9 mm)
908-561-6400
Delar Corporation
Surfactant
800-669-7499
Suter Dental Mfg

Hand instruments, sharpener
1-800-368-8376
20% Tucker discount
Emery Dental
Slim check bite trays
800-637-6611
Whipmix
Novocast investment
800-625-5651
47
Educational Materials
Richard V. Tucker DVD
This DVD contains all three of Dr. Tuckers videos:
The Gold Inlay
Basics for gold inlays and onlays that include preparations, impressions and finishing.
Variations in Cavity Design
Covers most of the preparations and variations that Dr. Tucker teaches.
The Laboratory
Lab basics and problem solving. A must see for dentists.
The cost of the DVD is $150. Order from:

Jensen Industries

1-800-243-2000 Ext 233

Ask for Ann Pellegrini
Plastic models of Tucker preparations

Copies of preparations cut by Richard V. Tucker for the video, Variations in Cavity Design.
Cost is $150 per set of 14 models. Order from:

Voda Die Reproduction

6800 K Montgomery
Albuquerque, NM 87109
(505) 881-8463
Ivoreen teeth
Plastic teeth to practice cutting preparations. Upper and lower first molars and second bicuspids
seem to be an adequate selection as well as some upper cuspids. Order from:

Columbia Dentoform Corporation

Long Island, New York
(718) 482-1569
Fax (718) 482-1585
49
University of Washington Dental School

Second floor clinic, D wing
stadium
Montlake Blvd
parking
University Hospital
Pacific Pl
Dental School
N E 45th
520
N E Pacific St
I-5
Patient Parking
Take your parking ticket with you

Get a discount stamp from your .Dr
Pay at the booth
Patient parking off

. of Pacific Pl.
entrance
Enter hospital at the main enterance.

Walk down the hallway and turn left at D-wing.
Take the elevator to the 2nd floor.
.
Turn right of
f of the elevator.
.
Tucker Institure June 19-23

Clinical Sessions:
Monday: 10AM, 2:00 PM
Tuesday: 9:30AM, 1:30 PM
Thursday: 9:30AM, 1:30 PM
Friday: 9:30AM, 1:30 PM
49
Rubber Dam Application

Dennis M. Miya, DDS
SETUP
Dam, punch, clamp, frame, waxed floss, mirror, explorer, cotton pliers.
PUNCHING
Uppers- Use depth of the punch as a guide (1 inch in from edge). Start at the central (center
of dam) and punch to molars.

Lowers- Divide the dam into thirds (vertically) and center (horizontally). Punch for

the clamp on the molar (center/third on side to restore) and continue to the central.The space

between the punches should be about 1.5-2mm. There should be enough rubber between the

holes for adequate tissue retraction. Always use the largest hole on the punch for the clamp

and the smallest hole for the lower incisors.
CLAMP SELECTION (Ivory clamps with wings)

Molars

14 standard workhorse clamp because it fits the most teeth.

56 distal extended bow gives good access for restoring second molar.

14ad, 8ad useful distal extension clamps when restoring the second molar.

8a for small molars. 14a for partially erupted molars.

Bicuspids 2, 0

Cuspids 2
PLACEMENT
An easy method is to take the dam, frame, and clamp to place as one unit. Pick your clamp and
pre-fit to the tooth if necessary. Attach the top of dam to the frame by placing tension between the
top two nibs and then the bottom portion is attached with tension between the bottom two nibs. This
allows plenty of play in the dam where the clamp will be attached. Attach the clamp to the dam
and frame via the wings on the clamp. Look through the hole in the clamp and place. Release the
dam over the wings with cotton pliers or an explorer. Stabilize the dam initially by flossing the front
tooth first and then work back to the molars. The dam is tucked around the teeth resulting two layers
of dam around each tooth. This helps retract the tissue and seal the dam to minimize saliva. The
technique is to invert the dam with an explorer or tissue packer while pulling gingivally on the dam.
Each tooth is simultaneously dried with air to facilitate the procedure. Re-adjust the dam to the
frame as necessary.
51
Basic setup
1
Dam punch table
Punched dam for upper and lower

14, 56, 8a clamps
Dam, frame and clamp as one unit
Inverting dam around each tooth
Initial placement
Completed rubber dam placemnt

51

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CONTENTS

Course Survival Tips

Laboratory Notes for Cast Gold Restorations

A Technique for Finishing Gold Castings

Conservative Cast Gold Restorations

All About Pins in Gold Castings

Cast Gold Clinical Instrument and Supply List

Laboratory Instruments and Supplies

Rubber Dam Placement

Dennis M. Miya, DDS

Tucker Institute Course Schedule

Course Survival Tips

Study Club Format

Inlay Cavity Preparation for Posterior Teeth

Laboratory Notes For Cast Gold Restorations

A Technique For Finishing Gold Castings

Conservative Cast Gold Restorations

Typical Cast Gold Restorations

Inlay, onlays, gold foil 3a

Onlay with buccal bale 3c

Fig 4 Outline without composite build-up (A) and with

Similar to other restorative materials, gold

Fig 5 Ideal bur inclination.

An auto-cure composite can be placed with a

Fig 7 Proximal wall enamel rods.

Fig 6 Wall Inclination/preparation taper (draw).

Proximal box form

Fig 8 Ideal preparation with uniform inclination

Fig 9 Instrumentation Sequence:

rods (Fig 7). Maximizing the use of the bur to

Fig 10 Gingival bevel too large (A), ideal bevel (B).

Fig 11 Occlusal bevel is only a few degrees more than the

Fig 14 DO bicuspid dovetail and

Fig 12 No undermined enamel

the box form and the occlusal outline, removing

Fig 15 Gingival wall.

Inlay Preparation Sequence

Fig 13a Occlusal preparation.

Fig 13d Instrument pulpal floor

Fig 13g Instrument axial wall.

Fig 13e Instrument gingival wall.

Fig 13f Instrument proximal

Fig 13j Occlusal bevel with Fig 13k Occlusal view of

Fig 13l Proximal view of

Fig 16 Internal bevel fuctions as a seating guide

The bevels on these instruments are less acute

Fig 18 Opposing proximal walls of mesial and distal box

Fig 17 The Tucker margin trimmers 30(top)

For one or two crowns or perhaps a quadrant

Fig 19 Coe and Emery checkbite trays.

Fig 20 Quadrant model with hinge articulator.

Fig 21 Dura Seal acrylic and temporary stopping.

the teeth to more completely interdigitate as the

tion due to the rubber dam or latex gloves can

Fig 22 Temporary stopping placed.

Fig 23 Dura Seal placed.

A semi-soft acrylic (Dura Seal, Reliance) is

Fig 24 Inadequate expansion: inlay loose with

The acrylic is placed with the liquid/powder

Fig. 25 Inlay without proper expansion. Note

Fig 26 Expansion recommendations for Novocast

resulting in marginal gaps that cannot be closed

Castings should be seated with anesthetic.