The

Tucker
Institute 2019

University of Washington,
Seattle

Page 1
 CONTENTS
3 Preface

4 Course Schedule
5 Course Survival Tips
7 Inlay Cavity Preparation for Posterior Teeth
Richard V. Tucker, DDS

10 Impression Technique
11 Temporaries
12 Laboratory Notes for Cast Gold Restorations
Richard V. Tucker, DDS
15 A Technique for Finishing Gold Castings
Richard V. Tucker, DDS
17 Conservative Cast Gold Restorations
Richard V. Tucker, DDS
Dennis M. Miya, DDS

42 All About Pins in Gold Castings

Richard D. Tucker, DDS
Richard V. Tucker, DDS

45 Cast Gold Clinical Instrument and Supply List

Richard V. Tucker, DDS
47 Laboratory Instruments and Supplies
Richard V. Tucker, DDS

48 Suppliers
49 Educational Materials
50 Rubber Dam Placement
Dennis M. Miya, DDS

52 Rubber Dam Placement

Victor D. Guerrero, DDS

58 Journal Articles

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PREFACE

The Tucker Institute was the collaborative vision of Dr.

Richard V. Tucker and Dr. Dennis Miya. A few years
ago, Dick Tucker and Denny Miya were having lunch at
Meany Hotel and they 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 the
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, but the development of the Tucker

Institute marked the beginning of Drs. Tucker and Miya’s
journey.

This journey was passed on to Dr. Richard D. Tucker, Mentor,

and Dr. Kris Swanson, Director, with the original vision
remaining true. Dr. Swanson directed the Institute from 2008 to
2011.

Dr. Hess was selected in February 2012 to take over the reins
from Dr. Swanson.

We hope that the information in this syllabus and your experience in the course will be of assistance for your
journey toward the perfection and enjoyment of gold castings.

Best regards,
Timothy A Hess, DDS, MAGD
Director- The Tucker Institute

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Tucker Institute Course Schedule

Sunday Monday Tuesday Wednesday Thursday Friday

8:00-9:30 Lecture 8:00-9:30 Lecture 8:00-9:30 Lecture 8:00-9:30 Lecture 8:00-9:30 Lecture

10:00 Preparation A 10:00 Preparation C 10:00 Laboratory 10:00 Seat Casting A 10:00 Seat Casting C

1:00 Lunch 1:00 Lunch 1:00 Lunch 1:00 Lunch 1:00 Lunch

2:00 Preparation B 2:00 Preparation D 2:00 Laboratory 2:00 Seat Casting B 2:00 Seat Casting D

5:00 Brief
Orientation 7:00 Closing Supper
Meeting and
Supper

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Course Survival Tips

Preparation
You are coming to learn Dr. Richard V. Tucker’s technique for gold restorations. You are at a
disadvantage if you do not have all of the exact instruments and supplies that are listed for the
technique. The Tucker Institute is pleased to supply handpieces, instruments and supplies that you
will use during the 5 days. You will only need to bring your loupes and your choice of a laboratory
coat or scrubs. You will find a complete list of the armamentarium in this syllabus.

To maximize your experience with Dr. Tucker, we would recommend the following preparation:
review the syllabus before you come to the course, watch Dr. Tucker’s DVD, and then practice cutting
preparations on ivorine teeth, trying to duplicate the preparations exactly as far as outline form,
proportion and preciseness.

Treatment Planning
We have tried to create a situation where you have the best chance of having a positive learning
experience. We have attempted to select patients that are tolerant of longer procedures in a study
club format. If you decide to bring your own patient to the Tucker Institute: Choose a patient that is
easy to work on. Please inform us if you are going to bring your own patient. 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

The Tucker Institute clinical hours will be structured similar to a typical RV Tucker Study Club
(www.arvtsc.org). We will photograph the operations, step-by-step, for the Mentor’s critique later in
the course.

During the Institute: 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 are
encouraged to then look at the completed procedure. Much is learnt from observing what others have
done. It is also a form of support and good etiquette for you and your fellow participants to take the
time to look at someone else’s procedure.

Assistants
We will provide you an assistant for the clinical operations while at the Tucker Institute. These are
dental assisting students from a local community college that are hand selected by their director to
participate during the week. We will have experienced assistants to provide them additional support.

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These students are very keen and many graduate and seek employment with “Tucker” dentists based
on their positive experiences with the Tucker Institute.

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 master’s 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
life- not 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
master’s 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; don’t 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.

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Inlay Cavity Preparation for Posterior Teeth
Richard V. Tucker, DDS
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.1
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 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 preparation 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

Page 7
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 is used 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 justified that 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
slight 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.

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 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, California, p.14.
3. Ellsperman, George E., Bellingham, Washington, 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 Cavity 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.

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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 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.
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. 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 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 Blu-
Mousse material can be taken. A new impression is generally not necessary.

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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 fingertips. 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.

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Laboratory Notes For Cast Gold Restorations
Richard V. Tucker, D.D.S.

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 manufacturer’s
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.

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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 mar-
gins.
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) Temperature ˚F 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).

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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 #2 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.

Page 14
A Technique For Finishing Gold Castings
Richard V. Tucker, D.D.S.

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 #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 handpiece, 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.

Page 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 interproximal 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 accomplish 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.

Page 16
Conservative Cast Gold Restorations
Richard V. Tucker, DDS
Dennis M. Miya, DDS

Introduction
Historically, the use of gold for restora-
tions in dentistry has declined with the develop-
ment 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 res-
toration maintains the beauty of a natural tooth Fig 1 Conservative gold inlays
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-mar-
restorations 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 dis- coefficient of expansion with tooth
color the teeth. structure.
2. Fragile areas of teeth can be protect-
ed 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 har-
bor plaque and consequently should
contribute to better tissue health.
5. The cast gold inlay can be finished to
be a highly polished and smooth sur-
face, 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 ser-
7. The dental anatomy can be more vice for more than 60.

Page 17
 Typical Cast Gold Restorations
Figs 3a to 3f

Inlay and onlays 3a Inlays 3b

Onlay 3c 7/8 Crown 3d

Full Crown 3e Distal of Cuspid 3f

Page 18

Fig 4 Outline without composite build-up (A) and with
build-up (B).
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 ex-
pensive 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
buccal areas of the maxillary poste-
riors.
Preparation
Cavity Preparation Sequence
• Place rubber dam
• Removal of previous restoration and
caries
• Calcium hydroxide base
• Composite buildup
• Occlusal preparation
• Proximal box form
• Hand instrumentation
• Occlusal bevel
• Disking of proximal walls
• Rubber dam
Placement of a rubber dam is standard
procedure for this technique. It allows the opera-
tor 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 swal-
lowing any preparation debris. The quality and
quantity of restorations are enhanced.1-3
• Remove previous restoration and caries
The entire existing restoration is expedi-
tiously removed. Care should be taken not to
extend the outline beyond the existing restora-
tion. 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 transillu-
minate with a fiber optic light during the evalu-
ation 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.
A thin film of calcium hydroxide (Dycal) is
placed on the internal of the preparation with a
small cotton pellet. It acts as a separator for
easy removal of the composite buildup prior to
cementation. Retentive pits for retention of the
composite can be placed with a #2 round bur
after the base is set.
• Composite buildup
The use of a composite buildup conserves
tooth structure because the operator can control
the depth of the occlusal and axial walls (Fig 4
). It allows the operator to cut a precise cavity
preparation that has ideal taper, smoothness and
proportions. A nice preparation will facilitate
subsequent procedures of impression taking,
casting fabrication and seating.
Page 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 inclina-
tion 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 some-
times 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.
Page 20

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).
• Hand instrumentation sequence
Smooth, precise preparations can be created
with minimum effort with very sharp instru-
ments. Instruments should be sharpened before
each procedure. The sequence is illustrated in
(Fig 9).
A. Pulpal and gingival walls are smoothedwith
a 42 S off angle chisel.
B. Proximal axial line angle
Ideally, this line angle can be formed with one
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 9 Instrumentation Sequence:
( A) Pulpal & gingival walls
(B) Proximal line angles
(C) Axial wall
(D) Gingival bevel
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 cut-
ting a large bevel.
The bevel is created in thirds to prevent get-
ting a swale in the middle where it is easiest to
cut. Start by cutting the buccal and lingual 1/3
by planing toward the proximal wall. Then join
the buccal and lingual segments by cutting the
middle 1/3 of the bevel last.
Gingival margin trimmers that are pre-sharp-
ened by the manufacturer (Suter) at a more acute
angle than normal (30˚) are marked “Tucker.”
The #232 Tucker gingival margin trimmer is
used on the distal. The #233 Tucker gingival
margin trimmer is used on the mesial.
Fig 10 Gingival bevel too large (A), ideal bevel (B).
Page 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 re-
move 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 insuffi-
cient for the disk. The single plane of the proxi-
mal 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 se-
quence 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 proxi-
mally (Fig 14).
For most bicuspids, an internal bevel is rec-
ommended 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.
Page 22
 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 Fig 13e Instrument gingival wall. Fig 13f Instrument proximal
with enamel hatchet. line angle.

Fig 13g Instrument axial wall. 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 Fig 13l Proximal view of
fissure bur. completed preparation. completed preparation.

Page 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 gingivo-
axial line angle. The gingival floor must be cut
approximately .5 mm wider than usual to accom-
modate an internal bevel
MOD Inlay
MODs are probably the most common
preparations made. The opposing mesial buc-
cal/distal lingual proximal walls and the mesial
lingual/distal buccal proximal walls are cut ap-
proximately 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 par-
allel 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 (Em-
ery) is used (Fig 19). The impression is taken
as the patient bites into centric occlusion. The
advantage of this procedure is that the impres-
sion registers the occlusion as the teeth are in
function there by allowing a more perfect occlu-
sion of the opposing arches. In turn this usually
allows the castings to be placed without need to
relieve the occlusion. This more accurate oc-
clusion registration is probaly due to the small
amount of movement in the periodontal mem-
brane that allows
Fig 19 Coe and Emery checkbite trays.
Page 24
 Fig 20 Quadrant model with hinge articulator.
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 dur-
ing 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 in-
terproximally. They should be left in place for
about 3 –4 minutes. Prior to taking the impres-
sion, 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 oc-
clusion 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 im-
pression because folds can occur at the interface
of the light and heavy body that are unacceptable
for inlay impressions. The potential set inhibi-
Fig 21 Dura Seal acrylic and temporary stopping.
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 hemor-
rhage. 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 pre-
pared to “assist” the patient into the proper jaw
position with gentle pressure on the chin. Con-
tinue 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.
Page 25
 Fig 23 Dura Seal placed. Fig 24 Inadequate expansion: inlay loose with
marginal gaps, crown will not completely seat.

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)
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 instru-
ment. Multiple preparations can be connected
with a single layer of acrylic. Be sure to tell the
patient they will not be able to floss.

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 plas-
tic 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 Fig. 25 Inlay without proper expansion. Note
of the adjacent teeth (Fig 22). Excess stopping marginal gaps and cement margins.
can be contoured and removed with a heated
instrument.

Page 26
 Water/Powder (cc)
Crown 15.5
3/4, 7/8 Cr 18
MODBL 18
MOD 18.5
DO, MO, Occ 15
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. Pa-
tients 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 cast-
ings and to communicate with your lab if refine-
ments 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
Temperature˚F Ring Liner
1175 2
1150 2
1150 2
1150 2
1175 2
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 manipu-
lating the investment are to decrease the water in
the water/powder ratio; increase oven tempera-
ture; increase the number of ring liners; hydro-
scopic expansion in water bath (100˚F).
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 tempera-
ture. This allows the casting temperature to be
below that which causes breakdown of
the investment.
Dr. Richard V. Tucker’s recommenda-
tions 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.
Page 27
 Fig 27 Moore 1/2 inch disks.
Just prior to cementation, all of the compos-
ite buildup should be removed. A high speed #2
round bur can be used to section it. The prepa-
ration 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 pow-
der 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 ce-
ment 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 medi-
um garnet disks prior to hardening of the cement.
The disks should always be rotated from gold to-
ward the tooth. The garnet disk is the workhorse
of the finishing process and usually several disks
are used. All margins can usually be finished
Fig 28 Polishing powders.
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 strip 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
Page 28
 Fig 29 Slight reflection at functional margins of gold Fig 30 Esthetically pleasing restoration of maxillary
inlay. Opening and gap formation at functional margins posterior teeth with conservative outlines allowing
of both porcelain inlays.. preservation of the buccal enamel.

can be accomplished by finishing the casting a Occlusion and marginal integrity

section at a time with all three lives of the same Based on results, the marginal integrity
cuttle disk. The life of a disk can be accelerated of the enamel/gold cavosurface margin holds
to a more worn stage by rotating it on the mirror up well under occlusal stress. The gold and
handle. tooth wear at a similar rate and the coefficient
Difficult access areas might be finished with of expansion is similar. Therefore, preparation
the smaller 3/8 inch disks. Small finishing dia- cavosurface margins can be placed without too
monds followed by brownie, greenie and super much concern for the opposing occlusion. The
greenie points work well for grooves and fissures gold margin exhibits only a slight reflection even
that are not accessible with disks. after many years of function where as functional
The casting is then ready to polish with margins of amalgam, composite and porcelain
powders. Care must be taken because the pow- will eventually open (Fig 29).
ders cut the tooth and gold at different rates and
can open up a margin or cause a reflection. This Esthetics
is especially true with flour pumice. Each of the If conservative gold restorations are
powders should be used with a clean, ribbed rub- properly designed and finished, gold display can
ber cup on a contra-angle. A slurry of pumice is be minimal or nonexistent. A tooth can be func-
used to give the gold a uniform finish after the tionally restored for a lifetime while the esthetics
disks. 15 micron aluminum oxide with alcohol of the original tooth can be maintained
is used next. The final powder, 1 micron alumi-
num oxide, is used dry while the assistant blows
continuous air and suctions.
After the rubber dam is removed, the oc-
clusion 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 Fig 31 Slight gold display at occlusal of 7/8 crown #4.
that a well finished gold surface accumulates less
plaque.

Page 29
 Fig 32 Color discrepancy of a porcelain crown as natu- Fig 33 Magnification.
ral teeth darken with age.

(Figs 30, 31). If a tooth cannot be restored es- esthetic treatment.

thetically 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 eventual-
ly 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
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).

Inlay vs onlay
VARIATIONS OF CAVITY DESIGN
The restoration of choice for a posterior tooth is remaining tooth structure might support an inlay,
an inlay because it preserves more functional generally it is advisable to onlay the tooth since
tooth structure and can be predictably fitted and predictable longevity is our goal. If there is suf-
finished. It is often very esthetic because most of ficient tooth structure, only the weakened portion
the enamel can be preserved. It is the experience of the tooth can be onlayed. However, in most
of the authors that cusp fracture of an inlay is cases both buccal and lingual cusps are onlayed
rare. An onlay restores the strength of a tooth but to distribute the occlusal forces over a broader
destroys more tooth structure and the gold display surface. An onlayed tooth can be stronger than
can be unesthetic. the original non-restored tooth. Cusp reduc-
tion for a functional cusp is about 1.5-2 mm.
Onlay Non-functional cusps can be reduced less. The
An onlay is indicated when there is not enough appropriate bevels are placed with a 7404 bur.
sound tooth structure remaining to support an The resulting hollow grind bevel gives bulk of
inlay. The basic technique is to always cut the gold at the bevel and provides a very nice margin
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.

Page 30
 Lower onlay
Both cusps have been reduced and counter bev-
eled. 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.
Invisible Onlay
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.
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.
Page 31
 Onlays
Fig 34a to 34l
Lower Onlay

Fig 34a Cut MOD first. Fig 34b Occlusal reduction with Fig 34c Occlusal reduction
#57 fissure bur. completed.

Upper Onlay

Fig. 34d Counter bevel on Fig 34e Onlay preparation Fig 34f Occlusal reduction
both buccal and lingual with completed. #56 fissure bur.
7404 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.

Page 32
Molar 7/8 Crown 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.

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
Preparation synopsis
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
Preparation sequence
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.

Page 33
 7. The fine cuttle disk is placed on the
occlusal edge of the buccal cusp to dull
•Hollow Grind Crown
and smooth the margin.

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 conserva-
tive reduction of the buccal wall to mini-
mize 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 re-
tention 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.
Preparation synopsis
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

Page 34
 3. 860-014 diamond
4. Brasseler 7404 bur
5. Fine cuttle disk
Preparation sequence
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
Preparation synopsis
Additional retention and resistance
form is created by making a buccal
wall more parallel to the other walls
by plac ing a buccal shoulder.
Preparation sequence
1. The preparation is cut in the typical
man- ner 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 defini- tion and bulk of gold at
the margins.19
•Hollow Grind Marginal Ridge
Indicati
on
Thin, weakened distal marginal
Page 35
 •OL Upper Molar

ridge, usually on second 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.

Preparation synopsis

Page 36
 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
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
Preparation synopsis
1. Hand instrumentation results in sharp
internal line angles.
2. Two plane labial and lingual walls en-
hance retention.
3. An internal bevel adds retention and aids
in seating of the casting during cementa-
tion.
4. A small definitive gingival bevel is
placed.
Preparation sequence
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 re-
tention. 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 occlu- sal
bevel which removes unsupported
enamel, smoothes the outline, and creates
a “funnel” which aids in seating.
36
Page 37
Distal Hollow Grind
Indication
Restoration of a large carious lesion or large
existing restoration with a lingual dove tail.20
Armamentarium
1. 56 fissure bur
2. Brasseler 7404 bur
Preparation synopsis
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.
Preparation sequence
1. Place the lingual dovetail with a 56 fis-
sure 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.
Distal Hollow Grind with a Pin
Indication
Large cavity needing additional
retention and resistance form.20
Armamentarium
1. #6 round bur
2. 169 L fissure bur
Preparation synopsis
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 pos-
sible.
Preparation sequence
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 tech-
nique 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.
Page 38
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.

Preparation synopsis
A small circular preparation with axial retention cut with a 35 inverted
one and a small occlusal bevel placed with a 7404 bur.

Preparation sequence
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.

Page 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.

Page 40
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. Johnston’s 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, Quin-
tessence Publ Co, 1974, p 16.
9. Tylman SD, Malone WFP. Tylman’s 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 maxi-
mum 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 con-
tact 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 silox-
ane) 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 As-
soc 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.

Page 41
All About Pins in Gold Castings
Richard D. Tucker, DDS
Richard V. 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 insuf-
ficient 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 prepara-
tion 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 ac-
commodate 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 subse-
quently 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 in-
spected 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.

Page 42
 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 resis-
tance 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 impres-
sion material to completely fill the pin hole. The needle is then slowly withdrawn as more impres-
sion 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 varia-
tion 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 compos-
ite to provide a buildup yielding optimum dimension to the internal of the casting.

*The Wilkinson Company Inc, 590 Clearwater Suite C, Post Falls Idaho 83854
Concept by Dr. Maurice Chechik, Vancouver, British Columbia, Canada

Page 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 impres-
sion 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 ma-
terial, and never in tooth structure.
This completes some options for increasing resistance and retention form through the in-
corporation 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

Page 44
Clinical Instruments and Supplies
Richard V. Tucker, DDS

Hand Instruments (one setup)

Front Surface Mirror
Cotton Pliers
#5 Explorer
42S Off Angle Chisel
43S Off Angle Chisel
232 Tucker Gingival Margin Trimmer
233 Tucker Gingival Margin Trimmer
Cord Packing Instrument
Crown and Bridge Scissors

*Only for Internal Bevel
232 Gingival Margin Trimmer
233 Gingival Margin Trimmer


*Only for Small Bicuspids or Cuspids
44S Off Angle Chisel
45S Off Angle Chisel

Rubber Dam
Dam Holder (Young’s Frame or Wizard) Dam (Extra Heavy 6x6 Dark)
Lubricant (Shaving Cream) Dam Punch, Clamp Holder Clamps: Ivory W8A, 8AD;
See Rubber Dam Application


Handpieces
High Speed
Low Speed - Straight & Contra-Angle Attachments


Burs (Brassler,Komet & Midwest)
56, 57 Straight Fissure
7404 Finishing Bur (Komet)
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

Page 45
Impression
Gingivi-Pak #3 -Not Braided (Surgident) Hemodent – 25% Aluminum Chloride (Premier)
Light Body Polyvinyl Siloxane
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 (Crown Forms)
Temporary Cement- Temp-Bond

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 #2100 (Young)
Flour Pumice #4 (Dixon)
Aluminum Oxide -15 & 1 Micron (Micro Abrasives)
Flecks Cement – Yellow(Mizzy)
Cement Slab & Spatula
Gluma or MicroPrime
1/4” Diameter Seating Sticks (Orange Wood or Chop Sticks)
Seating Mallet

Basic Items
Bibs & Clip
Suction Tips
Air/Water Tips
Topical Anesthetic
Anesthetic Syringe
Needles
Anesthetic Carpules
Cotton Swabs
Waxed Dental Floss
2x2s
Cotton Rolls Cotton
Cotton Pellets
Autoclave Bags
Patient Hand Mirror

Page 46
Laboratory Instruments and Supplies- Provided at Institute
By Richard V. Tucker, DDS

Models Casting Rings & Sprue Formers

4 Simple Hinge Articulators Wax Ready Made Round Shapes (Kerr #14)
Straight Pins Asbestos Liner
Debubblizer (Delar surfactant) Investment (Novocast)
Small Brush Measuring vial for water
Dowel Pins Distilled Water
Mixing Bowl Porcelain Crucible
Spatula Gold (JRVT Casting Alloy)
Fugi Rock Die Stone (Golden Brown)
Separating Medium (Ney Die Lube) Finishing
Coping Saw and Fine Blades Prevox
Parker Knife (#25 Blades) Tripoli
Die Relief (Tru-fit, Geo. Taub.) Jewelers Rouge
Microfilm (Kerr) Bristle Brushes (Buffalo #11, Stiff & Soft)

Ultra Thin Joe Dandy Discs

Waxing Heatless Stones
Inlay Wax (Yeti Grey) Disc Mandrels (Moore)
Wax Spatula (Clevedent #7) Medium Garnet Disc (Moore)
Roach Carver (SS White) Hollenback Carver Sand Fine Discs (Moore)
Waxing Instrument (P.K.Thomas 3) Cuttle Fine Discs (Moore)
Undercut Wax Felt Wheel & Chamois Wheel & Mandrel
Tooth Brush
Bunsen Burner or Alcohol Lamp
Investing & Casting
Lighter
Plastic Sprues (Williams #10)
169 taper Fissure Bur
Short Nosed Pliers
#.5 Round Bur (Straight Handpiece)
Kleenex
Sticky Wax

Page 47
 Suppliers

Komet
Burs E.C. Moore Co
888-566-3887 Discs and Mandrels
www.kometusa.com 800-331-3548
http://www.ecmoore.com

Columbia Dentoform
Ivorine teeth
718-482-1569
http://www.columbiadentoform.com

Delar Corporation Micro Abrasives

Surfactant Polishing powders (aluminum oxide)
800-669-7499 800-426-6046
http://www.delar.com http://www.microgrit.com

Emery Dental Northwest Dental Supply

Slim Check Bite Trays 700-701 Plastic pins
800-637-6611 800-842-2787

GC America Pfingst
Fugirock Die Stone Twits Drills (.6 & .9 mm)
800-323-7063 908-561-6400
http://www.gcamerica.com http://www.pfingstco.com

Jensen Industries Whipmix

Casting gold, Gold foil, DVD Novocast Investment
800-688-0662 800-625-5651
http://www.jensendental.com http://whipmix.com

Page 48
 Educational Materials
Richard V. Tucker DVD
This DVD contains all three of Dr. Tucker’s 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. This is a must see for dentists.

Cost is $150.
Order from:

Jensen Industries http://www.jensendental.com

1-800-243-2000

Plastic models of Tucker Preparations

Copies of preparations cut by Richard V. Tucker for the video, Variations in Cavity
Design. Cost is $80 per set of 14 models.

Order from:
Mark Ziemkowski markziem@yahoo.com
530-570-9774

Ivorine 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
800-688-0662
http://www.columbiadentoform.com

Page 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 other distal extension clamps when restoring the second molar.
8a for small molars. 14a for partially erupted teeth.
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.

Page 50
 Basic setup

1”
Dam punch table

Punched dam for upper and lower

14, 56, 8a clamps

Initial placement
Dam, frame and clamp as one unit

Inverting dam around each tooth Completed rubber dam placemnt

Page 51


RUBBER DAM APPLICATION
Dr. Victor D Guerrero

SET UP

LATEX DAM/ SILICONE DAM

Size: 6x6 inches
Types and indications:
a) Medium (0.2mm thickness)
- Restorative procedures.
- Tight interproximal contacts.
- Misplaced teeth.
b) Heavy (0.25mm thickness)
- Diastema.
- Dental preparations.
- Severely destroyed teeth.
- When extra tissue retraction is needed.


RUBBER DAM PUNCH
AINSWORTH
1. Lower anteriors.
2. Upper anteriors.
3. Premolars and canines.
4. Molars.
5. Molars w/clamp.

Keep the rubber dam punch holes clean
before use and sterilize.

Page 52


BREWER Clamp Forceps


CLAMP SELECTION
Retention wingless clamps are suggested

W3 Small molars upper/lower. Standard workhorse for molars

W2 Premolars upper/lower
Canines upper/lower

Page 53


W7 Bigger Molars upper/lower

#27 Molars upper/lower
Distal extended bow gives good acces to distal surfaces

Page 54


PUNCHING DAM

To punch the dam the Customized Technique is suggested.

Distance between hole variations depends on:
- Dam thickness.
- Interproximal contacts.
- Diastemas.
- Edentulous spaces.

Step 1: Divide the dam into halves (vertically) to have middle line clear.
Step 2: Divide the dam into thirds (vertically).
Step 3: Divide the dam into halves (horizontally).
Step 4: Mark the holes on the dam with a distance among 5 – 7 – 10mm (average).
Step 5: Start at the central (upper/lower) at a distance of 4cm from the edge.


Customize Technique escheme.

Page 55




RUBBER DAM PLACEMENT

And easy method is to take the clamp, dam and fram in separate steps called “3 step
technique”

Select the tooth where the Prefit the clamp on the tooth. Dam put on place after the
clamp will be put on place. clamp.
1st. Step:
Pick the clamp and prefit on the tooth (wingless clamps are suggested).
2nd. Step:
Put the lubricated rubber dam on place starting by the front tooth first and then work bak
to the molars..
3rd. Step
Adjust the dam to the fame as necessary.


Flossing the dam to helps retract the tissues

Invert the dam is necessary to retract the tissue, seal and minimize saliva and blood
contamination of the operative field.

Page 56


SECUENCE

1. Technique selection (goal).
2. Patient preparartion (anesthesia).
3. Use waxed dental floss to test and lubricate inter-proximal áreas.
4. Clamp selection.
5. Rubber dam selection and perforation.
6. Isolation.
7. Stabilization (clamp and dam).

Page 57


Page 58
PROFILE
Dr. Terry Donovan
Current Occupation
Full-time academics
Education
University of Alberta, DDS
University of Southern California (USC),
certification in prosthodontics
Academic Affiliation
Professor and director, Advanced
Education in Prosthodontics, USC
Professional Memberships
American Academy of Restorative
Dentistry
American Academy of Esthetic Dentistry
American College of Prosthodontists
CAIC Study Club
Positions Held
Past president, College of Dental
Surgeons of Saskatchewan
Chairman, American Dental Association
Council of Dental Materials Instruments and
Equipment
Section editor, Prosthodontics, Journal of
Esthetic and Restorative Dentistry
Honors/Awards
Walter Hancock Fellowship Award,
Western Canada Dental Society
Honorary life member, College of Dental
Surgeons of Saskatchewan
Honorary life member, Western Canada
Dental Society
Alumni of the Year, University of Alberta
School of Dentistry
Publications
Over 120 articles related to esthetic
restorative dentistry and prosthodontics in
peer-reviewed journals
On the editorial board of several journals and
is a reviewer on many different journals
including Journal of the American Dental
Association, Journal of Esthetic and
Restorative Dentistry, Journal of the
Canadian Dental Association, and
Compendium
Contributions to Dentistry
Pioneered work on all-porcelain margins for
metal-ceramic crowns
Has given several hundred presentations
related to esthetic restorative dentistry
throughout the world
Personal Interests
Fly fishing, hiking, mountain climbing,
hunting
Masters of Esthetic Dentistry
RETROSPECTIVE CLINICAL EVALUATION OF 1,314 CAST
GOLD RESTORATIONS IN SERVICE FROM 1 TO 52 YEARS
Terry Donovan, DDS*
R.J. Simonsen, DDS, MSy
G. Guertin, DDS, MSEdz
R.V. Tucker, DDS§
he contemporary clinician and placed by a single dentist in the
patient are faced with a private practice setting. Most of
bewildering number of options of the restorations evaluated had
dental materials for the restoration been in service for many years, and
of posterior teeth. Treatment 72% had been in service for
choices should be based on valid 20 years or more.
scientific evidence related to the
likely prognosis and life span of the LITERATURE REVIEW
therapy, anticipated benefits and Until recently, occlusal stress-
risks, costs, esthetic considerations, bearing restorations in posterior
and personal preferences of both the teeth were primarily fabricated from
patient and the dentist. Unfortu- either silver amalgam or cast gold.
nately, the evidence base for poste- Amalgam has proven to be an
rior dental restorations is less than extremely cost-effective material
optimal. It is generally believed by owing to its inherent direct place-
clinicians that properly fabricated ment and its self-sealing capac-
cast gold restorations provide ex- ity.1 One excellent study of this
cellent longevity and that esthetic material determined that the sur-
(tooth-colored) alternatives have a vival rate of large multisurface
predicted span of service that may amalgam restorations was > 90% at
be considerably shorter. However, 10 years.2
the evidence supporting these
assumptions is not as convincing as Many clinicians have noted anec-
is commonly believed. This study dotally that cast gold restorations
was undertaken to evaluate the have an exceptional record of lon-
long-term success rate of a large gevity; however, the scientific
number of cast gold restorations literature is, at best, equivocal in this
*Professor and director, Advanced Education in Prostho-
dontics, University of Southern California, Los Angeles,
CA, USA
y
Professor and associate dean, Preclinical Affairs and
Research, Arizona School of Dentistry and Oral Health,
Mesa, AZ, USA
z
Assistant professor, University of Montreal School of
Dentistry, Montreal, Quebec, Canada
§
Private practice, Ferndale, WA, USA
Page 59

respect. Some studies have revealed
relatively disappointing results with
cast gold,3,4 whereas others have
demonstrated excellent survival
rates.5–8 This variability in survival
rates is likely the result of differ-
ences in study design, operator
variability, and patient-related fac-
tors, such as differences in diet, oral
hygiene practices, caries suscepti-
bility, and parafunctional habits.
One short-term study of Class II cast
gold inlays reported a failure rate of
17% at 3 years,3 whereas another
reported a 50% failure at 7 years.4
A study evaluating outcomes of
restorative therapy done in a dental
school clinic reported 10-year
survival rates of 91% for cast gold
restorations, 72% for silver amal-
gams, and 56% for composite resin
restorations.5 One study that
focused on reasons for replacement
of cast gold restorations found the
mean age for failure was 18.5 years
(range 5 – 41 yr) and that the mean
age of successful, functioning cast
gold restorations was between
15 and 16 years. 6 The authors
concluded that the longevity of cast
gold restorations exceeds that of
available alternatives by a factor of
two or four, and thus concluded
that cast gold is clearly a cost-
effective material.
Another retrospective study of cast
gold inlays and partial veneer
crowns done in a dental school
clinic found that the mean survival
rate of 3,518 cast gold restorations
was 85.7% at 10 years.7 Survival
rates of specific types of restora-
tions varied from a low of 76.1%
for occlusal inlays to rates of
88.3% for mesio-occlusal inlays,
87.5% for mesio-occlusodistal
inlays, and 86.1% for partial
veneer crowns. This study made
no attempt to evaluate the quality
of the restorations.
A recent study developed criteria for
evaluation of cast gold restorations,
and evaluated 303 cast gold resto-
rations placed either in a dental
school clinic or two private prac-
tices.8 The mean age of the restora-
tions was 18.7 years, and 86% of
the restorations had been in the
mouth 15 years or more. The overall
failure rate at that time (18.7 yr)
was 13.8%. Kaplan-Meier survival
estimates were calculated and indi-
cated a survival rate at 10 years of
96.1%, at 15 years of 92.2%, at
20 years of 87.0%, and at 30 years
of 73.5%. Results from this study
indicate that the longevity of cast
gold restorations can be excellent.
M ETHODS A ND MATERIALS
A random review of charts in the
private dental office identified 120
patients who had multiple cast gold
restorations placed at least 10 years
previous to the examination date.
All of the patients had been treated
by one dentist (R.V.T.) between
1946 and 2001. Invitations were
sent asking patients to participate in
a noninvasive examination. Patients
were told that their restorations
would be evaluated and that clinical
D O N O VAN E T A L
photographs of the restorations
would be taken.
Letters were sent to the addresses of
record of all 120 identified patients.
Four of these letters were returned
either because the patients were
deceased or because of incorrect
addresses. One respondent was wil-
ling to be examined but was
unavailable at the examination
times. The remaining 115 patients
responded and made appointments
for the examination. One appointed
patient did not present for evalua-
tion owing to severe weather con-
ditions. Thus, the total number of
patients evaluated was 114.
Of the 114 patients who reported
for examinations, 39 (34.2%) were
male and 75 (65.8%) were female.
The mean age of the patients was
67.8 years, ranging from 31 to
91 years. Evaluations were done
using modified United States Public
Health Service (USPHS) criteria
(Table 1) by one evaluator and then
reevaluated by two investigators
using magnified high-quality digital
photographs that were taken of all
evaluated restorations at the exami-
nation appointments. When the
evaluation of the digital photo-
graphs differed from the clinical
evaluation, the lowest evaluation
was chosen.
Chart reviews were done prior to
patient examination, and placement
dates and restoration types were
noted. For those restorations
that had been replaced, date of
Page 60
 R E T R O S P E C T I V E C L I N I C A L E VA L U AT I O N O F 1 , 3 1 4 C A S T G O L D R E S T O R A T I O N S









A TYP ES

I. Marginal adaptation Number %
A. Margin not discernible; explorer does not catch; no visible discoloration Type (N
B. Explorer catches margin, but no visible opening
Inlays 644 49
C. Gap or chipping with dentin or liner exposed; distinct discoloration visible; Onlays 197 15
secondary caries Partial veneer 118 9
D. Partial fracture; fracture; loose restoration; fracture of abutment tooth
crowns
II. Anatomic form Full veneer 355 27
A. Correct contour with tight proximal contacts (floss); no wear facets on crown
restoration of opposing teeth
B. Slightly under- or overcontoured; weak proximal contact; small wear facets

on restoration or opposing teeth (< 2 mm) from 1 to 52 years (Table 2). Almost
C. Distinctly under- or overcontoured; missing proximal contact; large wear 90% of the restorations had been
facets on restoration or opposing teeth (> 2 mm) in place for at least 10 years, 72%
III. Surface texture had been in the mouth 20 years or
A. Smooth, glazed, or glossy surface more at the time of evaluation,
B. Slightly rough or dull surface and 45% had been in service from
C. Surface with deep pores, rough, or unevenly distributed pits; cannot 25 to 52 years.
be refinished
IV. Miscellaneous Forty-nine percent of the evaluated
restorations were inlays, 15% were
C. Primary caries; requires endodontic therapy; requires periodontal therapy;
onlays, 9% were partial veneer
extraction or additional restorative therapy
(three-quarter or seven-eighth)
United States Public Health Service criteria adapted from Studer SP et al.8
* Restorations with an A or B rating are considered successful. Those rated C or D are crowns, and 27% were complete
considered failures. veneer crowns. Inlay/onlay resto-
rations were recorded as onlays
(Table 3).

replacement and length of service A total of 1,314 restorations were
of the restoration were noted. A evaluated, 636 in maxillary teeth, To minimize the invasiveness of the
restoration was deemed a failure 678 in mandibular teeth. Seven examination, radiographs were not
if it had been replaced or if one hundred six of the restorations were taken, but the bite-wing radiographs
or more of the USPHS criteria placed in molars, 530 in premolars, had been taken for the majority of
were evaluated at a C or D level and 78 in canine teeth. The time of the patients within 2 years prior to
(see Table 1). service for the restorations ranged the examination. Given the age of
most of the restorations and the low
caries rates demonstrated by the
majority of the patients, this was
Time of
deemed adequate.

RESULTS
Number (N =
% of The number of restorations evalu-
ated, their years in service, and

Page 61

Time of Inlays Onlays
Service (yr) (n = 644) (n = 197)
1–9 (n =
10–19 (n =
20–24 (n =
25–29 (n =
30–39 (n =
40+ (n =
restoration type are displayed in
Table 4. The total number of
restorations that required replace-
ment in the patients who were
evaluated was 60 of 1,314. This
translates into 95.4% success or
4.6% failure rates, depending on
the viewer’s perspective. The num-
ber and percentage of failures as a
function of time are presented in
Table 5. It is important to note that
exponentially greater numbers of
failures do not occur over time.
Although a small number of failures
occurred in each time group, the
failure rates in the older restoration
groups are actually lower than
those in the 10- to 19-year group.
The earliest restoration loss occurred
at 7 years, and the mean time of
service for the restorations that
needed to be replaced in the six
Years
(N =
Failures (n =
Success rate
Partial Veneers Full Veneers
(n =118) (n = 355)
groups was 8, 15.9, 21.5, 26.1, 33.8,
and 41 years, respectively.
The number of failures as a function
of restoration type is presented in
Table 6. Note that the failure rates
are generally quite low. Although
there are differences in the failure
rates among the different types,
variability in case selection, amount
of tooth structure remaining, and
patient variables such as para-
functional habits and oral hygiene
preclude the drawing of any con-
clusions as to the superiority of any
type of restoration over any other.
Inlays had a failure rate of 4.7%,
onlays 3.0%, partial veneer crowns
8.5%, and full veneer crowns 3.9 %.
The failures related to the types of
restoration and time of service are
presented in Table 7. Note that only
Time of
D O N O VAN E T A L
RATES
Type of Total
Placed Failures
Inlays 644 30 4.7
Onlays 197 6 3.0
Partial veneers 118 10 8.5
Full veneers 355 14 3.9
4 failures of 132 restorations
occurred in years 1 to 9, with the
earliest failure recorded at 7 years.
All restorations were evaluated for
marginal integrity, anatomic form,
and surface texture. The data of
the analysis are presented in
Table 8. Overall, the restorations
were excellent in every respect, and
96% of the evaluations were rated
alfa. Only three restorations were
identified as needing replacement,
one because of an open margin
with recurrent caries after 26 years
of service, and two because of
cuspal fracture after 27 and
30 years of service.
D ISCUSSION
Perhaps the most interesting finding
in this study is the astonishing level
of voluntary participation by the
patients. Almost 100% of the
patients contacted were willing to
travel to the office for evaluation,
and 114 of 116 (98.3 %) patients
contacted were actually examined.
This speaks volumes in the area of
practice and s
lends validity to the age-old
cept that the optimum method
developing a loyal practice base
Page 62
R E T R O S P E C T I V E C L I N I C A L E VA L U AT I O N O F 1 , 3 1 4 C A S T G O L D R E S T O R A T I O N S

Time of Service (yr)

Restoration Type 1–9 (n = 132) 10–19 (n = 236) 20–24 (n = 356) 25–29 (n = 346) 30–39 (n = 227) 40+ (n = 17)

Inlays 2/57 11/113 9/164 3/191 4/102 1/17

Onlays 0/13 2/33 4/49 0/54 0/48 0/0
Partial veneers 1/10 4/16 1/39 3/29 1/24 0/0
Full veneers 1/54 6/76 4/104 1/69 2/52 0/0

over time is to provide quality oral
care for patients.
The strength of the study lies in
the numbers and longevity of the
evaluated cast gold restorations.
One thousand three hundred
fourteen restorations were eval-
uated, and the survival rate was
95.4%. Considering that 72% of
the restorations had been in the
mouth at least 20 years, this is an
impressive number.
It is worth noting that the evalua-
tion of the restorations was done by
independent evaluators who did not
fabricate or place the restorations.
The clinical evaluations of the
restorations were universally high.
It is clear that this was an evalua-
tion of extremely high-quality cast
gold restorations. Although it
would be inappropriate to suggest
that all cast gold restorations can
anticipate this specific success rate,
it is safe to conclude that properly
fabricated cast gold restorations can
indeed provide exceptional long-
term performance.
The study also has several obvious
deficiencies. All of the restorations
were placed by one dentist, and it
can be argued that the results
achieved cannot be extrapolated to
a broad spectrum of general den-
tists. However, it can also be argued
that the preparations and tech-
niques used to fabricate the cast
gold restorations evaluated in the
study have been published for many
years and are well established in the
dental community.9 For several
decades these procedures have been
taught successfully to many general
dentists worldwide through over
50 established R.V. Tucker cast
gold study clubs.
The study is retrospective in nature,
which inherently weakens its power.
Most of the failures reported were
the result of replaced restorations,
and the causes of failure and need
for replacement were not known to
the investigators. Thus, no data on
reasons for failure are reported.
There are also no control popula-
tions with the study.
Although all evaluations were done
by one investigator, the validity of
the evaluations was increased by a
secondary evaluation using magni-
fied high-quality digital photo-
graphs.10 Although patient
selection was not completely ran-
domized, the first 120 patients
identified as having multiple cast
gold restorations over 10 years of
age were accepted, and no patients
were omitted owing to specific
exclusion criteria.
The nature of the study makes it
impossible to determine what fac-
tors may have contributed to the
very high documented success rates.
The patients certainly seemed to
experience a ‘‘normal’’ caries rate
relative to the times of placement of
the restorations and averaged 11.5
cast gold restorations per patient.
This does not include other types of
restoration and indicates that a
highly caries-resistant population
was not recruited for this study. All
castings were cemented with zinc
phosphate cement, which is cur-
rently not in favor with many
E8 NI CAL VALUATION F
Alfa Bravo Charlie
Marginal 1,251 62 1 0
integrity
Anatomic 1,274 38 1 1
form
Surface 1,234 80 0 0
texture

Page 63

contemporary clinicians. It has
been speculated that even higher
success rates may have been
achieved with improved contem-
porary luting agents.11
Given the current preoccupation
with esthetics and tooth-colored
restorations, these demonstrated
long-term survival rates must be
viewed in context with the short-
term expectations of esthetic tooth-
colored alternatives. It should be
noted that 49% of the restorations
placed in this study were inlays,
Figure 1. These cast gold restorations had been in service from 25 to 32 years.
which can often provide an ex-
tremely acceptable esthetic result in
posterior teeth. The failure rate
with inlays was 4.6% over the
long time frame (almost 90% of
the restorations had been in service
at least 10 years) of this investi-
gation. Many cast gold restora-
tions on molars are not visible at
conversational distance and thus
can be considered for use with
many patients.
Conversely, neither clinical experi-
ence nor the dental literature indi-
D O N O VAN E T A L
cates that indirect tooth-colored
alternatives for posterior teeth pro-
vide a predictable long-term restora-
tive option for patients. There is a
paucity of literature related to the
long-term survival of laboratory
fabricated composite resin inlays.
One study evaluated results of
Concept R laboratory-processed
composite resin inlays versus cast
gold inlays at 7 years.12 The study
concluded that at 7 years, the Con-
cept system yielded clinically ac-
ceptable restorations. A careful
perusal of the article reveals that
Page 64
 R E T R O S P E C T I V E C L I N I C A L E VA L U AT I O N O F 1 , 3 1 4 C A S T G O L D R E S T O R A T I O N S
33% of the Concept restorations
were missing after 7 years, and that
the failure rate in molars was close
to 50% at that time. That success
rate pales in comparison with the
results of this current study (97% at
9 years).
Ceramic inlays and onlays have
received considerably more atten-
tion in the literature, and the
results, although mixed, are more
encouraging. Five-year survival
rates of ceramic bonded restora-
tions range from a low of 76% in
one study to acceptable rates of
95 to 96% in others.13–20 How-
ever, careful reading of these
investigations creates cause for
concern. There does appear to be
a high incidence of marginal
ditching with bonded ceramic
restorations. This can be progres-
sive and is clearly related to the
prebonding marginal gap. The
poorer the prebond gap, the
greater the marginal ditching.21
More importantly, this marginal
ditching is often associated with
microcracks in the ceramic resto-
ration that are highly likely to
propagate over time and result in
premature failure of the restora-
tions. The wisdom of restoring the
entire posterior dentition of
patients with unproven bonded
ceramic restorations in the name
of esthetics or occlusal rehabilita-
tion to some imagined optimal
maxillomandibular position must
be questioned.
The choice of restoration for pos-
terior teeth has become complex
with the wide variety of restorative
options that exist today. The
clinician and patient must consider
a number of variables before

Figure 2. These cast gold restorations had been in service from 10 to 15 years.

Page 65

making a decision. Although
esthetics is unquestionably a major
consideration for most patients,
two important variables are clearly
predictability and longevity.22–25
Cast gold restorations have been
available since 1907 when Taggert
introduced the lost-wax process to
dentistry.26 The cavity preparations
and techniques essential for success
have been studied and evaluated
for years and are well known and
can easily be learned.27 Con-
versely, the indirect tooth-colored
options are recent innovations, and
the cavity preparations and tech-
Figure 3. These cast gold restorations had been in service from 22 to 25 years.
nical procedures for success are
not known at this time and have
yet to be delineated through sci-
entific investigations.
The literature indicates that these
tooth-colored restorations provide
a significantly shorter life span
than does cast gold. The evidence
presented in this article indicates
that properly fabricated cast gold
restorations can provide extremely
long-term restorative service. It has
been speculated that perhaps the
esthetic dentistry pendulum has
swung too far.28
D O N O VAN E T A L
Before making treatment recom-
mendations for patients, clinicians
must perform an esthetic analysis to
determine the patients’ esthetic
expectations and also to evaluate
the dental display to determine
what is visible at conversational
distance with both a normal and
exaggerated smile.29–32 For many
patients, cast gold inlays can be
used to restore decayed or pre-
viously restored teeth with predict-
able longevity and no real negative
impact on esthetics. Similarly, many
molar teeth are not visible, even
with exaggerated smiles, and can
Page 66
 R E T R O S P E C T I V E C L I N I C A L E VA L U AT I O N O F 1 , 3 1 4 C A S T G O L D R E S T O R A T I O N S
optimally be restored with no es-
thetic impact with cast gold inlays,
onlays, partial veneer crowns, or
full veneer crowns. Placing bonded
ceramic inlays and onlays in man-
dibular and maxillary second
molars is an unnecessary exercise in
risk management.
The contemporary clinician should
offer patients a substantial menu
of posterior restorative services.
This menu should include silver
amalgam, cast gold, direct com-
posite resin, indirect tooth-colored
materials, and complete veneer
crowns. Limiting the patients’
Figure 4. These cast gold restorations had been in service from 29 to 35 years.
choice to metal-free materials is
not rational and deprives the pa-
tient of many valuable restorative
options.33 Clinicians must under-
stand that the term esthetics is not
synonymous with tooth colored.
Most patients request esthetic
dentistry, and, of course, do not
want restorations that display
metal. However, they do not
request metal-free dentistry and
will gladly accept metal restora-
tions that do not display metal in
return for longevity.
Patients deserve the best dentistry
has to offer, and clearly must pro-
vide the clinician with adequate
informed consent. Once they
understand the advantages and
disadvantages of the various
restorative options, they can choose
a restoration that best matches
their preferences. It is postulated
that both tooth-colored indirect
restoratives and cast gold are vi-
able options that can serve patients
well, depending upon their needs
and desires.
SUMMARY AND CONCLUSIONS
A retrospective clinical evaluation
of 1,314 cast gold restorations in
114 patients placed by one
Page 67

practitioner was conducted. A very
high percentage of patients con-
tacted (114/116 [98.3%]) partici-
pated in the evaluation. Almost
90% of the restorations had been
in service for over 9 years, 72%
for over 20 years, and 45% from
25 to 52 years. All restorations
had been cemented using zinc
phosphate cement. The restora-
tions were evaluated by indepen-
dent evaluators in terms of
marginal integrity, anatomic form,
and surface texture, and 96% of
the evaluations were excellent
(Figures 1–5).
Figure 5. These cast gold restorations had been in service from 18 to 27 years.
Sixty restorations required removal
and replacement, yielding an overall
failure rate of 4.6% or a survival
rate of 95.4%. The survival rates at
various time periods were 97% at
9 years, 90.3% at 20 years, 94.9%
at 25 years, 98% at 29 years, 96.9%
at 39 years, and 94.1% for restora-
tions in place > 40 years.
It appears that properly fabricated
cast gold inlays, onlays, partial
veneer crowns, and full veneer
crowns can provide extremely
predictable, long-term restorative
service. It is suggested that the
D O N O VAN E T A L
use of such restorations should
not be automatically precluded
simply because they are gold
colored. These restorations should
be considered in patients who are
more concerned with longevity
than esthetics, and in those
patients in whom placement of a
conservative cast gold restoration
would not result in an unesthetic
display of metal.
DISCLOSURE
The authors have no financial
interest in any of the companies
Page 68
R E T R O S P E C T I V E C L I N I C A L E VA L U AT I O N O F 1 , 3 1 4 C A S T G O L D R E S T O R A T I O N S
whose products are mentioned in
this article.
REFERENCES
1. Greener E. Amalgam: yesterday, today and
tomorrow. Oper Dent 1979; 4:24.
2. Plasmans PJJM, Creugers NHJ, Mulder J.
Long-term survival of extensive amalgam
restorations. J Dent Res 1998; 77:453.
3. Allan DN. The durability of conservative
restorations. Br Dent J 1969; 126:172.
4. Crabb H. The survival of dental restora-
tions in a teaching hospital. Br Dent J 1981;
150:315.
5. Bentley C, Drake CW. Longevity of resto-
rations in a dental school clinic. J Dent
Educ 1986; 50:594.
6. Mjor IA, Medina JE. Reasons for place-
ment, replacement, and age of gold resto-
rations in selected practices. Oper Dent
1993; 18:82.
7. Stoll R, Sieweke M, Pieper K, Stachniss V,
Schulte A. Longevity of cast gold inlays and
partial crowns: a retrospective study at a
dental school clinic. Clin Oral Investig
1999; 3:100.
8. Studer SP, Wettstein F, Lehnar C, Zullo
TG, Scharer P. Long-term survival esti-
mates of cast gold inlays and onlays with
their analysis of failures. J Oral Rehabil
2000; 27:461–472.
9. Tucker RV. Class II inlay cavity proce-
dures. Oper Dent 1982; 7:50.
10. Mezger PR, Vant’Hof MA, Letzel H, et al.
Methodological aspects in clinical evalua-
tion of cast restorations with color slides.
J Oral Rehabil 1985; 12:435.
11. Miya DM. Gold inlays bonded with a resin
cement: a clinical report. J Prosthet Dent
1997; 78:233.
12. Donly KJ, Jensen ME, Triolo P, Chan D. A
clinical comparison of resin composite inlay
and onlay posterior restorations and cast-
gold restorations at 7 years. Quintessence
Int 1999; 30:163.
13. Roulet JF. Longevity of glass-ceramic inlays
and amalgam: results up to 6 years. Clin
Oral Investig 1997; 1:40.
14. Lehner C, Studer S, Broadbeck U, Sharer P.
Six-year results of leucite-reinforced glass
ceramic inlays and onlays. Acta Medicinae
Dentum Helvetica 1998; 3:137.
15. Berg NG, Derand T. A 5-year evaluation of
ceramic inlays (CEREC). Swed Dent J
1997; 21:121–127.
16. Sjogren G, Molin M, van Dijken JW. A
5-year clinical evaluation of ceramic inlays
(CEREC) cemented with dual-cured or
chemically cured resin composite luting
agent. Acta Odontol Scand 1998; 56:
263–267.
17. Frankenberger R, Petschelt A, Kramer N.
Leucite-reinforced glass ceramic inlays and
onlays after six years: clinical behavior.
Oper Dent 2000; 25:459–465.
18. Hayashi M, Tsuchitani Y, Kawamura Y,
Miura M, Takeshige F, Ebisu S. Eight-year
clinical evaluation of fired ceramic inlays.
Oper Dent 2000; 25:473–481.
19. Molin MK, Karlsson SL. A randomized
5-year clinical evaluation of 3 ceramic
inlay systems. Int J Prosthodont 2000;
13:194–2000.
20. Bergman MA. The clinical performance of
ceramic inlays: a review. Aust Dent J 1999;
44:157–168.
21. Liebenberg WH. Variables which affect the
marginal accuracy of the resin bonded pos-
terior ceramic restoration: a pictorial essay.
J Dent Assoc S Afr 1993; 8:469–473.
22. Maryniuk GA. In search of treatment lon-
gevity: a 30-year perspective. J Am Dent
Assoc 1984; 109:739.
23. Mjor IA, Jokstad A, Qvist V. Longevity of
posterior restorations. Int Dent J 1990;
40:11.
24. Downer MC, Azli NA, Bedi R, Moles DR,
Setchell DJ. How long do routine dental
restorations last? A systematic review. Br
Dent J 1999; 187:432.
25. Hickel R, Manhart J. Longevity of resto-
rations in posterior teeth and reasons for
failure. J Adhes Dent 2001; 3:45.
26. Taggert WH. A new and accurate method
of making gold inlays. Dent Cosmos 1907;
49:117.
27. Donovan TE, Chee WWL. Conservative
indirect restorations for posterior teeth: cast
vs. bonded ceramic. Dent Clin North Am
1993; 37:433–443.
28. Christensen GJ. Cast gold restorations: has
the esthetic dentistry pendulum swung too
far? J Am Dent Assoc 2001; 132:809.
29. Marzola R, Derbabian K, Donovan TE,
Arcidiancono A. The science of communi-
cating the art of esthetic dentistry. Part I:
patient-dentist-patient communication.
J Esthet Dent 2000; 12:131.
30. Derbabian K, Donovan TE, Marzola R,
Cho GC, Arcidiancono A. The science of
communicating the art of esthetic dentistry.
Part II: diagnostic provisional restorations.
J Esthet Dent 2000; 12:238.
31. Derbabian K, Marzola R, Donovan TE,
Arcidiancono A. The science of communi-
cating the art of esthetic dentistry. Part III:
precise shade communication. J Esthet
Restor Dent 2001; 13:154.
32. Crispin B, Watson J. Margin placement of
esthetic veneer crowns. Part I: anterior tooth
visibility. J Prosthet Dent 1981; 45:278.
33. Donovan TE. Metal-free dentistry: con-
sumer generated or marketing hype?
J Esthet Restor Dent 2002; 14:71.
Reprint requests: Terry Donovan, DDS,
USC School of Dentistry, 925 W 34th Street,
Los Angeles, CA, USA 90089-0641;
e-mail: tdonovan@hsc.usc.edu
n2004 BC Decker Inc
Page 69
 ©
Operative Dentistry, 2008, 33-6, 601-605


Tucker Clinical Technique

Esthetic 7/8 Crown—

The Tucker Technique





RJ Allan







SUMMARY Limiting fac-
As restorative dentists, one of the largest challenges we tors to the opti-
face is to restore proper form and function while con- mum use of this
sidering the impact on the esthetic outcome. One must re s to ra tio n
include incipient
consider the clinical strengths and weaknesses of vari-
ous materials and their applicability in different situa- horizontal frac-

tions. For each clinical situation, there is always a most ture under the
favorable choice coordinating material and design for buccal or mesial-
optimum physiological, functional and esthetic results. buccal cusp of the
bicuspid or
The cast gold 7/8 crown with esthetic buccal margin, molar; over-
as designed and advocated by Dr Richard V Tucker, is extension of a
an extremely valuable procedure, providing a very long- pre-existing
lasting, esthetically pleasing restoration for extensive
restoration or
involvement of maxillary bicuspid or first molar teeth— lesion to the
particularly in cases where there has been some degree mesial-buccal,
of recession of the buccal or mesial-buccal cusp, while which would
that cusp remains strong and of good stock in the gin- require casting to
gival third of the tooth. Under the right circumstances, extend undesir-
these teeth can be extensively restored without show- ably out of the
ing the gold, while leaving the natural color and con-
embrasure; lack
tours of the buccal cusp and avoiding insult to the gin- of adequate tooth
gival tissues from the restoration margin. All of these stock of the
benefits contribute to esthetics that are superior to retained cusp.
porcelain-to-metal or all-ceramic restorations, with less
loss of tooth structure and trauma to the pulp.1 TECHNIQUE

This article addresses the maxillary first molar (Figure
1). However, the same design principles, with minor
*Randall J Allan, BSc, DMD, private practice, Vancouver, British modifications, can be used on maxillary bicuspids.
Columbia Provided the clinician has determined that the buccal
*Reprint request: 7575 Cambie Street, Vancouver, BC, Canada, cusp has adequate stock and is free from fracture, the
V6P 3H6; e-mail: dr.randallan@shaw.ca first step is to build-up the crown of the tooth with the
DOI: 10.2341/08-SA3

Page 70


material of choice to provide a platform for optimum
preparation design.
For expediency, the initial occlusal reduction can be
done with a straight diamond bur and refined with a
straight fissure bur in the final stages. A notation must
be made as to where the opposing functioning cusp will
fall on the occlusal table and the central groove of the
occlusal reduction placed accordingly. The inner incline of
the mesial-buccal cusp is not reduced at this time (Figure 2).
Using a Brasseler (Brasseler USA, Savannah, GA, USA)
Operative Dentistry
860-012 (or similar) bur (Figure 3), the next reduction is on
the mesial wall, taking particular care to have the mesial-
buccal cavosurface margin parallel with the buccal surfaces
of the anterior teeth in the arch, while extending past the
point of contact as little as possible.
The buccal aspect of the mesial reduction should form
roughly a 90° angle at the cavosurface. This is accom-
plished while establishing a concave or “hollow grind”
contour to the mesial wall (Figure 4). Establishing the
axial inclination of the mesial-buccal margin without
Page 71
 Allan: Esthetic 7/8 Crown—The Tucker Technique
over-extension is key to the esthetic success of this
restoration and dictates the draw of the rest of the
preparation, which is tilted slightly to the lingual.
The distal wall is then defined to draw with the
mesial. At this time, care is taken not to wrap the dis-
tal reduction around to the buccal, but rather to carry
it straight out from the embrasure (Figure 5). The
mesial and distal reductions are now joined by reduc-
tion of the lingual wall. The larger diameter Brassler
860-014 bur can now be used and, if space allows, it can
be carried onto the mesial and distal surfaces to provide
a more prominent chamfer and deeper hollow grind
(Figure 6).
The buccal wall reduction is only done on the distal half
of the tooth, and it need not extend any more gingival-
ly than necessary to capture the extension of the previ-
ous restoration or provide adequate compliment to the
resistance and retention of the rest of the preparation,
specifically the mesial hollow grind. The line angle at
the juncture of the distal and buccal walls remains
quite precise and not rounded (Figure 7). Care must be
taken not to finish the mesial aspect of the buccal
reduction in the mid-buccal groove, which would impair
optimum finishing of the margins with disks at cemen-
tation (Figure. 8). The distal reduction of the mesial-
buccal cusp must draw with the mesial hollow grind
(Figures 8-9).
The final stage is reduction of the mesial-buccal cusp.
The inner incline must be reduced enough to allow ade-
Page 72
 Operative Dentistry

Clinical Case 1

Figure 25. Tooth #3. Failing alloy with
replaced distal-lingual cusp.
Figure 26. Tooth #3. Fracture of the distal-
buccal cusp.
Figure 27. Esthetic 7/8 crown prep.
Note the minimal extention past the
mesial contact point and the mesial
margin of the buccal reduction being
short of the buccal height of contour of
the mesial-buccal cusp. There is a more
ideal lineangle between the mesial hol-
low grind and the lingual reduction.

cusp tip just to the height of the contour

(Figure 13).
The buccal line angle distal to the
mesial-buccal cusp is refined with a
Suter (Suter Dental Mfg Co, Chico,
CA, USA) 42S off-angle hatchet, first
Figure 28. Supragingival lingual margin at Figure 29. Note the rounded, simple on the distal of the cusp, then on the
insert. anatomy and buccal margin place- buccal wall (Figure 14). This provides
ment for optimum esthetics. for a flat, slightly wider surface of gold
to brace the distal aspect of the cusp
and compliment the bulk of gold of the
mesial hollow grind. The distal wall of
the mesial-buccal cusp is planed with
a medium garnet disk, maintaining a
flat surface and providing a straight,
precise cavosurface margin (Figure
15).
The final step in preparation is to
place a very fine counterbevel along
the buccal cusp tip with a fine cuttle
Figure 31. The mesial-buccal cusp appears
disk to eliminate loose enamel rods,
Figure 30. When viewed directly down the
buccal surfaces, the gold is hidden. unrestored in direct view, and the gold will taking care not to change the shape of
not show when talking or smiling. Note the the cusp tip outline, while smoothing
quate clearance for the opposing func- tooth color and contour, which cannot be the margin. Note the slight change in
tioning cusp without reducing the matched by a ceramic restoration. plane of the inner incline approaching
height or altering the outline of the cusp the cusp tip (Figure 16). Examination
tip. Using a mechanical pencil perpendicular to the of the casting reveals all details of the preparation
cusp tip, the height of contour of the cusp is defined steps (Figure 17). From the occlusal, the buccal-axial
(Figures 10-11). Reduction of the inner incline is done margin is short of the buccal height of contour and not
with a #56 straight fissure bur parallel to an imaginary in the concavity of the buccal groove, while the
line joining the already established central groove and occlusal-buccal margin finishes at the height of con-
height of contour of the cusp tip (Figure 12). The rest of tour of the cusp tip (Figure 18). When viewed from the
the occlusal reduction can be smoothed with the #56 distal, the sharp lineangle between the distal and buc-
bur at this time and the functional cusp counter bevel cal reductions is reflected by the presence of an “ear”
provided. Note the sharp line angle along the buccal of enamel at the casting margin (Figure 19).

Page 73
 Allan: Esthetic 7/8 Crown—The Tucker Technique
Clinical Case 2
Figure 32. Tooth #13. Note the discoloration,
owing to old alloy.
Figure 35. Casting is undetectable. Note
the natural tooth color blending with the
first molar and in contrast to the amal-
gam restored first bicuspid.
The lingual margin can be kept supragingival, owing
to the extremely retentive design, provided the old
restoration and tooth stock allows this. The height of
both buccal cusps are the same as the pre-operative
state and match the second molar (Figure 20). The gold
on the buccal wall distal to the mesial-buccal cusp is
blocked from view by contour of the mesial-buccal
cusp, while on the mesial, the mesial gold of the cast-
ing is well hidden in the embrasure. There is slight
plus gold covering the counter bevel to be reduced in
finishing (Figure 21). If visible at all, the gold on the
mesial buccal cusp is not readily noticeable, providing
that the margin is harmonious with the buccal con-
tours of adjacent teeth (Figure 22).
Figure 33. Tooth #13. Fractured Figure 34. Classic esthetic 7/8 design
lingual cusp. with narrower buccal reduction for the
bicuspid tooth. Note the return of natural
tooth color.
In the buccal view, the buccal cusps match the pre-
operative form and are harmonious with the second
molar (Figure 23). The mesial-buccal cusp will initially
show a slight “plus gold” covering the cusp tip counter-
bevel (Figures 22 and 23). However, after proper fin-
ishing with disks, the “plus gold” is eliminated, as it is
reduced to blend with the height of contour of the cusp
tip at the counter-bevel margin (see clinical cases—
Figures 25-35). The finished casting approximates
the original cusp height but appears unrestored,
owing to the esthetic margin technique (Figures 1 and
24).
When prepared properly in the right clinical circum-
stances and using proper finishing techniques, there is
no more superior restoration combining preservation of
tooth structure, longevity, biocompatibility and opti-
mum esthetics than the Esthetic-Buccal 7/8 crown.
Acknowledgement
All castings were fabricated by Akos Mankovits, Garden Court
Dental Lab, Abbotsford, British Columbia.
Reference
1. As learned from Richard V Tucker in Study Club over the
years.
Page 74
©
Operative Dentistry, 2010, 35-2, 250-252

The Tucker Technique

Cast Gold Molar

Proximal ½ Crown

DE Otterholt

SUMMARY
The molar proximal half-crown cast gold restora-
tion may be an ideal choice for the conservative
treatment of teeth with only one compromised
proximal aspect.

INDICATIONS
Cast gold restorative material is indicated when supe-
rior strength and longevity of service are desired. The
half-crown may be chosen when only one proximal por-
tion of a tooth is broken down by caries, cusp fracture
or previous restorative materials, while the other prox-
Figure 1. Tooth #15 preop view Figure 2. Amalgam and caries
imal portion is intact and sound. The half-crown may showing failed large amalgam. removed. Note the intact mesial
be placed on either the mesial or distal half of the tooth surface.
under treatment and is highly esthetic when placed on
the distal of maxillary molars. Limiting factors include
inadequate remaining tooth structure of the compro-
mised half to provide adequate retention and resist-
ance, encroachment upon the intact proximal surface
via existing buccal or lingual caries or fillings, or incip-
ient horizontal fractures at the base of cusps to be pre-
served.

TECHNIQUE
After evaluation and possible modification of opposing
plunging cusps and anesthesia administration, a rubber
dam is placed (Figure 1). All of the existing restorative
materials and caries are then removed (Figure 2). Figure 3. The intaglio surface of Figure 4. Final prep. Note the axial
casting. Note the grooves and bar grooves connected by occlusal
*Dana E Otterholt, DDS, private practice, Mount Vernon, WA, creating added resistance, retention groove.
USA and reinforcement.
*Reprint request: 104 North 15th Street, Mount Vernon, WA 98273,
USA; e-mail: dv.otterholt@verizon.net
DOI: 10.2341/10-T1

Page 75
 Otterholt: Cast Gold Molar Proximal ½ Crown


Careful evaluation of the tooth for unsuspected cracks, serve to add bracing and stiffness to the gold casting,
severe undermining of the cusps and the presence of ade- which counters possible distortion or springing open of
quate sound tooth structure beyond the proposed the margins under occlusal forces (Figure 3).
restorative margin will then allow for the final choice of Using the same straight fissure bur, the occlusal table
the half-crown preparation. is smoothed and the inlay portion (if present) is blended
At this time, tentative placement of the buccal and lin- into the rest of the preparation.
gual axial walls is determined. Both must extend onto The buccal and lingual groove cavosurface margins are
sound tooth structure gingivally and axially beyond the refined with a medium garnet disc to eliminate any irreg-
lesion. For finishing purposes, the buccal margin is ularities in the walls or weakened enamel. An occlusal
placed so as to avoid being directly in the buccal groove. bevel is placed on the inlay extension (if present) using a
It is also determined whether an extension of the exist- new #56 fissure carbide bur to complete the preparation
ing filling into the occlusal portion of the intact half of the (Figures 4, 5 and 6). These final steps in the preparation
tooth will require an inlay component to the final restora- sequence provide a very sharp cavosurface margin for
tion. A buildup using material of choice is then placed. laboratory fabrication of an accurate casting and ease of
The initial occlusal reduction is performed using a finishing at the delivery appointment.
straight diamond bur (Brasseler KS2-014, Brasseler Placement and finishing of the casting at the seating
USA, Savannah, GA, USA), which is extended to just appointment are accomplished by a series of discs, strips
short of the anticipated position of the axial walls. and polishing powders, to achieve a highly refined tooth
Proximal and axial reductions are made using a flame- to gold interface (Figures 7, 8 and 9).
shaped diamond (Brasseler 860-012 or 860-014), taking
care to extend the buccal and lingual walls only to the The highly retentive cast gold half-crown, when care-
previously determined location. fully selected, prepared and finished, allows for conser-
vation of tooth structure via preserving an intact proxi-
Additional resistance and retention features, drawing mal half (Figure 10) and possible preparation of
with the rest of the preparation, are added next. Buccal supragingival margins (Figure 11). It is also a very
and lingual grooves are
placed using a round end
taper diamond bur
(Brasseler 8856.31.016) to
a depth of approximately
1 mm at the leading edge
of their respective axial
reductions. These grooves
form a butt joint at the
cavosurface and deter-
mine the visible outline of
the casting. Using a
straight fissure #56 car-

bide bur, the occlusal Figure 5. Prep buccal view. Note the Figure 6. Prep lingual view. Note the

Figure 7. Final finish occlusal view.
inlay preparation is com- length, depth and crispness of the lingual groove configuration. Note the marginal integrity, flowing
pleted (if indicated), and buccal groove. outline and high polish.
the occlusal groove is pre-
pared to a depth of 1½
mm, connecting the buc-
cal and lingual axial
grooves. The length and
parallelism of the axial
grooves, in concert with
the occlusal groove,
together form a thick “U”-
shaped staple at the
medial aspect of the
preparation. They act
together to add signifi-
cantly to the retention Figure 8. Final finish palatal view. Figure 9. Final finish buccal view. Figure 10. Occlusal view, rubber
and resistance of the dam removed. Note the intact
preparation. They also mesial proximal surface.

Page 76


Figure 11. Palatal view. Note the
supragingival margin.
Figure 14. Tooth #30 distal half
crown with gold foil in the mesial
occlusal pit. (Restorations by
Richard V Tucker, DDS.)
Figure 16. Tooth #31 mesial half-
crown with inlay extension.
Figure 12. Buccal view. Note the
supragingival margin, gold hidden
behind the height of the contour of
the MB cusp. No need for porcelain
shade matching.
Figure 15. Tooth #2 distal half-
crown with inlay extension.
Figure 17. Tooth #3 mesial half-
crown, PFM.
Operative Dentistry
Figure 13. Final finish occlusal view. Note the marginal
integrity, flowing outline and high polish.
esthetic solution to maxillary molars, as the gold is hid-
den behind the height of contour of the untouched mesial
portion of the tooth and there is no need for shade match-
ing (Figure 12).
Restorative variations (Figures 13 through 16) demon-
strate the flexibility offered by this preparation to treat
numerous clinical indications.
Acknowledgements
Castings are by Mr Roger Griffen, Skagit Dental Lab, Mount
Vernon, WA, USA. The preparation design and inspiration are
from Dr RV Tucker. The author acknowledges guidance from his
study club mentor, Dr Silvan Strandwold.
(Received 17 November 2009)
Page 77

The Tucker Technique:
Conservative Molar
Inlays Preserving
the Transverse Ridge
TA Hess • CPK Wadhwani
SUMMARY
Conservation of healthy tooth structure should
be the aim of any restorative procedure. Two
inlays may be an ideal choice for the treatment
of maxillary molars to preserve the transverse
ridge and maintain structural integrity.
INDICATIONS
When mesial and distal proximal surface restora-
tions are indicated on the maxillary first molar that
has an unaffected oblique ridge, separate two-
surface cavity preparations are indicated rather
than a mesio-occlusodistal preparation, inasmuch
as strength of the tooth crown is significantly greater
when the oblique ridge is intact.1,2 Cast gold inlays
have long been used to conservatively restore
compromised tooth structure. Often the clinician is
faced with two areas requiring restoration on a
maxillary molar interrupted with an intact oblique
ridge of ample stock. Ideally, the dentist would elect
to maintain this transverse ridge to minimize the
separating forces of occlusion that flex the buccal
and lingual halves of the molar from one another.
Various combinations of inlays are possible depend-
ing on the surfaces involved.
*Timothy A Hess, DDS, private practice, Auburn, WA, USA
Chandur PK Wadhwani, BDS, MSD, private practice, Belle-
vue, WA, USA
*Corresponding author: 1268 East Main Street, Auburn,
WA 98002, USA; e-mail: drhess@tahessdds.com
DOI: 10.2341/11-048-T
©
Operative Dentistry, 2012, 37-1, 93-97
Clinical Technique/Case Report
TECHNIQUE
Tooth #14 (Figures 1 and 2) was observed to have an
existing mesial-occlusal composite and separate
occlusal composite in the distal portion of the
occlusal surface. Although the restorations were still
serviceable, the patient was a dental hygienist who
understood that all restorations have a limited life
span. The hygienist, having been informed of the
clinical data available with respect to materials and
techniques, 3 requested the removal and replacement
of her composites with cast-gold restorations utiliz-
ing the Tucker Technique. Occlusion was evaluated,
anesthesia administered, and a heavy weight rubber
dam (Coltene/Whaledent, Cuyahoga Falls, OH, USA)
placed. Typically, all the existing restorative mate-
rial and any caries would be removed. However, in
this case, the operator elected to utilize the existing
composites as block-out with the knowledge that
very little if any would remain after preparation
with the remaining removed prior to cementation.
Initial occlusal preparation was performed using a
#57 fissure carbide bur (Midwest/Dentsply Interna-
tional, York, PA, USA) taking care not to overextend
to the buccal in the mesial-buccal aspect of the
preparation. The depth of the central groove area
was reduced to approximately 1.5 mm and the buccal
and lingual walls 2.5 mm because of the inclines of
the cusps. The #57 carbide was used to create an
angulation of approximately 3–5 degrees on each of
the occlusal walls, and therefore a preparation taper
of 6-10 degrees was produced. A definite buccal
dovetail feature was created in the buccal groove to
prevent the proximal dislodgment of the casting and
Page 78
 Operative Dentistry

Figure 1. Pre-operative view of tooth #14.

negate the need for an internal bevel in the proximal

box. The #57 bur was used to establish a proximal
box to a depth of 1.5 mm gingival to the pulpal floor
or 4 mm from the proximal-occlusal cavosurface. The
buccal wall of the proximal box was prepared with a
169L tapered fissure carbide bur held perpendicular
to the occlusal surface to establish the mesiobuccal
cavosurface and minimize extension to the buccal.
The #57 carbide bur was used to prepare the
mesiolingual wall of the proximal box and ensure
that the axial depth of the proximal box had
sufficient depth. A ½ inch sandpaper disc (E.C.
Moore, Dearborn, MI, USA) was used to blend the
mesiolingual with the lingual wall of the occlusal
with slight flare to allow ease of finishing and create
taper to be harmonious with the conservative taper
of the mesiobuccal wall. The 42S chisel (Suter
Dental, Chico, CA, USA) was utilized to remove
any friable enamel rods and accentuate the axiogin-
gival line angles and true the gingival floor. The
axial wall was smoothed with the 43S chisel. A 0.5-
mm external bevel was placed using a H248-009
beveled cylinder carbide bur (Axis, Coppell, TX,
USA) and planed with the #233 Tucker gingival
margin trimmer (Suter Dental).
The occlusal-lingual groove was prepared using a
#7404 bur (Brassler USA, Savannah, GA, USA). This
was a relatively simple preparation with a rounded
Figure 2. Pre-operative radiograph of tooth #14. pulpal floor and no line angle with draw created by

Page 79
 Hess & Wadhwani: Conservative Molar Inlays Preserving the Transverse Ridge
Figure 3. Completed preparation.
the shape of the bur. Retention was maximized by
keeping the #7404 bur at a consistent perpendicular
angle to the occlusal surface as the bur follows the
groove. Care was taken to create enough depth in the
lingual extension for bulk of gold during casting and
accuracy of fit when seating and finishing. Instead of
Figure 4. Initial seating of the restoration showing the casting slightly overfinished.
the groove being prepared as a gentle arc from
occlusal to lingual, resistance form was enhanced by
creating more of an acute angle from the occlusal to
lingual aspect (Figure 3). Try-in prior to cementation
verified the superb retention and resistance of this
preparation design. It was also noted that at the
Page 80

Figure 5. Post-operative occlusal view.
occlusal mesiobuccal cavosurface, the casting was
slightly over finished and would need to be ad-
dressed with finishing (Figure 4).
Seating involved anesthesia, removal of the provi-
sional, and placement of a heavy weight rubber dam.
Figure 6. Post-operative buccal view.
Operative Dentistry
Castings were tried in together to verify fit and
proximal contact. The castings were seated one at a
time using separate mixes of zinc phosphate cement
(Fleck’s Cement, Myerstown, PA, USA). The zinc
phosphate was slaked with a small amount of
powder in the liquid until the liquid appeared clear
Page 81
 Hess & Wadhwani: Conservative Molar Inlays Preserving the Transverse Ridge
Figure 7. Post-operative lingual view.
and then mixed according to the manufacturer’s
directions. Cement was applied to the castings, and
an orange wood stick was used to seat the castings
along with light malleting. A shortened orange wood
stick was then used between the castings and lower
molar until the hydraulic pressure of cementation
had dissipated. A series of sandpaper disks (medium
garnet, fine sand, and fine cuttle; E.C. Moore),
strips, and polishing powders were used to refine
the tooth to gold interface. Often the operator will
find that only the fine sand and fine cuttle discs are
necessary and that the medium garnet may intro-
duce unnecessary scratches in the gold that will
require additional finishing time. In this case, no
garnet discs were utilized. Wet #4 laboratory pumice
(Kerr Corp, Romulus, MI, USA) was used next with a
ribbed prophy cup (Young Dental, Earth City, MO,
USA). A light touch rotating from casting to tooth
was employed to avoid the uneven removal of tooth
and gold if the pumice was used too aggressively or
for too long. Next, wet 15-micron aluminum oxide
powder (Micro Abrasives Corp, Westfield, MA, USA)
with a new ribbed prophy cup was used. Important
to note is that in between polishing steps, a thorough
rinse and dry of the area should be performed to
prevent incorporating scratches late in the sequence.
Final polishing was performed dry with 1-micron
aluminum oxide powder (Micro Abrasives Corp) and
again a new ribbed prophy cup. No finishing strips
were deemed necessary in this case (Figures 5
through 7).
Once the rubber dam was removed, the occlusion
was checked and the patient released.
Acknowledgements
Castings are by Mr Gary Burke, Issaquah, WA, USA. The
preparation design is from Dr RV Tucker. The authors
acknowledge guidance from their study club (RVT-60) mentor,
Dr Robert Ward.
(Accepted 17 March 2011)
REFERENCES
1. Sturdevant CM, Barton RE, Sockwell CL & Strickland WD
(1985) The Art and Science of Operative Dentistry Mosby,
St Louis 224-226.
2. Markley MR (1951) Restorations of silver amalgam
Journal of the American Dental Association 43(2) 133-146.
3. Donovan T, Simonsen RJ, Guertin G & Tucker RV (2004)
Retrospective clinical evaluation of 1,314 cast gold resto-
rations in service from 1 to 52 years Journal of Esthetic
Restorative Dentistry 16(3) 194-204.
Page 82
 Ó
Operative Dentistry, 2014, 39-4, 000-000

The Tucker Technique: The

Proximal Hollow Grind to Address a
Root Concavity
TA Hess

Clinical Relevance
This case report describes a modification of the Tucker technique to manage a concavity of
a proximal surface when a traditional cast gold box form would be too invasive. A
conservative and esthetic alternative to this box form is the proximal hollow grind.

SUMMARY maxillary first molar where the oblique ridge is not

Cast gold inlays have long been used to con-
servatively restore compromised tooth struc-
ture. When the mesial or distal proximal
surfaces are indicated for restoration and a
cast gold restoration is desired, traditionally a
box is prepared with an external bevel. Often a
root concavity does not allow for a standard
box form or the external and/or internal bev-
els. A proximal hollow grind can be utilized to
address limits of standard inlay or onlay
preparation design.
INDICATIONS
Cast gold inlays have long been used to conserva-
tively restore compromised tooth structure. When
the mesial or distal proximal surfaces are indicated
for restoration and a cast gold restoration is desired,
traditionally a box is prepared with an external
bevel.1 With a single proximal box on a bicuspid or
*Timothy A Hess, DDS, Private Practice, Auburn, WA, USA
*Corresponding author: 1268 East Main Street, Auburn,
WA 98002, USA; e-mail: drhess@tahessdds.com
DOI: 10.2341/13-158-T
broken, often an internal bevel is placed in the
dentin to create a guiding plane for accurate seating
of the casting.2 The internal bevel ensures a tight
gingival seal upon cementation. Often a root concav-
ity does not allow for a standard box form or the
external and/or internal bevels. A proximal hollow
grind can be utilized to address limits of standard
inlay or onlay preparation design.3
TECHNIQUE
Teeth 4 and 5 were observed to have mesial and
distal decay secondary to excessive consumption of
highly acidic energy beverages. Tooth 4 was re-
stored with a MOD amalgam, and a composite
buildup was placed in tooth 5 for a future inlay
restoration. Twelve months later, the patient re-
turned with a fractured tooth 4–MOD amalgam
despite what appeared to be sufficient occlusal
depth of the preparation (Figures 1 and 2). The
patient elected to have teeth 4 and 5 restored with
MOD cast gold inlay restorations to resist failure
due to fracture.4,5
The occlusion was evaluated and anesthesia
administered. A rubber dam retainer (Hu-Friedy,

Page 83
2 Operative Dentistry
Figure 1. Preoperative condition.
Chicago, IL, USA) was applied to tooth 3, and holes
with approximately 3.5 mm of space between each
were punched in the heavy-weight rubber dam
(Hygenic Dental Dam Latex; Coltène/Whaledent,
Cuyahoga Falls, OH, USA). The rubber dam was
placed for optimal isolation and access by extending
from tooth 3 to tooth 11. Typically all of the existing
restorative material and any caries would be
Figure 2. Bitewing radiograph illustrating thickness of tooth 4 amalgam.
removed. However, in this case the operator elected
to utilize the existing composite buildup on tooth 5.
The fractured amalgam was removed from tooth 4
with a #6 high-speed round bur (Midwest/Dentsply
International, York, PA, USA). A band and retainer
(Tofflemire; Water Pik Inc, Fort Collins, CO, USA)
without gingival wedging was applied to tooth 4, and
dual-cure composite (ParaCore; Coltène/Whaledent)
Page 84
Hess: The Proximal Hollow Grind to Address a Root Concavity
with its associated adhesive was used to build up to
close-to-original contours.
An essential concept of the Tucker technique is the
use of a buildup. The buildup allows conservative
cavity preparation because the operator does not
need to extend occlusal and axial walls to address
undermining caries or extensions of previous resto-
rations. Ideal taper, smoothness, and proportions
can be created.
Initial occlusal preparation of both tooth 4 and 5
was performed using a #56 fissure carbide bur
(Midwest/Dentsply International). The mesiobuccal
line angle of tooth 4 was used as a guide for
preparation to minimize the buccal extension and
the display of gold to maintain esthetics. On both
tooth 4 and 5, depth of the central groove area was
reduced to approximately 1.5 mm and that of the
buccal and lingual walls 2.5 mm as a result of the
inclines of the cusps. The #56 carbide was used to
create an angulation of approximately 38-58 on each
of the occlusal walls, and therefore an ideal prepa-
ration taper of 68-108 was produced.
The mesial of tooth 5 was initially prepared using
the #56 bur. Once the mesial concavity was visual-
ized the decision to prepare a mesial hollow grind
was made. A relatively simple preparation with
rounded internal angles was made with a #7404 bur
(Brasseler USA, Savannah, GA, USA).3 Retention of
the casting was maximized by keeping the #7404 bur
at a consistent perpendicular angle to the pulpal
wall as the bur was carried interproximally. Because
of the diameter of the #7404 bur, the buccal and
lingual extensions were finalized with a #7901 flame
finishing bur (Midwest/Dentsply International). The
#7901 bur is used to avoid contact with the adjacent
tooth. Care was taken to create enough axial depth
in the buccal and lingual extensions for bulk of gold
during casting and accuracy of fit when seating and
finishing. The #7901 bur was held perpendicular to
the pulpal floor and was used in the painting stroke
from the mesiobucco-gingival point angle and in
blending occlusally to the bucco-occlusal line angle
with a minimal lean toward the buccal. The #7901
bur was then used to finish from the mesiolinguo-
gingival point angle to the linguo-occlusal line angle
with slightly more angulation toward the lingual
than was used toward the buccal. Ideal draw was
achieved without unesthetic extension to the mesial
buccal of tooth 5.
The mesial proximal draw of tooth 5 guided the
preparation of its distal box. The #56 bur was used to
establish a proximal box to a depth of 1.5 mm gingival
3
to the pulpal floor, or 4 mm from the proximal-
occlusal cavosurface on the mesial and distal of tooth
4 and distal of tooth 5. The mesiobuccal extension of
tooth 4 was kept conservative by planning the draw
of tooth 4, including axial and proximal walls, to
allow seating of tooth 4 before tooth 5.
The proximals, excluding the mesial of tooth 5,
were trued using hand instrumentation. The 42S off
angle chisel (G Hartzell & Son, Concord, CA, USA)
was utilized to smooth the pulpal and gingival walls.
Mesial proximal axial line angles are placed with the
42S off angle chisel, and distal proximal axial line
angles are placed with the 43S off angle chisel (G
Hartzell & Son). The mesial axial wall was smoothed
with the 43S off angle chisel and the distal axial line
angle with the 42S off angle chisel. External bevels
(0.5 mm) were placed using a beveled cylinder
carbide bur (H248-009; Axis, Coppell, TX, USA)
and planed with the #233 Tucker gingival margin
trimmer (G Hartzell & Son) on the mesial and the
#232 Tucker gingival margin trimmer on the distal
(Figure 3). The Tucker gingival margin trimmers
have an angulation of 308 rather than the 458
angulation of non-Tucker gingival margin trimmers
(G Hartzell & Son). Forty-five–degree gingival
margin trimmers are used to place the internal
bevel on restorations with a single proximal box.
Internal bevels will increase retention and resis-
tance form.
A small gingival retraction cord (#0 Ultrapak;
Ultradent Products Inc, South Jordan, UT, USA)
soaked in 25% aluminum chloride solution (Hemo-
dent: Premier, Plymouth Meeting, PA, USA) was
tucked into the sulci of teeth 4 and 5. Next a braided
cord (#2 Gingi-Pak; Belport Co Inc, Camarillo, CA,
USA) was placed into the sulci above the smaller
cord for five minutes prior to being removed. Upon
removal the preparations were impressed using only
light-body polyvinyl siloxane (Flexitime; Heraeus,
South Bend, IN, USA) syringed around the prepa-
rations and into a double arch tray (Check Bite; GC
America, Alsip, IL, USA). Upon setting the impres-
sion was removed and inspected and judged to have
sufficient detail. It was noted that the impression
material capturing the mesial concavity of tooth 5
obscured the gingival margin when viewed directly
from above (Figure 4).
Provisionalization was achieved with a piece of
temporary stopping (Hygenic Temporary Dental
Stopping; Coltene/Whaledent) heated with a lighter
and placed with a Woodson 2 composite instrument
(Hu-Friedy) into the proximals so that the acrylic
(DuraSeal; Reliance Dental Mfg Co, Worth, IL, USA)
Page 85
4 Operative Dentistry
Figure 3. Final preparations.
would not contact soft tissue. Care was taken not to
aggressively pack the stopping and create separation
of the teeth. The temporary stopping was kept below
the contact so that the acrylic would lock in. Acrylic
was added using a liquid/powder technique and a
disposable brush (Benda Brush; Centrix, Shelton,
Figure 4. Impression.
CT, USA). While the acrylic was soft the patient was
instructed to bite and go into excursive movements.
Once the acrylic was set the #0 gingival retraction
cords were removed from the sulci. The patient was
advised that he would be unable to floss this area
prior to the seating appointment.
Page 86
Hess: The Proximal Hollow Grind to Address a Root Concavity
Figure 5. Try-in of castings with open contact.
Seating involved anesthesia, removal of the provi-
sionals, and placement of a heavy-weight rubber
dam. Gold castings (JRVT Gold 77% Au, 1% Pd, 13%
Ag; Jensen Industries Inc, North Haven, CT, USA)
were tried in together to verify fit and proximal
contacts. Unfortunately, there was inadequate con-
Figure 6. Final restoration—occlusal view.
5
tact between the castings (Figure 5). The distal of
tooth 5 was chosen to add to because it looked
slightly undercontoured. Gold was added to the
distal of tooth 5 using solder (650 Fine; Jensen
Industries Inc) and flux (Brown Fluoride Flux;
Jensen Industries Inc). A mixture of water, phos-
Page 87
6 Operative Dentistry
Figure 7. Final restoration—buccal view.
phoric acid, and urea (Prevox Liquid; Ivoclar
Vivadent Inc, Amherst, NY, USA) was heated in a
fume hood and used to remove the oxidation layer
from the soldering process.
The inlay castings were seated one at a time
beginning with tooth 4. Tooth 4 was seated first so
that the mesiobuccal aspect could be accessed for
ideal finishing. Separate mixes of zinc phosphate
cement (Fleck’s Cement; Myerstown, PA, USA) for
each tooth were used to give adequate time for
finishing of tooth 4. A resin-modified glass ionomer
or self-adhesive modified resin cement could have
been used.6,7 The zinc phosphate was slaked with a
small amount of powder in the liquid until the liquid
appeared clear and was then mixed according to the
manufacturer’s directions. Cement was applied to
the castings, and an orange wood stick (Pearson
Dental, Sylmar, CA, USA) along with light tapping
with a Gourley mallet was used to seat the castings.
A shortened orange wood stick was then used
between the castings and lower premolars until the
hydraulic pressure of cementation had dissipated. A
series of sandpaper disks (medium garnet, fine sand,
and fine cuttle) (EC Moore, Dearborn, MI, USA),
linen strips (Moyco Dental, Philadelphia, PA, USA),
and polishing powders were used to refine the tooth-
to-gold interface. Wet #4 laboratory pumice (Kerr
Corp, Romulus, MI, USA) was used next with a
ribbed prophy cup (Young Dental, Earth City, MO,
USA). A light touch rotating from casting to tooth
was employed to avoid the uneven removal of tooth
and gold if the pumice was used too aggressively or
for too long.
The tooth 5 inlay was then seated utilizing the
same steps described above. After the #4 laboratory
pumice, wet 15-lm aluminum oxide powder (Micro
Abrasives Corp, Westfield, MA, USA) with a new
ribbed prophy cup was used. Rinsing and drying of
the castings and teeth were performed between
polishing steps to prevent incorporating scratches
late in the sequence. Final polishing was performed
dry with 1-lm aluminum oxide powder (Micro
Abrasives Corp), again with a new ribbed prophy
cup (Figures 6 and 7).
Once the rubber dam was removed the occlusion
was verified with bite registration tape (AccuFilm;
Parkell, Edgewood, NY, USA) lightly coated with
petroleum jelly (Vaseline; Unilever, Englewood
Cliffs, NJ, USA) to improve the visibility of marks
obtained. The patient was released after occlusion
was confirmed with the patient supine and then
again upright.
Acknowledgements
Castings are by Mr Gary Burk (Issaquah, WA, USA). The
preparation designs are based on those of Dr RV Tucker. The
Page 88
Hess: The Proximal Hollow Grind to Address a Root Concavity
2013 Tucker Institute Syllabus, Drs RV Tucker, RD Tucker,
DM Miya, and WK Johnson, provide the guidance and details
for the technique steps. The author acknowledges support
from his study club mentor, Dr Robert Ward.
Conflict of Interest
Dr Hess, author of this manuscript, certifies that he has no
proprietary, financial, or other personal interest of any nature
or kind in any product, service, and/or company that is
presented in this article except for personal interests in The
Academy of RV Tucker Study Clubs.
(Accepted 15 July 2013)
References
1. Sturdevant JR (2013) Class II cast metal restorations In:
Heymann H, Swift EJ, Ritter AV, Sturdevant CM (eds)
Sturdevant’s Art and Science of Operative Dentistry
Elsevier/Mosby, St Louis, Mo 455-517.
7
2. Hess TA, & Wadhwani CP (2012) The Tucker technique:
Conservative molar inlays preserving the transverse ridge
Operative Dentistry 37(1) 93-97.
3. Tucker RV (2008) Distal hollow grind with pin. Operative
Dentistry 33(4) 367-369
4. Donovan T, Simonsen RJ, Guertin G, & Tucker RV (2004)
Retrospective clinical evaluation of 1,314 cast gold resto-
rations in service from 1 to 52 years Journal of Esthetic
and Restorative Dentistry 16(3) 194-204.
5. Tucker RV (2008) Why gold castings are excellent
restorations Operative Dentistry 33(2) 113-115.
6. Farrrell CV, Johnson GH, Oswald MT, & Tucker RD (2008)
Effect of cement selection and finishing technique on
marginal opening of cast gold inlays Journal of Prosthetic
Dentistry 99(4) 287-292.
7. Miya DM (1997) Gold inlays bonded with a resin cement: A
clinical report Journal of Prosthetic Dentistry 78(3)
233-235.
Page 89
Ó
Operative Dentistry, 2017, 42-2, 122-132
A Direct Refractory Die Technique
for Cast Gold Restorations
CT Smith  KE Diefenderfer
Clinical Relevance
This direct refractory die technique eliminates wax pattern distortion and facilitates the
creation of accurate, precisely fitting cast gold restorations.
ABSTRACT
Fabricating accurate cast gold restorations
can be challenging for both clinicians and
laboratory technicians. Removing the wax
pattern from the master die often distorts
the pattern, which, in turn, compromises the
overall fit and marginal adaptation of the
casting. This article demonstrates a laborato-
ry technique in which the final restoration is
cast directly on the refractory die without
removing the wax pattern. Thus, distortion of
the wax pattern is avoided, enabling the
production of superbly fitting gold castings
for both intracoronal and extracoronal resto-
rations.
INTRODUCTION
Producing cast gold restorations that are consistent-
ly precise and well fitting can be a challenge for both
clinicians and dental laboratories. Contributing to
this challenge is the issue of wax pattern distortion
*Cleveland T Smith, DMD, private practice, Columbia, SC,
USA
Kim E Diefenderfer, DMD, MS, MS, associate professor, Dept
of Cariology, Operative Dentistry & Dental Public Health,
Indiana University School of Dentistry, Indianapolis, IN,
USA
*Corresponding author: 3710 Landmark Dr., Suite 102,
Columbia, SC 29204, USA; e-mail: clevelandtrammell@
hotmail.com
DOI: 10.2341/15-290-T
during the fabrication process.1-3 Distortion of the
wax pattern during removal from the master die and
investment is ‘‘unavoidable.’’3,4 However, use of
refractory die techniques can greatly reduce this
problem if carefully employed in the process.5-7
Refractory die techniques have been used for the
laboratory fabrication of various dental appliances
and restorations for many years.8-11 Currently,
however, a precise and consistent fabrication tech-
nique for cast gold restorations on refractory dies has
remained elusive and underutilized in restorative
dentistry.
Described here is a clinical and laboratory tech-
nique for fabricating extremely accurate, smooth,
and detailed gold castings for both intracoronal and
extracoronal restorations.
CLINICAL PROTOCOL
After the tooth preparation has been completed
(Figure 1), the gingiva is retracted with a hemostat-
ic-impregnated cotton cord and the preparation
cleaned of all debris, then air-dried. A rigid metal
check-bite tray (GC America, Alsip, IL, USA) with
perforated sidewalls is tried in the mouth. All large
open embrasure spaces and undercuts should be
blocked out with wax or some other material (in the
quadrant to be impressed) prior to the impression
procedure. This will minimize the possibility of
locking and distorting the impression.
The preparation is impressed with a light/heavy-
bodied polyvinyl siloxane impression material sys-
Page 90
Smith & Diefenderfer: Direct Refractory Die Technique for Cast Gold Restorations 123

Figure 1. Number 19 defective resin composite with secondary

caries. (A): Pretreatment. (B): Completed cast gold onlay preparation.
The DB and DL cusps were judged to have sufficient dentin support to
warrant conservative preparation. Note that the interseptal rubber dam
has been cut to enable retraction cord placement with the dam in
place.

tem (Aquasil [Dentsply/Caulk, York, PA, USA] is

recommended) in the usual manner, ensuring that
the patient closes into maximum intercuspation.
Support the patient’s mandible in the closed position
with the loaded impression tray in place. The
impression is allowed to set according to the
manufacturer’s recommendations, but verify that
the material exhibits ‘‘total rebound to blunt depres-
sion’’ before removing from the mouth.
On removal from the mouth, the impression is
rinsed with a surfactant solution (Harvest Surfac-
tant, Harvest Dental, Brea, CA, USA) and dried
thoroughly with air. Make sure all the preparation
finish lines are well defined and visible, with no
bubbles or distortions present in this area (Figure 2).
LABORATORY TECHNIQUE
Die Preparation
The impression is now taken to the laboratory for
pouring and mounting. Undercuts or excess impres-
Figure 2. Final impression must be well defined and clean.
Figure 3. The impression is boxed with putty on the mesial and distal
of the tray.
sion material are removed with a sharp surgical
blade prior to boxing of the impression. The
impression is boxed with a polyvinyl siloxane putty
on the mesial and distal portions of the tray (Figure
3) to prevent the refractory investment from spilling
out over the ends of the tray.
To create the refractory die, the impression is
poured using a high heat micro-fine phosphate-
bonded investment material (Starvest, Emdin In-
ternational Corporation, Irwindale, CA, USA) rath-

Table 1: Powder-to-Liquid Ratios for Gold Castingsa

Casting Starvest Powder (g) Starvest High-Expansion Liquid (g) Distilled Water (g)
Inlays (one to four surfaces) 50.000 14.250-14.500 0.400
Onlays and crowns (partial or full) 50.000 14.750-15.000 0.400
Post and cores 50.000 13.850-14.250 0.400
a
The ratios may need adjusting according to the lot number of the investment being used at the time. Different lots of the investment can vary in physical characteristics
and may have different expansions. Adjust as needed by increasing or decreasing the weight of the expansion liquid (an increase of expansion liquid will cause more
expansion of the casting). Keep the weight of H2O constant. Small incremental changes of the high-expansion liquid can make significant changes in expansions of the
castings.

Page 91
124
er than conventional die stone. This finely ground
investment has a powder particle size of 5-7 microns
and produces a smoother cast surface, both inter-
nally and externally, than was possible in the past
with other investments. The older refractory in-
vestment powders had a larger particle size, which
may result in rougher surfaces and less precise
castings.12 Exactly 50 g of investment powder are
weighed out in a plastic container. A predetermined
weight of high-expansion colloidal silica mixing
solution (Emdin High-Expansion Liquid, Emdin
International), combined with a corresponding
weight of distilled water, is used for specific
preparation configurations (Table 1). The liquid
components are weighed to 0.001 g in a tared
vacuum-mixing bowl on a digital analytical scale.
Figure 5. (A): Lang Investpress. (B): Pressurize to 40 psi.
Operative Dentistry
Figure 4. Starvest phosphate-bond-
ed investment material (A) mixed
under vacuum (B) and poured into
the impression (C and D).
The investment powder is added and the mixture
spatulated in a digital vacuum mixer under vacuum
for 60-90 seconds at 450 rpm.
The investment is carefully poured and vibrated
into the impression. A small soft brush can be used
to paint investment into the preparation (Figure 4);
this may be helpful in avoiding bubbles on the
refractory die and adjacent surfaces. The remaining
investment is added until the preparation is
covered with 3-5 mm of investment. The poured
impression is immediately placed in a dry pneu-
matic pressurized curing unit (Investpres, Lang
Dental Manufacturing Co, Inc, Wheeling, IL, USA)
at a pressure of 40 psi for 30 minutes (Figure 5).
Allowing the investment to set under positive
pressure results in improved surface smoothness,
with fewer and smaller surface voids in the set
cast.13,14 Moreover, in our experience, the refracto-
ry dies are more resistant to abrasion by metal
waxing instruments, and the subsequent castings
appear to be smoother, enabling more efficient
polishing.
Following complete setting, the poured check-
bite tray impression is mounted on a quadrant
articulator (Monotrac V2, Monotrac Articulation,
Midvale, UT, USA). The articulator base is first
lubricated with a silicone separating medium (MS3
Master Separator, Harvest Dental, Table 2). Next,
a second batch of investment material is mixed to a
thicker consistency and poured into the articulator
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Smith & Diefenderfer: Direct Refractory Die Technique for Cast Gold Restorations 125

Figure 6. Monotrac articulator base

with a thick mix of investment.
Figure 7. Opposing arch poured and
mounted after the working arch hard-
ens.
Figure 8. Remove the flash and
plastic form from the articulator.
Figure 9. Lightly tap the base until a
small space is formed.
Figure 10. Use a separating disc to
create a slot in the base.
Figure 11. Gently separate the cast
from the articulator base.

base (Figure 6); exact measurement of the liquid-
to-powder ratio is not necessary for this step. A
portion of this mixture is placed on the exposed
hardened side of the investment in the impression.
The check-bite tray impression is now placed on
the articulator base and stabilized for 30 minutes
for hardening. The opposing arch of the impression
is then poured in a conventional die stone (Figure
7).
Separation of the refractory model from the
impression should be done carefully. First, remove

Figure 12. (A): Make a 4-5-mm-deep cut with a die saw on the proximal. (B): Section the remainder of the base with a separating disc.
Figure 13. Trim the die to expose the preparation finish lines and tooth emergence profiles.

Page 93
126
Figure 15. Contrasting bright opaque wax margin is applied first.
Figure 16. Final wax-up.
Figure 17. Section the refractory die and wax pattern from the base.
Operative Dentistry
Figure 14. (A): High-temperature
paint for the die spacer. (B): Applica-
tion of two to three coats creates a
matte finish.
the distal of the impression tray from the refractory
investment die/base. This will decrease the potential
for distortion of the metal tray and impression.
Break off the excess refractory investment and
plastic form from the articulator (Figure 8). Tap
with a small hammer lightly on the plastic base near
the articulator hinge to create a thin space between
the refractory investment base and the plastic base
(Figure 9). Next, use a large diamond separating disc
(Brasseler USA, Savannah, GA, USA) to place a
horizontal slot in the front of the refractory die base
where the plastic base and the investment meet
(Figure 10). Insert a Buffalo knife blade into the slot
and gently rotate back and forth to loosen and
separate the refractory die base from the articulator
base (Figure 11).
Remove the refractory die base from the articu-
lator base. Make a 4-5-mm-deep saw cut in the
proximal(s) (Figure 12A) and section the remaining
portion with a diamond- or glass-reinforced sepa-
rating disc (Dynex disc, 40 mm 3 0.5 mm, Renfert,
Hilzingen, Germany) from the underside of the
base (Figure 12B). Trim the die with a mounted
diamond stone and appropriate instruments to
expose the preparation finish lines and tooth
emergence profiles (Figure 13). Clean dies and
models with pressurized air to remove all refracto-
ry residue.
A high-temperature automotive paint (XTC, KBS
Coatings, Valparaiso, IN, USA; Figure 14A) is an
ideal die spacer. Mix 10%-20% refractory investment
powder thoroughly into the paint and apply to the
appropriate surfaces (pulpal floor and axial wall[s]
for inlays; pulpal floor, axial walls, and occlusal
portion for onlays; and the occlusal and axial walls
for extracoronal preparations]. Two or three coats
should be applied and allowed to dry completely; this
should produce a smooth matte rather than a glossy
finish (Figure 14B) and should provide approximate-
ly 25 microns of die relief, which is adequate space
for the luting agent (the material can also be used as
a block out for undercuts). It is not always necessary
Page 94
Smith & Diefenderfer: Direct Refractory Die Technique for Cast Gold Restorations
to place a die spacer in refractory inlay dies. When
carefully executed, manual relief of the inlay casting
axial walls and pulpal floor with a white stone can
provide space for a luting agent and relieve under-
cuts on cast inlays.
Wax-Up
Begin the wax-up by applying a thin line of bright-
orange–colored contrasting wax (Consequent, Yeti
Dental, Engen, Germany) to all finish lines of the
preparation (Figure 15). This is a block-out wax, but
works well to highlight the margins during the wax-
up of the restoration. The refractory die material is
very white, and most buildup waxes are too
translucent to enable detection of overextended
wax margins. This results in castings with overex-
tensions of gold on the margins. Next, apply a
sculpting wax (Thowax, Yeti Dental) to the remain-
der of the die. Finalize all external contours of the
127
Figure 18. (A): Sprue the wax pat-
tern and refractory die. (B and C):
Sprue through the die for one-surface
inlays.
wax pattern. Remove all excess wax at the cavosur-
face margins with a wax-carving instrument (DPT
Carver, Hu-Friedy, Chicago, IL, USA). Gently
smooth the wax pattern with an artificial soft sable
brush and carefully polish the axial surfaces and
margins with a microfiber lens cleaning cloth to
finish the wax pattern (Figure 16).
Investing the Wax Pattern
Using a diamond- or glass-reinforced separating
disc, section and cut the refractory die, with its wax
pattern in place, from the base 3 mm below the
existing margins (Figure 17). Keep the wax pattern
and die free of the refractory die residue by
frequently cleaning with pressurized air. If refrac-
tory residue is left on the wax pattern, a rough
surface will be produced on the casting. The wax
pattern is sprued on the contact areas or cusps of
full crowns, onlays, and multiple-surface inlays
Page 95
128
Figure 19. Attach the wax pattern and refractory die to the sprue
base.
Figure 20. Cover the refractory die and wax pattern with a second
(identical) mix of Starvest phosphate-bonded investment.
Figure 21. Break out the casting from the investment.
(Figure 18A). Single-surface wax patterns are often
sprued through the refractory die to the bottom of
the wax pattern (Figure 18B). This is accomplished
by boring a small hole(s) through the underside or
side of the refractory die to the underside of the wax
pattern. Attach the wax pattern/refractory die to a
3-5-mm length on a sprue base (Figure 19), then
place the investment forming ring on the sprue
Operative Dentistry
base, orienting the angle of wax pattern/refractory
die to be in the trailing position of the centrifugal
casting machine’s rotation. Index this position on
the ring former and the hardened investment for
orientation in the cradle of the centrifugal casting
machine.
The wax pattern/refractory die is now invested,
using the same phosphate-bonded investment
material (Starvest) as used for the refractory die.
Mix this investment using the same liquid:water:-
powder ratio and mixing protocol as used to make
the refractory die. If the component proportions
differ from that of the refractory die, the expansion
rates of the two investments will differ, possibly
producing cracks in the investment. Gently vibrate
and pour the investment into the ringless invest-
ment ring at an angle, covering the wax pattern/
die with 3-5 mm of investment (Figure 20). Place
the ring assembly into a dry Lang Investpres to a
pressure of 40 psi for 60 minutes. Setting of the
investment material under positive pressure may
result in the production of fewer surface irregu-
larities in the final casting.15 Remove the ring
assembly from the Lang Investpress and remove
the base and plastic ring former from the hardened
investment ring.
Burnout and Casting
Check to see that no flakes or residue of
investment are embedded in the sprue wax button
on the underside of the investment ring before
placing the investment ring into a calibrated
room-temperature burnout furnace. Place the
orientation mark on the investment facing toward
the oven door. Set the temperature rate at 78F per
minute to rise to a final temperature of 13508F.
After reaching the temperature of 13508F, hold the
temperature for 30 minutes before casting. The
total burnout time is approximately three hours
and 30 minutes.
Cast and allow the invested casting to bench cool
before divesting. Do not divest the casting with an
air abrasion unit. Break out the casting with a small
hammer in the palm of the hand or on a soft surface
(Figure 21). Place the casting in a plastic sealed
container containing a solution of 38% hydrofluoric
acid or substitute hydrofluoric acid (Figure 22). Place
the container in an ultrasonic cleaner and vibrate
until the investment is dissolved away. Check the
casting under magnification for any bubbles, under-
cuts, and artifacts; these can be carefully removed
with a white stone.
Page 96
Smith & Diefenderfer: Direct Refractory Die Technique for Cast Gold Restorations
A second pour of standard die stone is made to
fabricate the working master cast for fitting and
finishing of the casting (Figure 23). GC Fujirock
golden tan (GC America) is the preferred material
for this important step because it produces extreme-
ly accurate dies consistently across product lot
numbers, as verified by evaluations using machined
metal standardization dies (C. T. Smith, unpub-
lished data) and its proven record of success over
129
Figure 22. Casting before (A) and
after (B) acid divestment.
Figure 23. Working die.
years of use in R. V. Tucker Study Club sessions. Mix
30 g of stone with 6.4 g of distilled water for 30
seconds under vacuum using a digital vacuum
mixer. Pour and mount the impression on a Mono-
trac Articulator. After the stone has set, separate the
master model from the impression. Section and trim
the master die to expose margins and emergence
profiles as needed. The casting should be gently tried
on the master die. Evaluate the casting and master
Figure 24. (A-C): Try the restoration
on the working die. (D and E): Adjust
the rubs and pressure points.
Page 97
130
die for minute rubs or powder streaks, which
indicate small undercuts or pressure points on the
surfaces of the casting and die. These areas on the
casting are relieved with the Shofu Dura-White
stone (CN1 HP) and lightly abraded with a 27-lm
aluminum oxide air abrasive. The casting is placed
again on die with gentle pressure, and the sequence
of fitting, relieving, and air abrading of the internal
surface of the casting is repeated until the casting
seats completely and passively on the master die
(Figure 24).
When the casting has been completely seated on
the working model die, the proximal contact(s) can
now be adjusted to final form and fit. The final finish
and polish are completed. The casting is now ready
for clinical try-in, finishing, and cementation proce-
dures (Figure 25). Table 2 lists the materials and
equipment used throughout these procedures.
SUMMARY
The clinical and laboratory techniques described
here result in accurate, precise-fitting, and smooth
gold castings. Distortion of the wax pattern has been
eliminated because there is no removal of the wax
pattern from the die once it is waxed.5 The molten
Operative Dentistry
Figure 25. (A): Initial try-in of the
casting before cementation. (B-D):
Finished restoration.
gold alloy is cast directly onto the refractory die,
resulting in a casting that is the exact mirror image
of the die and tooth preparation. Every bur mark,
undercut, and detail will be reproduced on the
casting due to the micro-fine particle size of the
investment. Ultimately, when this technique is
utilized properly, a very predictable, consistent,
and precise casting will be obtained. This will save
chair-side time, reduce remakes and operator anxi-
ety, and increase both the quality of treatment and
patient satisfaction. In addition, the long-term
prognosis of the restoration is enhanced due to the
precise fit and marginal adaptation of these restora-
tions.16
This technique has been successfully employed
in several Tucker Study Club sessions, during
which various configurations of cast gold restora-
tions are prepared, fabricated on-site, and deliv-
ered over a three-day period. The technique has
demonstrated the potential to enable operators of
varying experience to efficiently produce and
deliver extremely precise, conservative restora-
tions with a very long functional prognosis (Figure
26).
Page 98
Smith & Diefenderfer: Direct Refractory Die Technique for Cast Gold Restorations 131

Table 2: Materials and Equipment

Product
Aquasil Ultra Heavy Type 2
Heavy Body PVS impression
material
Aquasil Ultra XLV Light Body
PVS impression material
Harvest Dental MS3 Master
Model Separator and Surfactant
Starvest Phosphate Bonded
Investment (High-Expansion
Green Liquid/Powder)
Investpres Pneumatic
Pressurized Curing Unit
Monotrac V2 Quadrant Articulator
Diamond Separating Disc
Dynex Glass-Reinforced
Separating Discs (40 3 0.5 mm)
XTC Xtreme Temperature
Coatings High-Temperature
Automotive Paint
Consequent Orange Wax
Grey Thowax (sculpturing wax)
DPT Carver
COE CheckBite Trays
GC Fujirock Golden Tan Die
Stone
Dura-White Stones (CN1 HP)
Elite HD soft putty
Practicum 200-Gram Digital
Analytical Balance
Whipmix/Jelrus Infinity L30 Digital Whip Mix Corporation
Burnout Furnace
Whipmix VPM Digital Vacuum
Mixer
Whipmix 60-Gram Ringless
Formers and Bases
Acknowledgements
All clinical and laboratory procedures and all photographs
were completed by the first author. The authors express their
deepest gratitude to Drs Warren K. Johnson and Melvin R.
Lund for reviewing this manuscript and, most importantly, for
Manufacturer
Dentsply Caulk
York, PA, USA
www.dentsply.com
Harvest Dental
Brea, CA, USA
www.harvestdental.com
Emdin International
Corporation
Irwindale, CA, USA
www.emdin.com
Lang Dental Manufacturing
Co, Inc
Wheeling, IL, USA
www.langdental.com
Monotrac Articulation
Midvale, UT, USA
www.monotrac.com
Brasseler USA
Savannah, GA, USA
www.Brasselerusadental.com
Renfert
Hilzingen, Germany
www.renfert.com
KBS Coatings
Valparaiso, IN, USA
www.KBS-Coatings.com
Yeti Dental
Engen, Germany Figure 26. Additional examples.
www.yeti-dental.com
Hu-Friedy, Inc
Chicago, IL, USA
https://www.hu-friedy.com their invaluable friendship, support, mentorship, inspiration,
GC America and encouragement.
Alsip, IL, USA
www.gcamerica.com Conflict of Interest
Shofu Dental Corporation The authors of this article certify that they have no
San Marcos, CA, USA proprietary, financial, or other personal interest of any nature
www.shofu.com or kind in any product, service, and/or company that is
Zhermack SpA presented in this article.
Badia Polesine, Italy
www.zhermack.com (Accepted 21 February 2016)
Sartorius
Göttingen, Germany REFERENCES
www.sartorius.us
1. Phillips RW, & Biggs DH (1950) Distortion of wax
Louisville, KY, USA patterns as influenced by storage time, storage temper-
www.whipmix.com ature, and temperature of wax manipulation Journal of
the American Dental Association 41(1) 28-37.
2. Fusayama T (1959) Factors and technique of precision
casting part I Journal of Prosthetic Dentistry 9(3)
468-485.
3. Jörgensen KD, & Ono T (1984) Distortion of wax crowns
Scandinavian Journal of Dental Research 92 253-256.
4. Finger W, & Oshawa M (1984) Accuracy of cast
restorations produced by a refractory die-investing
technique Journal of Prosthetic Dentistry 52(6) 800-803.

Page 99
132
5. Lund MR, & Shyrock EF (1967) Castings made directly to
refractory dies Journal of Prosthetic Dentistry 18(3)
251-256.
6. Kaplan I, & Newman SM (1983) Accuracy of the
divestment casting technique Operative Dentistry 8(1)
82-87.
7. Baum L, Phillips RW, & Lund MR (1995) Cast gold
restorations In: Baum L, Phillips RW, Lund MR (eds)
Textbook of Operative Dentistry 3rd edition WB Saun-
ders, Philadelphia 564-571.
8. Chana HS, Pearson GJ, & Ibbetson RJ (1997) A
laboratory evaluation of the construction of resin-bonded
cast restorations British Dental Journal 183(4) 130-134.
9. Rubin JG, & Sabella AA (1955) One-piece castings for
fixed bridgework. Journal of Prosthetic Dentistry 5 843-
847.
10. Abramowsky ZL (1960) Fixed partial dentures by one-
piece casting. Journal of Prosthetic Dentistry 10 938-945.
11. de Oliveira Correa G, Henriques GEP, Mesquita MF, &
Sobrinho LC (2006) Over-refractory casting technique as
an alternative to one-piece multi-unit fixed partial
Operative Dentistry
denture frameworks Journal of Prosthetic Dentistry
95(3) 243-248.
12. O’Brien WJ (1997) Gypsum products In: Dental Materials
and Their Selection 2nd edition Quintessence Publish-
ing, Chicago 51-77
13. Ryerson NV (2000) Effect of pressurized atmosphere on
void size and quantity in dental stone and fine-grained
phosphate-bonded investment Journal of Dental Tech-
nology 17(6) 13-15.
14. Tourah A, Moshaverinia A, & Chee WW (2014) Effects of
setting under air pressure on the number of surface pores
and irregularities of dental investment materials Journal
of Prosthetic Dentistry 111(2) 150-153.
15. Bedi A, Michalakis KX, Hirayam H, & Stark PC (2008)
The effect of different investment techniques on the
surface roughness and irregularities of gold palladium
alloy castings Journal of Prosthetic Dentistry 99(4)
282-286.
16. Donovan T, Simonsen RJ, Guertin G, & Tucker RV (2004)
Retrospective clinical evaluation of 1,314 cast gold
restorations in service from 1 to 52 years Journal of
Esthetic and Restorative Dentistry 16(3) 194-204.
Page 100
Operative Dentistry, 2008
©
Why Gold Castings
Are Excellent Restorations
W
e, in dentistry, still have choices to make. Probably,
at no time has the profession been offered so many
choices in patient treatment,
especially as it relates to restorative dentistry.
“Esthetic dentistry” has become a major focus in
recent years, and it is difficult to know if this interest
is generated by patients or by the dentist. In any case,
the quality of esthetic treatment is a major considera-
tion in restorative treatment today. Hopefully, white is
not the only consideration. Until recently, gold was con-
sidered to be the esthetic restorative for posterior teeth,
as it does not discolor the teeth and the color gold was
considered less objectionable than other materials. As
we have become more aware of esthetics in den-
tistry, we also have developed new techniques, even
with gold, which do not destroy the beauty of a smile.
For example, with the conception of the invisible onlay,
no longer does the buccal cusp of a maxillary premolar
need to be “shoed” with a mm or more gold. There is
renewed emphasis on intracoronal gold restorations,
which can be placed by showing no metal or, in some
cases, very little metal, by the proper design of cavity
preparations. We also show proper consideration of a
badly destroyed tooth by placing tooth-colored crowns,
rather than display so much metal. As new materials
and concepts evolve, dentists have learned to perform
very esthetic dentistry by using gold as a restorative.
As mentioned, I would hope that other considera-
tions, such as longevity of the restoration, would be
considered, along with proper contour, proper contacts
and maintenance of the occlusion. No material satisfies
these requirements as well as gold. Of all the attrib-
utes gold has to offer, the most valued is the longevity
of gold restorations.1 We would never tell a patient
when we seat an inlay or onlay, that we think it will
probably last for the patient’s lifetime. However, I have
seen countless patients whose teeth were restored with
gold 40 or 50 years ago, many without further treat-
ment than the original restorations.
When my oldest daughter was born, I took the occa-
sion to restore my wife’s teeth with gold, which had
amalgam on all posterior surfaces. (She was in the no-
Guest Editorial
fluoride generation.) Every tooth, except for a lower
second molar that fractured a cusp, has remained as
restored as it was originally done 60 years ago. Not a
single tooth is submarginal, leaking in contour or has
open margins or lacking proper contacts.
It is this type of experience that has caused me to list
the following reasons to support the use of gold cast-
ings.
DISADVANTAGES
1. Gold is Not Tooth-colored
The gold inlay or onlay is obviously not tooth-colored.
However, the filling is usually not objectionable,
because it is in the posterior part of the mouth, where
it is not normally visible. It would seldom, if ever, be
recommended for anterior teeth. The teeth should be
prepared in such a manner that the patient would not
display gold as they speak or smile.
2. Gold Restorations are More Expensive Than
Some Other Types of Fillings
Gold casting is more expensive than amalgam or com-
posite restorations. It requires two appointments: one
to prepare the cavity and a second to deliver. In addi-
tion, there is the expense of the laboratory fabrication
between preparation and delivery. The dentist must
design a cavity preparation with no undercuts, allow-
ing the casting to withdraw from the cavity, while ful-
filling all the other requirements of a good preparation.
There are many different preparation designs, depend-
ing on the extent and position of the lesion on the tooth.
Some things have made the process easier over the
years, including significant improvements in impres-
sion materials, which enable extremely accurate repro-
duction of the preparation for the laboratory. The actu-
al gold casting, which is an alloy that gives the most
advantageous properties to the metal, is fabricated in
the dental laboratory, providing the control necessary
to obtain a very accurate fit. The cost of the gold itself
is a minor expense and, although more effort and time
are necessary, the cost, when compared to the longevi-
ty of the restoration, suggests that it is not really more
expensive for the patient in the long run.
Page 101

3. Gold Castings Require Considerable Care, Skill
and Technique From the Operator
As with any dental procedure, the dentist must be
trained to accomplish successful gold restorations.
Knowledge and understanding are required, so that
the final restoration is accurate and fulfills all the
requirements of providing long-term function and serv-
ice. It is a fairly demanding procedure for the dentist
and is definitely not for someone who is not willing to
make the necessary effort.
ADVANTAGES
1. Gold Castings Will Not Break or Fracture
The gold casting will never break or fracture when
properly prepared. Silver amalgam, due to its brittle
nature, has a greater tendency to fail under load. This
is not to infer that dental amalgam is not a “perma-
nent” filling, but points out a greater propensity for
fracture in the mouth. Fracture does not seem to be a
significant problem with resin composites.
2. Gold Will Not Exhibit Marginal Wear of the
Material Itself
The gold casting maintains marginal integrity even
after many years of function. The composite filling,
though tooth-colored, gradually erodes away, which
may leave the enamel margins unsupported and prone
to chipping and wear.
3. Gold Has a Coefficient of Expansion Similar to
Tooth Structure
The favorable coefficient of expansion of the gold alloy,
as compared to that of the tooth, is important. The
tooth and restorative material shrink when exposed to
cold and expand with exposure to heat. Since the tem-
perature in the mouth varies from cold ice cream to hot
coffee, it is important that the filling material expands
and contracts to a similar extent as the tooth structure.
4. Gold Supports and Protects the Enamel Margins
of the Tooth
The gold casting can be placed so accurately in the
tooth that the enamel at the margin of the cavity is
supported, so that, as the patient functions, the enam-
el is protected from breakage. It is as if the gold braces
the enamel rods to prevent them from breaking down.
5. Gold Can Provide Precise, StableAnatomical Form
Returning a tooth to its normal, healthy form is ele-
mentary for any restoration. This produces a restora-
tion that allows proper function with opposing teeth
and allows food to pass over the dentition in a normal
chewing and grinding motion. The gold casting is made
in the laboratory from an accurate replica of the prepa-
ration and adjacent and opposing teeth. Since it is fab-
Operative Dentistry
ricated outside the mouth in a far more open environ-
ment, it is possible to create a final restoration that is
as close as possible to ideal.
6. Gold Restorations Can Be Finished to a Very
Smooth Surface
There are obviously advantages to having a highly pol-
ished restoration. It is much easier to accomplish this
in the laboratory, where we have much better access
and visibility and are not dealing with oral tissues and
fluids. The polish surface is less likely to accumulate
plaque and presents a more pleasing feel to the tongue.
7. Gold Does Not Flow or Change Shape
While it is true that gold is not likely to flow or change
shape in the mouth, the improvements in high copper
amalgams tend to make it less of a comparative factor
than it was 30 years ago.
8. Gold Does Not Absorb Oral Fluids
Saliva and other oral fluids will not penetrate the sur-
face of a gold casting. On the other hand, resin com-
posites are penetrated by oral fluids and occasionally
absorb enough so that there is a putrid smell when
they are removed.
9. Gold Does Not Oxidize in the Mouth
Gold fillings are of such a noble metal that they do not
oxidize or corrode as can amalgam fillings over time.
Resin composites also discolor over time, although they
would still be considered more esthetic for anterior
restorations.
10. Gold Does Not Produce Discoloration of the
Tooth
Gold castings do not produce discoloration of the tooth,
which may occur from ion penetration with silver
amalgams. Occasionally, if the tooth is very thin, the
gold may reflect through the enamel, but it does not
usually create any esthetic liability.
11. Gold Allows for Easier Formation of Proximal
Contacts
Since the anatomy of the tooth is carved as a wax pat-
tern in the dental laboratory, it is relatively easy to
simulate the broad contact area of a natural tooth. It is
also simpler to produce a well-rounded marginal ridge
that produces the appropriate occlusal spillways for
food movement during mastication.
12. Gold Is Esthetic
Before tooth-colored materials were available, gold was
often placed for esthetic reasons, particularly because
it does not discolor a tooth and has a “clean” look.
Today, dentists are careful to display as little gold as
possible by creating a cavity preparation that does not
extend out to visible areas of the tooth.
Page 102

Tucker: Why Gold Castings Are Excellent Restorations


13. Gold Castings Can Be Cemented 19. The Physical Properties of Gold
Success- fully Without Adhesive Bonding Support Long-term Occlusal Function
It is the opinion of some that time-tested zinc phos- with Minimal Thickness
phate cement is still the luting agent of choice for the The bonded composite changes dimensionally on both
cementation of castings, although glass ionomer polymerization and thermal cycling, often producing
cements are also used extensively. Since retention and micro-fractures in tooth structure. Amalgam apparent-
marginal seal are primarily obtained by minimally ly can produce some fracturing under the restoration.
tapered preparations, well-fitting castings, luting Both types of fracture can produce sensitivity to both
agents of minimal film thickness and precise finishing, thermal insult and pressure. This is not a factor with
the use of adhesive bonding is really unnecessary. gold fillings. Because of its physical properties, includ-
ing high tensile strength, gold can be placed in very
14. Cast Gold Restorations Allow Good thin layers, providing cuspal protection with minimal
Tissue Health removal of tooth structure.
A gold restoration is biotolerated extremely well by the
gingiva and supporting tissues. These restorations can 20. Gold Restorations Have Excellent Longevity
have imperceptible margins, with no discrepancies to Gold castings are usually relatively permanent. We
harbor plaque; gold is non-reactive and does not usu- often see gold restorations that have been in service for
ally contribute to allergic responses; and the smooth 40 or 50 years. The permanence of gold fillings is the
surface that is obtainable does not act as a primary most obvious reason for their use. If there were a “life-
irritant nor does it produce gingival inflammation. In time” restoration, gold casting would be it.
addition, many patients report increased comfort and
note how the smooth tooth/restoration margins are not
detectable. Richard V Tucker

1
15. Gold Restorations Do Not Abrade the Masters of Esthetic Dentistry
Retrospective Clinical Evaluation of 1,314 Cast Gold Restorations
Opposing Dentition
in Service from 1 to 51 years
The gold casting does not wear or abrade teeth in the Terry Donovan, DDS RJ
opposing arch when the patient masticates or grinds Simonsen, DDS, MS G
his or her teeth, as porcelain is likely to do over a peri- Guertin, DDS, MSEd RV
od of time. Composites can also produce wear, as filler Tucker, DDS

particles are liberated and contribute to three-body
abrasion.


16. There Is No Mercury in Gold Casting
Alloys

Many studies have attested to the fact that mercury, as
used in amalgam fillings, is not a health hazard for

patients. However, for those individuals who still have
concerns with mercury, gold is an obvious choice.


17. Wear of the Gold Restoration Is Similar
to Normal Wear of Tooth Structure

The gold alloy used in inlays, onlays and crowns is of a

hardness that is compatible with tooth structure. It is
soft enough that it will wear slightly over time as nat-
ural teeth wear, so, the result is similar to natural

equilibration over a period of time. As the teeth “flat-
ten” with age, so does the gold.


18. Gold Does Not Liberate Toxins

There have been studies that indicate a release of tox-
ins from resin restorations of an estrogenic nature.

This has been essentially discounted as a health haz-
ard but, like mercury, gold may be the material of

choice for concerned patients.
Richard V Tucker

Page 103