Cast Gold Restoration Lec 10 Operative (2)

- Definition of “Cast gold restoration” : The precise metallic duplicate for the prepared
cavity which is fabricated outside the oral cavity and which is cemented in place (inside the
prepared cavity) in one piece (not in increments) in order to restore the lost tooth structures
permanently.

ّ‫ يًكٍ اتُيّ ألٌ بيكٌٕ في‬gold ‫ يٍ انـ‬thin sheet ‫ نٕ أَا عُذي‬، soft (malleable) ٌٕ‫ بيك‬pure gold ‫ انـ‬-
ّ‫ يعُي بيعًهٕن‬alloying ّ‫ بيعًهٕن‬to be used in dental practice ٍ‫ نك‬، ّ‫ عاني‬malleability
ٍ‫ ي‬alloys ‫ يعُي بيعًهٕا‬silver, copper, indium, zinc, tin ‫ زي انـ‬mixing with other metals
.suitable to be used in dental practice ‫ عهي أساس إَّ يبقي‬cast gold ‫انـ‬

Materials for cast restorations (Types of cast gold restorations) :

 Type I (Soft) :

soft type ‫ فبيبقي انـ‬mixed with little percentage of metals ‫ أٔ بيبقي‬pure gold ‫ بيبقي‬soft type ‫انـ‬
.gold ًّ‫يعظ‬

- Low strength for casting, subjected to low strength.

- Maximum yield strength 140 MPA and elongation is 18 %.

- Use : Small inlay as in classes III and V.

 Type II (Medium) :

- Medium strength for casting, subjected to medium strength.

- Yield strength 140 - 200 MPA, Min. elongation is 18 %.

- Use : Large inlay, and onlay as in classes I and II, i.e. in stress bearing areas.

 Type III (Hard) :

- High strength for casting subjected to high stress.

- Yield strength 200 - 340 MPA, Min. elongation is 12 %.

- Uses :

1- Onlay.

2- Thin cast backing (Backing of veneer).

3- Pontic full crown.

4- Short span bridge.

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 Type IV (Extra hard) :

- Extra-high strength for casting, subjected to high stress.

- Uses :

1- RPD bars, saddles, clasps.

2- Long-span FPD (Long span bridge).

3- Inlays.

- Gold content in dental casting alloy is measured by :

1- Karat : The parts of pure gold in 24 parts of an alloy.

2- Fineness : The number of parts per thousand of gold in alloy.

- Note : Pure gold is 24 karat or 1000 fineness. Thus, if ¾ (75 %) of the gold alloy is pure
gold, it is said to be 18 karat or 750 fineness.

- Advantages of cast gold restorations : Cast gold is the most accepted (suitable) biological
material to be used as a restorative material because it is :

1- Indestructible (Doesn’t dissolve) in oral fluids.

2- Resist tarnish and corrosion.

3- Have high strength (mechanical) properties and can protect the surrounding cavity
margins.

4- Dimensionally stable, i.e. its coefficient of thermal expansion is like that of tooth
structure, i.e. it doesn’t undergo expansion and contraction.

5- Can reproduce and maintain tooth anatomy, i.e. it reproduces the anatomy and details of
pits and fissures and contour of tooth structure

6- High surface hardness, so it shows highly smooth lustrous surface during finishing and
polishing.

7- Need short chair side time (Time saving for both the dentist and patient) because most of
the work is done in the laboratory.

8- Production of tooth anatomy depends on the skill of the laboratory technician.

9- Biologically inert, i.e. Doesn’t cause any irritation to the gingiva.

10- Long life span (Long functional life).

.ُّ‫ يبيتأثرش ال بانًيّ انباردِ ٔال انسخ‬gold restoration ‫ انـ‬-

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- Disadvantages of cast gold restorations :

1- Poor (Lack of) adaptability with the surrounding tooth structure (cavity walls) due to the
presence of the luting cement.

‫ عهطاٌ يبقي‬space ‫ الزو يكٌٕ في‬cementation ‫ ؟ عهطاٌ أعًم‬disadvantage ‫ يعتبر‬cement ‫نيّ ٔجٕد انـ‬
.tooth structure ‫ ٔانـ‬restoration ‫ يابيٍ انـ‬intimate contact ‫ يعُي كذِ إٌ يفيص‬occupied by the cement

- Note : To solve this ↑ problem, i.e. to insure proper adaptation with the surrounding tooth
structures, the following must be avoided :

a- Fitting (casting) inaccuracy of the cast restoration, i.e. under size casting or oversize
casting or distorted casting.

b- Excessive surface roughness because this will prevent the proper and complete seating of
the restoration due to presence of nodules on the fitting surface that result from the excessive
surface roughness.

c- Poor luting cement (Using cement with inferior quality) because it will lead to incorrect
consistency, decreased strength and increased dissolution (solubility) tendency.

d- Too thin mix of cement because it will have decreased strength and increased dissolution
(solubility) tendency.

e- Too thick mix of cement (High amount of powder) because this will prevent the proper
and complete seating of the restoration.

f- Wrong cementation techniques such as :

i- Improper seating of the restoration.

ii- Moisture contamination.

iii- Improper application of the casting (inlay).

iv- Failure to apply and maintain pressure on the casting until partially seating of the
cement occurs.

g- Failure to burnish all thinned out margins of the restoration on against the preparation.

margins thin ‫ بُقٕل عهيٓا‬restoration ‫ بيبقي في حرٔف في انـ‬application of the restoration ‫بعذ يا بعًم انـ‬
margins of restoration ‫ يابيٍ انـ‬direct contact ‫ ٔبضغظ عهيٓا عهطاٌ يبقي في‬large ball burnisher ‫فبجيب‬
.exposure of the cement layer to saliva ‫ انهي يٕجٕد فأقهم انـ‬space ‫ عهطاٌ أقهم انـ‬tooth structure ‫ٔانـ‬

h- Premature and injudicious finishing of the restoration because this will break cement
interlocks.

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2- Poor (Lack of) retention (Less retentive to the cavity) because undercuts are removed
because the restoration is inserted as one piece. To solve this problem, the following should
be done :

a- The surrounding walls of the cavity should be either parallel to each other and to the path
of insertion and withdrawal or at least with slightly divergent walls (5º-10º). The nearer the
cavity walls to parallelism, the better is the frictional action and retention.

b- Beveling of the cavity margins to :

i- Indirectly expose the underlying cement film to the effect of oral flora.

ii- Do circumferential retention.

3- Have metallic gold color.

4- Require 2 clinical stages and 1 laboratory stage.

.delivery ّ‫ بيرجعهي بعًه‬patient ‫ بعذيٍ ببعت نهًعًم بعذيٍ انـ‬preparation ّ‫ بيجيهي أٔل يرِ بعًه‬patient ‫انـ‬

5- Increased tooth tissue destruction due to removal of undercuts.

6- Microleakage due to presence of cement line, & recurrent caries.

7- Luting cement flash causing gingival Irritation (worst with porcelain inlays).

8- Gold inlays may result in galvanic reaction if amalgam in opposing or adjacent teeth.

9- Cost : Too expensive.

10- Its manipulation requires many equipments and many laboratory procedures.

- Indications of cast gold restorations :

1- Teeth with excessive attrition and abrasion (Eroded and abraded lesions).

2- To restore occlusal cavities on bicuspids (premolars) where the steepness of their cusps
increases their tendency to split and fracture.

‫ يعُي نيٓا إَحذار‬with steepness ٌٕ‫ بتك‬cusps ‫ انـ‬، 2 large cusps ٍ‫ زي يإْ يعرٔف بتتكٌٕ ي‬premolars ‫انـ‬
‫ نهسُّ يعُي‬splitting ‫ يًكٍ يحصم‬amalgam ّ‫ ٔحطيت في‬improper cavity preparation ‫ فأَا نٕ عًهت‬، ‫كبير‬
‫ بتعًم‬inlay ‫ انـ‬inlay ‫ نكٍ نٕ أَا عًهت‬، narrow ‫ بتاعٓا زي يإْ يعرٔف‬thickness ‫تتكسر َصيٍ عهطاٌ انـ‬
.‫ في انحانت دي‬cast gold ‫ عهطاٌ كذِ بُستخذو انـ‬premolar ‫ نهـ‬support

3- To restore badly broken down teeth. Inlays may substitute crowns in restoring these teeth
into correct form and occlusion.

4- As a restoration for cases when it is needed to save time for both the operator and patient,
since most of the work can be completed in the laboratory by a trained technician.

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5- Large cavities that offer difficulty of access in cavity preparation and material application
(Inaccessible large cavities).

‫ نٕعأز أحظ‬، ّ‫ بتاعتي يص يظبٕط‬visibility (accessibility) ‫ ٔانـ‬large cavity ‫نٕ عُذي‬

‫ طيب أَا يص‬، cavity ‫ ٔيحتاج إٌ أَا أٔصم نهـ‬isolation ‫ أَا يحتاج أعًم‬amalgam or resin composite
‫ ٔاخذ انـ‬preparation for cast restoration ‫ ألَي ْعًم‬cast gold restoration ‫عارف فٓستخذو انـ‬
.all the work will be done outside the oral cavityٔ impression

6- If moisture contamination during cavity preparation and its restoration is impossible

(Impossible complete dry field = Impossible isolation).

‫ ألٌ يعظى انطغم زي ياقٕنُا ْيتعًم‬cast gold restoration ‫ ُْستخذو انـ‬complete isolation ‫نٕ يص قادر أعًم‬
.‫في انًعًم‬

7- For the restoration of teeth with wide interproximal spacing.

‫ عهطاٌ أقفم انـ‬amalgam or resin composite ‫ نٕ حطيت‬2 adjacent teeth ‫ كبير يابيٍ انـ‬space ‫نٕ عُذي‬
.cast gold restorations ‫ قٕيت فبُستخذو انـ‬material ‫ فأَا عأز‬، break down ‫ دِ ْيحصهٓى‬space

8- For the restoration of teeth presenting problems in occlusion and arch alignment.

9- To restore cavities extending deep subgingivally.

10- To restore and cap the endodontically treated molars and bicuspids, where protected
against fracture tendency.

11- To restore teeth in special patients who cannot withstand prolonged operations as
handicapped, mentally compromised patients, too young patents, too old patients.

12- To restore and splint teeth with weakened periodontal ligaments (Periodontally involved
teeth as in case of periodontitis).

13- As bridge retainers.

- Contraindications of cast gold restorations :

1- In patients with high carious susceptibility (high caries index = bad oral hygiene) where
the changes for the solubility of the luting cements increase and caries recurrence becomes
more likely, i.e. the acidity that results from the caries will dissolve the cement.

2- In mouth with multiple amalgam restorations to avoid galvanic activities and failure by
corrosion.

3- In cases where other permanent restorative materials are preferred (Where any other
permanent restoration can be used) for reasons of tooth conservation.

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- Casting problems for gold alloys :

1- Distortion.

2- Surface irregularities.

3- Incomplete casting.

- General considerations in inlays preparation (Cavity design cast gold inlay) :

1- Retention is achieved (obtained) by :

a- Nearly parallel opposing walls.

b- Close (high) adaptation of the casting to cavity walls.

c- Close (high) adaptation of the cementing medium to cavity walls.

2- Adequate thickness of gold in the areas of occlusal contact provides good resistance to
occlusal forces to avoid perforation of the restoration in these areas.

3- The outline form (cavity outline) should run smoothly with no sharp irregularities and
include pits, fissures and other enamel defects such as decay.

4- The width of isthmus portion may be narrower than that of amalgam and reverse curve is
not necessary since gold is not brittle and so a bulk of gold is not necessary.

5- Sufficient access into the proximal area is created owing to the divergence of their walls.

6- The gingival cavosurface point angles are rounded for ease of finishing gold.

7- The proximal outline form is harmonious with adjacent tooth contours and diverges
occlusally.

8- There are no undercuts, and the buccal and lingual walls diverge occlusally.

9- All internal line and point angles are formed to provide better resistance and retention
forms.

10- The axial wall converges towards the occlusal side.

11- The axial walls are straight in an occluso-gingival direction (diverged occlusally) and
into 0.5 mm dentin.

12- The pulpal floor is parallel to the occlusal table of the tooth.

13- The gingival wall is straight buccolingually providing a definite axiogingival line angle
as a seat for the casting.

14- The axiopulpal line angle is beveled to prevent voids (air bubbles) in the working and
nodules in the casting that would cause a difficulty in proper seating of the casting.

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15- All margins of the cavity should be beveled. The type of bevel is long or full bevel.

16- To axial retentive grooves may be created on the bucco-axial and linguo-axial line angles
to increase the means of retention, these grooves should be parallel to each other and path of
insertion and removal.

17- Reverse bevel is created in class II cavity as a mean of retention.

- Notes :

1- The correct pulpal depth for an inlay is established using tapered fissure bur. The tapered
sides are used to establish the desired divergence of the walls. The tapered fissure bur is
positioned at an angle to give an occlusal divergence for the retentive grooves. The grooves
should be at a depth of half the diameter of the bur.

2- A tapered diamond or bur is used to create a short but distinct bevel at the occlusal finish
lines. The bevel is extended across the entire occlusal margin and blended with the other
bevels.

‫ يعُي خذٔا‬، ‫ انهي بقٕنكٕا عهيٓا‬alloys ‫ انذكتٕر قال بانُص " دي انـ‬: ‫ دي ↓ ٔانجذٔل انهي بعذْى‬effects ‫ بانُسبت نهـ‬-
‫ انهي فيٓا انجذٔل انذكتٕريٕقفص عُذْا‬slide ‫ انهي ٔراْى حتي انـ‬slides ‫فكرة عُٓا دي يص ضغهتُا " ٔقاو قانب ع انـ‬
: " ‫ ففي انغانب كذِ يص ُْتسأل فيٓى " هللا أعهى‬، ‫خانص‬

- Effects of alloying components in gold alloys :

1- Au, Ag, Pd, Pt → Corrosion resistance.

2- Ag → Cheaper.

3- Pd → Increased melting point (MP) & hardness.

4- Pt → Increased MP.

5- Fe, In, Sn → Oxide formers for gold alloys.

6- Zn → Oxygen scavenger.

- Effects of alloying components in other alloys :

1- Cr, Ti → Oxide formers in other alloys.

2- Ni, Co, Fe → Increased modulus of elasticity.

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