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Medical Forum / General / Dentistry / August 2005Gold or porcelain onlays
I have to replace an amalgam filling in my upper molar that is large. From what I understand, one option is to have the tooth reconstructed with a porcelain or gold onlay, rather than a composite "white" filling for durability. My question is, would a gold inlay filling be an option, rather than the onlay? Isn't gold as strong as the amalgam? If I have the reconstruction, should I choose gold over the porcelain? I would like to keep as much of the tooth as possible and to use the more friendlier material for tooth enamel. Thanks rtwin Depends on the tooth and the condition of the tooth. One procedure I love is Steve Mancuso's CEREC cad-cam dental restoration, that is prepared, constructed, and cemented in one visit. Can someone please e-mail this to Steve, just in case he is off-line right now? Joe -- Joel34 Not to steal Steve's thunder, but as a little coming attraction, here i an image as seen by the CEREC device. The CEREC sees the image of th prepared tooth and designs a restoration which will be subsequentl milled in the milling chamber. The restoration is milled from porcelain block. CAD-CAM means computer aided design/ computer aiding milling. Joel . [image: http://tinypic.com/b4au6o.jpg] . PS- There's still time to get some popcorn and candy at our refreshmen stand before our main feature begins ....... STEVE! Where are you? I need your help. http://tinypic.com/b4au6o.jp -- Joel34 > Not to steal Steve's thunder, but as a little coming attraction, here is > an image as seen by the CEREC device. The CEREC sees the image of the [quoted text clipped - 18 lines] > > http://tinypic.com/b4au6o.jpg Thanks for the information Joel. I'll do my research on CEREC. Rob Thanks. By the way, gold is traditionally the best restorative material but the CEREC opens an entire new technology. Joe -- Joel34 >I have to replace an amalgam filling in my upper molar that is large. > From what I understand, one option is to have the tooth reconstructed [quoted text clipped - 9 lines] >Thanks >rtwin Gold compared to laboratory fired porcelain onlay, the gold is better. Gold compared to machine milled ceramic, the porcelain is better. I would not recommmend doing a large filling in composite or amalgam. If you like jewlery in your mouth, opt for gold. If you like teeth which look and feel natural, choose *machine-milled* ceramic. This is my opinion based on my personal experience, the experience of the other dentsits I have spoken with, and the research articles that Ihave read in the past 6 years. > Gold compared to laboratory fired porcelain onlay, the gold is better. > Gold compared to machine milled ceramic, the porcelain is better. I > would not recommmend doing a large filling in composite or amalgam. Do I have the option of a filling rather than the onlay? If yes, should I have it filled with the machine-milled ceramic or with gold? > If you like jewlery in your mouth, opt for gold. If you like teeth > which look and feel natural, choose *machine-milled* ceramic. Would like to save a much of the tooth as possible and use the most friendly filling for the enamel. > This is my opinion based on my personal experience, the experience of > the other dentsits I have spoken with, and the research articles that > Ihave read in the past 6 years. Thank you much for your expert/experienced advise. Much appreciated. How would I possibly know about your particular specifics from an internet description? IF it is "large", then a filling is not adequate for long term service. I prefer machine milled ceramic (CEREC), but then again I have a bias based on 6 years of using this stuff.I have found this material to be much kinder to tooth structure than gold. >> Gold compared to laboratory fired porcelain onlay, the gold is better. >> Gold compared to machine milled ceramic, the porcelain is better. I [quoted text clipped - 14 lines] > >Thank you much for your expert/experienced advise. Much appreciated. Dr. Steve, How is a CEREC or a Cad-Cam milled all ceramic restoration kinder to the tooth than gold? Flap http://flapsblog.com >Dr. Steve, > [quoted text clipped - 4 lines] > >http://flapsblog.com Non-glazed (but polished) porcelain is almost equal in wear characteristics to enamel. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>Dr. Steve, >> [quoted text clipped - 6 lines] > >Non-glazed (but polished) porcelain is almost equal in wear characteristics to enamel. Closer to enamel in wear characteristics and in thermal expansion-contraction than gold. >>>Dr. Steve, >>> [quoted text clipped - 9 lines] > Closer to enamel in wear characteristics and in thermal > expansion-contraction than gold. Really? I'm not doubting you, just that I'd always understood that no dental material was closer to tooth structure in wear and cfe than gold. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>>>Dr. Steve, >>>> [quoted text clipped - 14 lines] > >Steve That was true in the 1980's. It is no longer the case. If you glaze the machine milled ceramic, then it gets almost as hard as laboratory fired porcelain. But,,,,,,,,,,, polished, the ceramic has a surface hardness between gold and tooth (closer to tooth than gold). ``````````````````````` Stephen (What's a temporary?) ~~~~~~~~~~~~~~~~~~~~~ Dr. Steve, This is quite a claim and I do not believe it is supported by the peer reviewed literature. But, if you have a study or a paper I would be glad to consider it. Here is a link to a Canadian Dental Association Paper: http://www.cda-adc.ca/jcda/vol-64/issue-8/580.html#8 And if you polish a Cad-Cam milled porcelain restoration what do you do about aesthetics? All restorations have their indications and I do not want to appear to bag on just Cerec Cad-Cam restorations because Empress and other porcelains will wear teeth as well. Flap http://flapsblog.com There's an article which discusses enamel wear characteristics here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9 699442&dopt=Abstract "CONCLUSIONS: It was concluded that the hydrothermal and the machinable ceramics were significantly less abrasive and more resistant to wear than the conventional aluminous and bonded porcelains. Gold was the least abrasive material and most resistant to wear, although the difference in wear between the machinable ceramic and gold was not statistically significant." Thanks for the citation LetsConnect, This study was based on 50 extracted teeth in a wear machine back in 1998. This was an in vitro study conducted in Jordan. The paper is interesting but not very credible. My clinical observations of over 27 years is that porcelain wears the opposing dentition and gold does not. Unglazed or broken porcelain significantly wears natural teeth and gold alike. Dr. Steve, do you have any Cerec studies over a few years regarding attrition of opposing dentition? And glaze vs. non-glaze Cerec restorations? Thanks Letsconnect. Flap http://flapsblog.com > Thanks for the citation LetsConnect, > > This study was based on 50 extracted teeth in a wear machine back in > 1998. This was an in vitro study conducted in Jordan. Unfortunately, that was the closest to a controlled experiment I could come up with on pubmed. I realize that research into this area is sadly lacking. From what I've read, I would deduct that cerec restorations are kinder to opposing teeth than lab porcelain, but not quite as good as gold. Letsconnect, I am struggling a bit with the format here at SCM so forgive me if I appear a bit disjointed. I just posted a link to a Canadian Dental Association Study: http://www.cda-adc.ca/jcda/vol-64/issue-8/580.html#8 It appears more recent but I will await some papers from Dr. Steve, who may be up on the latest about Cerec Cad-Cam porcelains. Again, I am not bagging on Cerec or Cad-Cam I just want to make sure what the indications for all porcelain crowns are in the posterior area. If they wear the opposing teeth like conventional porcelains or a little better that is one thing. If they are like gold then that is a "new" finding. Flap http://flapsblog.com >>Dr. Steve, >>How is a CEREC or a Cad-Cam milled all ceramic restoration kinder to >>the tooth than gold? >>Flap >>http://flapsblog.com >Non-glazed (but polished) porcelain is almost equal in wear characteristics to enamel. Closer to enamel in wear characteristics and in thermal expansion-contraction than gold. My reply : This has not been my long-time clinical experience. Porcelain wears the opposing dentition. Gold does not. Do you have a peer reviewed reference that supports your statement? Thanks, Flap http://flapsblog.com >>>Dr. Steve, > [quoted text clipped - 22 lines] > >http://flapsblog.com I would have to hunt for it, but it is there. Now,,,,,,, remember that I am referring to polished ceramic, not glazed and fired. This material is not the same as laboratory produced porcelain. The factory can vary the chemistry, the firing temperature, pressure, time etc. and the factory can standardize this process. They do this and engineer the characteristics into the ceramic that they desire. They fire a huge sheet of this stuff at one time, then mill it into small blocks. Also,,,,,,,,,,,,, the ceramic blocks are only fired one time, as compared to laboratory porcelain which gets fired a few times at various stages. ``````````````````````` Stephen (What's a temporary?) ~~~~~~~~~~~~~~~~~~~~~ >>>Dr. Steve, >>>How is a CEREC or a Cad-Cam milled all ceramic restoration kinder to >>>the tooth than gold? >>>Flap >>>http://flapsblog.com >>Non-glazed (but polished) porcelain is almost equal in wear characteristics to enamel. >Closer to enamel in wear characteristics and in thermal >expansion-contraction than gold. >My reply : >This has not been my long-time clinical experience. Porcelain wears the >opposing dentition. Gold does not. >Do you have a peer reviewed reference that supports your statement? >Thanks, >Flap >http://flapsblog.com I would have to hunt for it, but it is there. Now,,,,,,, remember that I am referring to polished ceramic, not glazed and fired. This material is not the same as laboratory produced porcelain. The factory can vary the chemistry, the firing temperature, pressure, time etc. and the factory can standardize this process. They do this and engineer the characteristics into the ceramic that they desire. They fire a huge sheet of this stuff at one time, then mill it into small blocks. Also,,,,,,,,,,,,, the ceramic blocks are only fired one time, as compared to laboratory porcelain which gets fired a few times at various stages. ``````````````````````` Stephen (What's a temporary?) Flap's reply: Dr. Steve, I would like to see the study or studiesand whether it is a longitudinal study (over how many years). Pascal Magne at USC told me that you cannot get around the wear factor with porcelain, Cerec, CAD-CAM or not. Now, if you do not glaze a Cerec are they not unaesthetic? I have seen quite a few not refired/or glazed and you never could use one say anterior to a second premolar. They just look dull. Flap http://flapsblog.com Has to do with surface hardness, modulus of elasticity, thermal coefficient of expansion, not wearing a leaking provisional for 2-3 weeks, not being exposed to exothermal changes during provisional fabrication, to not having separate cores, and to completing the entire tratment in 90 minutes. Steve [What's a temporary?] >Dr. Steve, > [quoted text clipped - 4 lines] > >http://flapsblog.com >If you like jewlery in your mouth, opt for gold. If you like teeth >which look and feel natural, choose *machine-milled* ceramic. Please... can you post a reference to *machine-milled* ceramic. techniques. Is this a technique in common practice.? >>If you like jewlery in your mouth, opt for gold. If you like teeth >>which look and feel natural, choose *machine-milled* ceramic. > >Please... can you post a reference to *machine-milled* ceramic. >techniques. Is this a technique in common practice.? Very common in my practice. Google for CEREC. You will find a lot of stuff out there. |
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