The type of protective restoration most frequently placed is a porcelain crown. Yet,the most frequently root canalled teeth are those with porcelain crowns. This is because, along with the accumulated traumas earlier described, a porcelain crown requires that 35 – 40% additional healthy tooth structure be removed circumferentially as well from top down to make room for the porcelain and underlying metal or zirconium materials fabricated within it that give it strength. This causes a lot of pulp/nerve trauma, as the surface of the tooth at its neck area just above the gum needs to be cut into deep enough around its base to provide strength of material. This area - 360 degrees around the base of the tooth - is especially close to its nerve.
Back teeth can generate more than 500 pounds per square inch biting pressure, so the ideal material would be one that is strong enough to withstand these forces without being very thick in the interest of tooth structure conservation, and this is - hands down - gold. Any good dentist will tell you that well-placed conservative cast gold restorations are the best of the lot, bar none, in that they are kindest to teeth from several perspectives:
- A high quality gold restoration is alloyed for strength and wear qualities that simulate that of tooth structure – they don’t break! A gold crown can be thin and strong and requires less than half the tooth structure removal as that required for a porcelain crown.
- High quality gold restoration will wear at the same rate as natural tooth structure. Porcelain essentially is glass, and if its biting surface opposes a natural tooth, the glass will always “win” and wear the opposing tooth structure.
- Gold does not have to completely cover the tooth, and a dentist trained* in conservative cast gold restorative technology can engineer restorations that remove very little good tooth structure, will strengthen the tooth, minimize drilling trauma and have the potential to last a life time.
- My experience of teeth with porcelain crowns needing root canals compared to those with conservative cast gold restorations is around 100 to 1.
- Many people “don’t want gold,” especially here in California compared for example to people in the Pacific Northwest where they don’t seem to be as concerned with the gold color. It is interesting to note that in those areas there aren’t as many root canal dentist specialists per general dentist as there are in California.