The dilemma that I face when recommending these restorations (which I have had placed in my own teeth) has to do with the intent residing within the oath I signed upon becoming a dentist which states, “First, Do No Harm…” in juxtaposition to the patient’s desire to have natural tooth color, which is understandable. I know that when I drill off a lot of tooth structure I may be inviting a root canal treatment which could occur around treatment time, or delayed, maybe for years. And a root canal treatment on a back tooth is not a guarantee of its safety for the future. I have seen many back teeth fracture underneath the best of crowns requiring the tooth’s removal. Now we’re looking at an extraction, root replacement implant and new crown.
Some of the new porcelain materials are stronger, look great and fit better than those of the past, however they haven’t as yet compiled the track record of gold which has been used for over 100 years. However, in most cases, mercury amalgam fillings can be replaced with conservative cast gold restorations in a very inconspicuous manner.
I believe that it is very important to consider all parameters involved when making decisions concerning the health and longevity of one’s oral system, not only regarding safety in removing mercury amalgam fillings, but the type of materials used in replacing them, the quality of the dental laboratory, and the individuality of the patient. I want to honor my patient’s desires, however I also want their decisions to be influenced by facts that will allow them to make a properly informed one prior to even taking the first step.
*Dr. McBride received awards for excellence in gold technology in dental school and has been trained by Dr. Richard V. Tucker as a member of the Richard V. Tucker Study Club.
“I trusted Dr. McBride’s judgment from the beginning in his dental recommendations. I had a lot of cavities as a teenager and young adult, and first of all he taught me how to stop getting them. Then he restored my teeth with conservative cast gold restorations which he said would be least traumatic to the teeth nerves and the most long lasting treatment available if done properly. I guess they were in that they have kept my teeth strong and healthy for over 30 years and I have had no cavities, re-treatment of his work or root canals on any of my teeth since I started with him. I love my smile – you can’t see any of the gold –but what’s more, they will probably last a lifetime. Treatment that’s done right the first time pays off year after year and is one of the best investments I’ve ever made in my health. Thank you Dr. McBride.” –Pam R.
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.