17

Direct Gold Restorations

GREGORY E. SMITH

D
irect gold is a gold restorative material that is manufactured into pieces, and wrapped in No. 4 or No. 3 foil (see Fig. 17.3B).
for compaction directly into prepared cavities. Two types Several sizes of these pellets are available. his product is marketed
of direct gold are manufactured for dental use: gold foil as Williams E-Z Gold (Ivoclar-Williams, Amherst, NY).
and powdered gold. hese gold materials difer in their metallurgic
structure. Coheion and Degaing
Pure gold has been in use in dentistry in the United States for
more than 100 years.1-6 Various techniques have been advanced Direct gold is inserted into tooth preparations under force. he
for its use in the restoration of teeth. It is generally agreed that purpose of the force is to weld the gold into restorations containing
this noble metal is a superior restorative material for treatment of minimal porosity or internal void spaces.9-11 Welding occurs because
many small lesions and defects in teeth, given sound pulpal and pure gold with an absolutely clean surface coheres as a result of
periodontal health. Success is achieved with direct gold restorations metallic bonding. As the gold is forced and compressed into a
if meticulous care is given to an exacting technique in tooth tooth preparation, succeeding increments cohere to those previously
preparation design and material manipulation. Direct gold restora- placed. For successful welding to occur during restoration, the
tions can last for a lifetime if attention is paid to details of restorative gold must be in a cohesive state before compaction, and a suitable,
technique and to proper home care. he longevity of direct gold biologically compatible compacting force must be delivered.
restorations is a result of the superb biocompatibility of gold with Direct gold may be either cohesive or noncohesive. It is non-
the oral environment and its excellent marginal integrity. cohesive in the presence of surface impurities or wax, which prevents
his chapter discusses the various forms of direct gold presently one increment of gold from cohering to another. he manufacturer
available and explains the principles required for their manipulation. supplies books of gold foil or prerolled cylinders in a cohesive or
he principles of tooth preparation are reviewed as they are applied noncohesive state. E-Z Gold pellets are supplied with a wax coating
to direct gold restorations. Class I, V, and III preparations and that must be burned of before compaction.
their restoration are considered in detail. Because gold attracts gases that render it noncohesive, such
gases must be removed from the surface of the gold before dental
Material and Manufacture compaction. his process usually is referred to as degassing or
annealing and is accomplished by application of heat. he term
Several physical types of direct-illing gold have been produced.7 degassing is preferable because the desired result is to remove residual
All are “compactable” in that they are inserted into tooth prepara- surface contamination (although further annealing, resulting in
tions under force and compacted or condensed into preparation additional internal stress relief or recrystallization, also may occur
line and point angles and against preparation walls. in this process). All direct-filling gold products are degassed
he gold foil referred to in the restorative sections of this chapter immediately before use except when noncohesive foil is speciically
is in pellet form (Figs. 17.1 and 17.2). Each piece is placed on desired. Underheating during degassing should be avoided because
clean ingertips, and the corners are tucked into the center (see it fails to render the gold surface pure. Overheating also should
Fig. 17.1B and C), and then the foil is lightly rolled into pellet be avoided because it may cause the gold to become brittle or melt
form (see Fig. 17.1D). In addition, cylinders of gold foil may be and render it unusable. Degassing is accomplished by heating the
rolled from the segments of a sheet (see Fig. 17.1A). After pellets gold foil on a mica tray over a lame or on an electric annealer or
of gold are rolled, they may be conveniently stored in a gold foil by heating each piece of gold over a pure ethanol lame (Fig. 17.4).
box (see Fig. 17.2), which is divided into labeled sections for he advantage of the technique involving use of the pure ethanol
various sizes of pellets. Cylinders of foil and selected sizes of other lame is that each piece of gold is selected and heated just before
types of gold also may be stored in the box. Preferential contamina- insertion, and waste of gold is avoided. A careful technique is
tion is suggested by placing a damp cotton pellet dipped into 18% needed to degas an increment of gold in the lame correctly. he
ammonia into each section of the box. his serves to prevent deleteri- gold is passed into the blue inner core of the lame on the tip of
ous oxides from forming on the gold until it is used. a foil-passing instrument and held just until the gold becomes
Powdered gold is made by a combination of chemical precipita- dull red, and then the instrument is withdrawn from the lame.
tion and atomization, with an average particle size of 15 mm (Fig. After a few seconds are allowed for cooling, the gold is placed in
17.3A).8 he atomized particles are mixed together in wax, cut the preparation. Although any of the three degassing procedures

e69
e70 C HA P T E R 1 7 Direct Gold Retoration

A B

C D

• Fig. 17.1 A, 10 × 10 cm (4 × 4 inch) book of foil marked for cutting and rolling into pellets of various
sizes. B and C, Corners of foil piece are tucked into center. D, Foil is rolled into a completed pellet. (A,
Courtesy Terkla and Cantwell.)

A technique preferred by many clinicians uses a hand mallet

to deliver light blows to a condenser held by the dentist (Fig.
17.5A). his technique allows great control of malleting forces
when variations are called for, and it allows for rapid change in
condenser nibs, or tips, when a multitude of condensers is required.
In any case, a suitable condenser must be stepped over the gold
systematically to achieve a dense, well-compacted restoration (see
Fig. 17.8 later in the chapter).
Condensers are designed to deliver forces of compaction to
direct gold. Condensers used in the handpieces of the Electro-Mallet
or pneumatic mallet consist of a nib, or working tip, and a short
shank (approximately 2.5 cm in length) that its into the malleting
handpiece. Condensers used with the hand mallet are longer
(approximately 15 cm) and have a blunt-ended handle that receives
light blows from the hand mallet.
• Fig. 17.2 Gold foil box. Compartments are labeled to show pellet size. Condenser nibs are available in several shapes and sizes (see
Fig. 17.5B). All have pyramidal serrations on the nib faces to
prevent slipping on the gold. Condensers described in this chapter
is satisfactory for gold foil, this is not the case for E-Z Gold. he are (1) the round condensers, 0.4 to 0.55 mm in diameter; (2)
E-Z Gold pellet must be heated 1 2 to 2.5 cm (1 inch) above the the Varney foot condenser, which has a rectangular face that is
ethanol lame until a bright lame occurs (caused by ignition of approximately 1 to 1.3 mm; and (3) the parallelogram condensers,
the wax) and the pellet becomes dull red for 2 to 3 seconds, then which are used only for hand pressure compaction and have nib
it is withdrawn from above the lame. faces that measure approximately 0.5 to 1 mm.
Condenser shanks may be straight, monangled, or ofset, and
Principle of Compaction their nib faces may be cut perpendicular to the long axis of the
handle or perpendicular to the end portion of the shank (Fig. 17.6).
Direct-illing gold must be compacted during insertion into tooth he smaller the nib face size (i.e., area), the greater the pounds
preparations.12 With the exception of E-Z Gold, the compaction per square inch delivered (given a constant malleting force). If the
takes the form of malleting forces that are delivered either by a nib diameter is reduced by half, the efective compaction force in
hand mallet used by the assistant or by an Electro-Mallet (McShirley pounds per square inch is four times greater (because the area of
Products, Glendale, CA) or a pneumatic mallet used by the dentist. a circle is proportional to the square of the diameter). For most
E-Z Gold, because of its powdered form, may be compacted by gold, the 0.4- to 0.55-mm diameter nibs are suitable. Smaller
heavy hand pressure delivered in a rocking motion with specially condensers tend to punch holes in the gold, whereas larger ones are
designed hand condensers.13,14 Successful malleting of the gold foil less efective in forcing the gold into angles in the tooth preparation.
may be achieved with any of the currently available equipment. Two fundamental principles involved in compaction of cohesive
Some operators prefer the Electro-Mallet or the pneumatic mallet gold are to (1) weld the gold into a cohesive mass and (2) wedge
because a dental assistant is not required for the procedure. as much gold as possible into the tooth preparation.15 Welding
 CHAPTER 17 Direct Gold Retoration e71

A B

• Fig. 17.3 Scanning electron micrographs of direct-illing golds. A, Spheres of E-Z Gold. B, Wrapped
E-Z pellet that contains spheres. (Courtesy Ivoclar-Williams Company, Inc., Amherst, NY.)

A B C

• Fig. 17.4 A, Pellet of gold foil is degassed in pure ethanol lame. B, Mica tray mounted over alcohol
lamp for degassing several increments of gold simultaneously. C, Gold foil degassed on an electric
annealer. (Courtesy of Terkla and Cantwell.)

A B

• Fig. 17.5 A, Hand mallet and condensers used for hand mallet compaction of direct gold. B, Selection
of variously shaped nibs. Left to right, Three round-faced nibs, oblique-faced nib, foot condenser, and
rounded rectangular nib. (A, Courtesy of Terkla and Cantwell.)
e72 C HA P T E R 1 7 Direct Gold Retoration

5
c
4
3
2
1

A B b

• Fig. 17.6 A, Oblique-faced condenser with the nib face established • Fig. 17.8 Diagrammatic order of compaction for increment of direct-
perpendicular to long axis of handle and perpendicular to line of force (a). illing gold. Condensers are moved across surface of gold in an orderly
B, Conventional monangle condenser; the nib face is not perpendicular stepping motion. Each succeeding step of the nib overlaps the previous
to line of force (b); the condenser nib face is established perpendicular to one by at least half of the nib face diameter. Condensation begins at
end portion of shank rather than perpendicular to handle (c). position 1 and moves to the right, then resumes at 2 and repeats move-
ment to the right. Finally, it continues in rows 3, 4, and 5.

• Fig. 17.7 Compacted gold foil. Linear channels are evident between
creases in the foil pellet. Dark spots are void spaces in the compacted
mass.

takes place primarily as a result of the coherence of the noble metal

a
to itself. Wedging results from careful compacting technique.
Regardless of the technique used, some bridging occurs, resulting • Fig. 17.9 Line of force (a) remains parallel with the shaft or handle of
in void spaces not only in the compacted gold but also along the the condenser, regardless of any angles in the shank of the instrument.
preparation walls. Success depends on minimizing these voids,
particularly on the surface of the restoration and at the cavosurface
interface, where leakage to the internal aspects of the restoration the condenser overlaps (by half ) the previous one as the condenser
may begin. Gold foil compacts readily because of its thin form is moved toward the periphery (Fig. 17.8). he gold moves under
and produces a mass with isolated linear channels of microporosity the nib face of the condenser, efecting compaction as malleting
(Fig. 17.7). Because the thin folds of the gold pellet weld to each proceeds.
other, the remaining channels of microporosity do not appear to he most eicient compaction occurs directly under the nib
be entirely conluent with one another. face.15 Some compaction also occurs by lateral movement of the
It is recommended that compaction of E-Z Gold be done by gold against surrounding preparation walls. he result of compaction
hand pressure. As compaction is performed, the bag of atomized is to remove most of the void space from within each increment
gold is opened and the spheres of gold powder move over one of gold, to compact the gold into line and point angles and against
another and against the preparation walls. Heavy and methodic walls, and to attach it to any previously placed gold via the process
hand pressure with the condensers is required to compact this of cohesion.16
form of gold efectively. he line of force is important when any gold is compacted.
he line of force is the direction through which the force is delivered
Compaction Technique for Gold Foil (i.e., the direction in which the condenser is aimed) (Fig. 17.9).
Speciic instructions regarding line of force are given in subsequent
Compaction begins when a piece of gold is placed in a tooth sections as they relate to the restorations.
preparation. he gold is irst pressed into place by hand, then a Research has shown that a biologically acceptable pulpal response
condenser of suitable size is used to begin malleting in the center occurs after proper direct gold procedures.17 Care is required when
of the mass (often this is done while this irst increment is held condensing forces are applied to preclude pulpal irritation. he
in position with a holding instrument). Each succeeding step of Electro-Mallet is an acceptable condenser if the manufacturer’s
 CHAPTER 17 Direct Gold Retoration e73

instructions for mallet intensity are followed. Correct hand-malleting Indication and Contraindication
technique requires a light, bouncing application of the mallet to
the condenser, rather than delivery of heavy blows. Class I direct gold restorations are one option for the treatment
of small carious lesions in pits and issures of most posterior teeth
Compaction Technique for E-Z Gold and the lingual surfaces of anterior teeth. Direct gold also is indicated
for treatment of small, cavitated Class V carious lesions or for the
Using an amalgam condenser or a gold foil condenser, the irst restoration, when indicated, of abraded, eroded, or abfraction areas
pellet of E-Z Gold is pressed into the depth of the tooth preparation on the facial surfaces of teeth (although access to the molars is a
and tamped into position. A small condenser is selected to thrust limiting factor). Class III direct gold restorations can be used on
and wedge the gold into opposing line angles and against opposing the proximal surfaces of anterior teeth where the lesions are small
walls, to secure the mass in the preparation. Additional pellets are enough to be treated with esthetically pleasing results. Class II
added (one at a time, banking against the preparation walls) until direct gold restorations are an option for restoration of small cavi-
the entire preparation is illed. To avoid creation of large void tated proximal surface carious lesions in posterior teeth in which
spaces in the restoration, a dense, fully condensed surface is obtained marginal ridges are not subjected to heavy occlusal forces (e.g.,
with each pellet before subsequent pellets are added. the mesial or distal surfaces of mandibular irst premolars and the
mesial surface of some maxillary premolars). Class VI direct gold
restorations may be used on the incisal edges or cusp tips. A
Principle of Tooth Preparation for Direct defective margin of an otherwise acceptable cast-gold restoration
also may be repaired with direct gold.
Gold Retoration Direct gold restorations are contraindicated in some patients
whose teeth have very large pulp chambers, in patients with severely
Fundamental of Tooth Preparation periodontally weakened teeth with questionable prognosis, in
he principles of tooth preparation for all direct gold restorations patients for whom economics is a severely limiting factor, and in
demand meticulous attention to detail for success. Failure to give handicapped patients who are unable to sit for the long dental
attention to outline form may result in an unsightly restoration appointments required for this procedure. Root canal–illed teeth
or, at the least, one in which cavosurface deiciencies are immediately are generally not restored with direct gold because these teeth are
obvious. Poor resistance form can result in tooth fracture; inadequate brittle, although in some cases gold may be the material of choice
retention form may result in a loose restoration that is frustrating to close access preparations (for root canal therapy) in cast-gold
to the dentist. Lack of detailed convenience form may render an restorations.
otherwise excellent tooth preparation unrestorable. he preparation
must be smoothed and debrided to permit the irst increments of Tooth Preparation and Retoration
gold to be stabilized.
he margins in outline form must not be ragged. hey are his section presents the preparation and the restoration of Class
established on sound areas of the tooth that can be inished and I, V, and III lesions. he preparations described may be restored
polished. he outline must include all structural defects associated entirely with pellets of gold foil, or E-Z Gold may be used. If
with the lesion. he marginal outline must be designed to be powdered gold is selected, heavy hand pressure compaction may
esthetically pleasing because the inal restoration may be visible. be substituted for hand mallet or automatic mallet techniques.
Resistance form is established by orienting preparation walls Class I and V E-Z Gold restorations may be veneered with gold
to support the integrity of the tooth, such as a pulpal wall that is foil pellets, if desired. he Class III tooth preparation discussed
lat and perpendicular to occlusal forces. All enamel must be in this chapter is recommended by Ferrier, and only pellets of gold
supported by sound dentin. Optimally placed axial or pulpal walls foil are used for the restoration. All tooth preparations and restorative
promote the integrity of the restored tooth, providing a suitable procedures are accomplished after a suitable ield of operation has
thickness of remaining dentin. been achieved (usually by application of rubber dam).
he retention form is established by parallelism of some walls
and by strategically placed converging walls (as described in detail Cla I Tooth Preparation and Retoration
for each tooth preparation). In addition, walls must be smooth
and lat where possible (to provide resistance to loosening of the Tooth Preparation Design
gold during compaction), and internal line angles must be sharp he marginal outline form for the Class I tooth preparation for
(to resist movement). Internal form includes an initial depth into compacted gold is extended to include the lesion on the tooth
dentin, ranging from 0.5 mm from the dentinoenamel junction surface treated and any issured enamel. he preparation outline
(DEJ) in Class I preparations to 0.75 mm from cementum in may be a simple circular design for a pit defect or it may be oblong,
Class V preparations. triangular, or a more extensive form (if needed to treat a defective
Optimal convenience form requires suitable access and a dry issure) (Fig. 17.10A). Preparation margins are placed beyond the
ield provided by the rubber dam. Access additionally may require extent of pits and issures. All noncoalesced enamel and structural
the use of a gingival retractor for Class V restorations or a separator defects are removed; the outline is kept as small as possible,
to provide a minimal amount of separation (0.5 mm maximum) consistent with provision of suitable access for instrumentation
between anterior teeth for Class III restorations. Sharp internal and for manipulation of gold.
line and point angles are created in dentin to allow convenient For Class I tooth preparations, the external walls of the prepara-
“starting” gold foil as compaction begins. Rounded form is permitted tion are parallel to each other. In extensive occlusal preparations,
when E-Z Gold is used to begin the restorative phase. Removal the mesial or distal wall (or both) may diverge slightly occlusally,
of remaining carious dentin, inal planing of cavosurface margins, however, to avoid undermining and weakening marginal ridges.
and debridement complete the tooth preparation for direct gold. he pulpal wall is of uniform depth, parallel with the plane of the
e74 C HA P T E R 1 7 Direct Gold Retoration

surface treated, and established at 0.5 mm into dentin. he pulpal use of a high-speed handpiece with air-water spray, the No. 330
wall meets the external walls at a slightly rounded angle created or No. 329 bur is aligned, and the outline form (which includes
by the shape of the bur. Small undercuts may be placed in dentin the limited initial depth) is established (see Fig. 17.11B). When
if additional retentive features are required to provide convenience the preparation is extensive because of the inclusion of issured
form in beginning the compaction of gold (see Fig. 17.10B). enamel, a small hoe ( 6 1 2 - 2 1 2 -9) may be used to complete the
Undercuts, when desired, are placed facially and lingually in desired degree of latness of the pulpal wall. With a No. 33 1 2 bur
posterior teeth (or incisally and gingivally on the lingual surface at low speed, small retentive undercuts are prepared into the dentinal
of incisors) at the level of the ideal pulpal loor position. hese portion of the external walls at the initial pulpal wall depth; these
undercut line angles must not undermine marginal ridges. A slight also may be prepared using a 6 1 2 -(90)- 2 1 2 -9 angle-former chisel.
cavosurface bevel may be placed to (1) create a 30- to 40-degree Round burs of suitable size are used to remove any infected carious
metal margin for ease in inishing the gold and (2) remove remaining dentin that remains on the pulpal wall. he preparation is completed
rough enamel. he bevel is not greater than 0.2 mm in width and by inishing the cavosurface with an angle former, a small inishing
is placed with a white rotary stone or suitable inishing bur. bur (e.g., No. 7802), or a lame-shaped white stone (see Fig.
17.11C–E).
Instrumentation
For description and illustration, the preparation of a carious pit Restoration
on the mandibular irst premolar is presented (Fig. 17.11A). By he restorative phase begins with the insertion of a pellet of E-Z
Gold or gold foil. he gold is irst degassed in the alcohol lame,
cooled in air for a few moments, and inserted into the preparation
with the passing instrument. he gold is pressed into place with
the nib of a small round condenser. In larger preparations a pair
of condensers is used for this initial stabilization of the gold. Next,
compaction of the gold begins with a line of force directed against
a the pulpal wall (Fig. 17.12A). Hand pressure is used for E-Z Gold;
malleting is used for gold foil. he gold is compacted into the
pulpal line angles and against the external walls, and the line of
force is changed to a 45-degree angle to the pulpal and respective
external walls (to compact the gold best against the internal walls)
(see Fig. 17.12B). Additional increments of gold are added, and
the procedure is repeated until the preparation is about three quarters
b full of compacted gold. If E-Z Gold is to be the inal restoration
A B surface, compaction is continued until the restoration is slightly
overilled.
• Fig. 17.10 A, Typical Class I occlusal marginal outlines for pit restora- If gold foil is selected to veneer this restoration, pellets of suitable
tions with direct gold. B, Cross section of model of lingual Class I prepara- size are selected; in larger preparations, large pellets are convenient,
tion on maxillary incisor. Undercuts (a, b) are placed in dentin incisally and whereas for small pit preparations, the operator should begin with
gingivally for additional retention. 1 -size pellets (Fig. 17.13). he pellet is degassed and carried
64

A B C

D E

• Fig. 17.11 Class I preparation for direct gold. A, Preoperative view of pit lesion. B, No. 330 bur is
aligned properly for occlusal preparation. C, Occlusal cavosurface bevel is prepared with white stone. D,
The bevel may be placed with an angle former. E, Completed tooth preparation.
 CHAPTER 17 Direct Gold Retoration e75

A B

• Fig. 17.12 A, Compaction forces are delivered by the condenser held at 90-degree angle to the pulpal
wall. B, Gold is condensed against the external preparation walls.

• Fig. 17.13 Placement of pellet of gold foil and compaction into tooth • Fig. 17.14 Compaction of gold foil has proceeded suficiently to cover
preparation. all the cavosurface margins.

to the preparation. First, hand pressure compaction is used to restorations. Care must be taken at this stage to avoid abrading
secure the pellet against the compacted E-Z Gold and spread it the surface enamel. After use of the discoid-cleoid, a small round
over the surface; next, mallet compaction is used. Likewise, each inishing bur (No. 9004) is used to begin polishing (see Fig. 17.15C).
succeeding pellet is hand compacted, and then is compacted with It is followed by the application of lour of pumice and tin oxide
the mallet. he condenser point is systematically stepped over or white rouge (see Fig. 17.15D). hese powdered abrasives are
the gold twice as malleting proceeds. Generally the line of force applied dry, with a webless, soft rubber cup in a low-speed hand-
is perpendicular to the pulpal loor in the center of the mass and piece. Care is taken to use light pressure. Gentle blasts of air cool
at a 45-degree angle to the pulpal loor as the external walls are the surface during polishing. he completed restoration is illustrated
reached. At this stage and during all building of the restoration, in Fig. 17.16.
the compacted surface should be saucer shaped, with the compac-
tion of gold on the external walls slightly ahead of the center. Cla V Tooth Preparation and Retoration
he surface should never be convex in the center because this
may result in voids in the gold and poor adaptation of the gold Operating Field
along the external walls when the condenser nib is “crowded out” As with all direct gold restorations, the rubber dam must be in
along the wall by the center convexity. he operator continues place to provide a suitable, dry ield for a Class V restoration. For
building the restoration until the cavosurface margin is covered lesions near the gingiva or that extend into the gingival sulcus, it
with foil (Fig. 17.14). One needs to exercise extreme care that gold is necessary to provide appropriate access to the lesion by placing
is always present between the condenser face and the cavosurface a No. 212 retainer or gingival retractor. he punching of the rubber
margin; otherwise the condenser may injure (i.e., fracture) the dam is modiied to provide ample rubber between teeth and to
enamel margin. he central area of the restoration’s surface is illed provide enough rubber for coverage and retraction of the soft
in to the desired level. Tooth surface contour of the gold is created tissue on the facial side of the tooth. he hole for the tooth to be
to simulate the inal anatomic form, and a slight excess of gold is treated is punched 1 mm facial of its normal position, and an
compacted on the surface to allow for the inishing and polishing extra 1 mm of dam is left between the hole for the treated tooth
procedures. and the holes for the immediately adjacent teeth.
he irst step in the inishing procedure is to burnish the gold Several modiications may be made to the No. 212 retainer to
(Fig. 17.15A). A lat beaver-tail burnisher is used with heavy hand facilitate its use. If the notches that are engaged by the retainer
pressure to harden the surface gold. A discoid-cleoid carver is used forceps are shallow, they may be deepened slightly with a large,
to continue the burnishing process and remove excess gold on the carbide issure bur to provide a more secure lock for the forceps
cavosurface margin. he cleoid, always directed so that a portion (Fig. 17.17A). If the tips of the retainer jaws are very sharp, they
of the working edge is over or resting on enamel adjacent to or may be slightly rounded with a garnet disk, then polished to avoid
near the margins, is pulled from gold to tooth across the surface. scratching cementum during placement. For application to narrow
his is done to smooth the surface and trim away excess gold (see teeth (e.g., mandibular incisors), the facial and lingual jaws may
Fig. 17.15B). If considerable excess gold has been compacted, a be narrowed by grinding with a heatless stone or carborundum
green stone may be necessary to remove the excess in Class I disk, after which they are polished with a rubber wheel. To expedite
e76 C HA P T E R 1 7 Direct Gold Retoration

A B

C D

• Fig. 17.15 Steps in inishing Class I direct gold restoration. A, Burnisher work-hardens the surface
gold. B, The discoid-cleoid instrument removes the excess gold from the cavosurface margins. C, A
No. 9004 bur is used to begin the polishing phase. D, Polishing abrasives are applied with a rubber cup.

to distribute compaction forces among all the teeth included in

the retainer application.

Tooth Preparation Design

he typical Class V tooth preparation for restoration with direct
gold is trapezoidal (Figs. 17.20, 17.21, and 17.22). his outline
form is created to satisfy esthetic needs and the requirements for
the retention and convenience forms in the treatment of lesions
in the gingival third of the clinical crowns of teeth. he straight
occlusal margin improves the esthetic result, and by virtue of its
• Fig. 17.16 Completed restoration. straight design, excess gold is readily discerned and removed in
the inal stages of the restorative process. he gingival outline is
shorter than the occlusal route because the tooth narrows in the
placement on rotated teeth, the jaws may be modiied by grinding gingival area. In addition, it is prepared parallel with the occlusal
suitable contour to the tip edge (see Fig. 17.17B). he jaws may margin for easy identiication in the inishing phases. he mesial
be bent for use on teeth where gingival access to lesions is diicult. and distal margins connect the gingival margin to the occlusal
his is done by heating the jaws to a cherry-red color in a lame, margin.
then grasping the entire facial jaw with suitable pliers and slightly he occlusal margin is straight and parallel with the occlusal
bending the jaw apically. he procedure is repeated for the lingual plane of the teeth in the arch (see Fig. 17.20); it is extended
jaw, bending it slightly occlusally (Fig. 17.18). occlusally to include the lesion. (When several adjacent teeth are
he No. 212 retainer must be applied carefully to avoid damage restored, some additional extension is permissible to create a uniform
to soft or hard tissue. he retainer is secured in the retainer forceps level that may be more esthetically pleasing.) Often, the mesiodistal
and carried to the mouth after the rubber dam has been placed. extension to the line angles of the tooth places the junction of the
he lingual jaw is positioned just apical to the lingual height of occlusal and mesial and distal margins gingival to the crest of the
contour, and the index inger is placed against the jaw to prevent free gingiva, rendering the most esthetic result. he gingival margin
its movement. he retainer is rotated faciogingivally with the is also straight, parallel with the occlusal margin, placed only far
forceps, while the thumb retracts the dam; the facial jaw is set enough apically to include the lesion, and it extends mesiodistally
against the tooth (Fig. 17.19A). Next, a ball burnisher is placed to the line angles of the tooth.
into one of the retainer notches and used to move the facial jaw he mesial and distal margins are parallel to the proximal line
gingivally (without scraping the jaw against the tooth) to the inal angles of the tooth (see Fig. 17.22A) and usually are positioned
position (i.e., 0.5–1 mm apical of the expected gingival margin) suiciently mesially and distally to be covered by the free gingiva.
(see Fig. 17.19B). Gentle pressure is used to position the facial he mesial and distal margins are straight lines that meet the
jaw so that only the free gingiva is retracted, and the epithelial occlusal margin in sharp, acute angles and meet the gingival margin
attachment is not harmed. he retainer is supported and locked in sharp, obtuse angles, both of which complete the trapezoidal
into this desired position with the compound, which is softened, form.
molded by the ingers, and placed between the bows and the he depth of the axial wall varies with the position of the
gingival embrasures (see Fig. 17.19C). he compound also serves preparation on the tooth. he axial wall is approximately 1 mm
 CHAPTER 17 Direct Gold Retoration e77

A B

• Fig. 17.17 A, Notches are deepened for secure holding of the No. 212 retainer. B, Jaws may be
modiied with a disk to facilitate retainer placement on rotated teeth.

A B
• Fig. 17.18 A, Drawing of a No. 212 retainer as received from the manufacturer. B, Modiied facial and
lingual jaws.

A B C

• Fig. 17.19 Placement of No. 212 retainer. A, Initial placement of facial jaw after irst placing lingual
jaw. B, Use of ball burnisher to carry the facial jaw to the inal position. C, Retainer stabilized with com-
pound to distribute compaction forces, prevent tipping, and to prevent either apical or occlusal movement
of retainer.

deep in the occlusal half of the preparation. As the outline to remove infected caries that has progressed deeper than the ideal
approaches the cervical line, the axial wall depth may decrease axial wall placement.
from 1 to 0.75 mm. he axial wall must be established in dentin, he occlusoaxial internal line angle is a sharp right angle. he
and occlusogingivally it should be relatively flat and parallel occlusal wall also forms a right angle with the external enamel
(approximately) with the facial surface of the tooth (see Fig. 17.22B). surface, precluding undermining of the enamel. he gingivoaxial
Mesiodistally, the axial wall also is prepared approximately parallel internal line angle is a sharp, acute angle, created at the expense of
with the surface contour of the tooth. his contour may create a the gingival wall (see Fig. 17.22B). he mesioaxial and distoaxial
slight mesiodistal curvature in the axial wall in convex contoured internal line angles are sharp, obtuse angles. hese obtuse line
teeth and where the preparation is extensive proximally. Mesiodistal angles are created to prevent the undermining of the mesial
curvature of the axial wall prevents encroachment of the tooth and distal enamel, although still providing some resistance to
preparation on the pulp. Excessive axial curvature results in a movement of the gold during compaction. hey must never be
preparation that is either too shallow in the center or too deep at acute angles.
the proximal extensions, and it further complicates restoration by he mesial and distal prepared walls are lat and straight. hey
failing to provide a reasonably lat wall against which to begin meet the occlusal wall in a sharp, acute line angle and meet the
compaction. A subaxial wall may be created within the axial wall gingival wall in a sharp, obtuse line angle. he mesial and distal
e78 C HA P T E R 1 7 Direct Gold Retoration

• Fig. 17.20 Facial view of Class V tooth preparation for direct gold. The • Fig. 17.21 Facioocclusal view of design of gingival wall in Class V
occlusal and gingival margins are straight, parallel with each other, and preparation for direct gold. The axiogingival line angle is acute and has
extend mesially and distally to the respective mesiofacial and distofacial been prepared at the expense of the gingival wall. This gingival margin is
tooth crown line angles. The mesial and distal walls diverge facially and on cementum. If on enamel, the gingival cavosurface would be beveled
form obtuse angles with the axial wall. Line angles and point angles are slightly (see also Fig. 17.26E).
sharp (see also Fig. 17.22B).

B
• Fig. 17.22 A, Clinical Class V tooth preparation. Note the proper isolation of the operating ield. This
gingival margin is on cementum. B, Longitudinal section, facioocclusal view, and cross section. Line and
point angles are sharp.

walls provide resistance for gold compaction, but they provide no by sloping the gingival wall internally to meet the axial wall in a
retention. sharply deined acute line angle. Retention is provided by the facial
he orientation of the gingival wall is the key to the retention convergence of the occlusal and gingival walls. Gold wedged between
form of the preparation. It is straight mesiodistally, meeting the these two walls is locked into the tooth. If the gingival margin is
mesial and distal walls in sharp line angles. Retention is provided established on enamel, the cavosurface is beveled slightly to remove
 CHAPTER 17 Direct Gold Retoration e79

unsupported enamel (see Fig. 17.26E later in the chapter). When walls (see Fig. 17.25C and D). he gingival and mesial walls may
placed on cementum, the gingival cavosurface is not beveled (see be prepared with the side of the bur if access so dictates (see Fig.
Fig. 17.24B later in the chapter). 17.25E and F). he end of the bur is used to place the axial wall
he outline of the preparation may be modiied. In clinical in dentin (see Fig. 17.25G).
situations demanding reduced display of gold, such as in anterior he 6 1 2 - 2 1 2 –9 hoe or the larger 10-4-8 hoe is useful for planing
teeth, the incisal outline may be curved to follow the contour of preparation walls, establishing sharp internal line angles (Fig.
soft tissue mesiodistally (Fig. 17.23). his modiication is made 17.26A), and inishing margins. he Wedelstaedt chisel is used to
only when required because preparation instrumentation and inish the occlusal cavosurface margin (see Fig. 17.26B) and may
inishing of gold are more diicult than when a straight marginal be used to plane the axial wall. he acute axiogingival angle is
outline is created. A similar modiication may be made in the established with the 6 1 2 - 2 1 2 -9 hoe, cutting from the cavosurface
occlusal outline when caries extends more occlusally as the proximal to the axial wall in a push-cut stroke (see Fig. 17.26C). he chips
extensions are reached. Also the mesiodistal extension (i.e., dimen- of dentin produced at the axiogingival angle may be removed with
sion) of a preparation may be limited when caries is minimal, the tip of an explorer (see Fig. 17.26D) or the point of a 6 1 2 -
conserving intact tooth structure. When access requires, the gingival (90)-2 1 2 -9 small angle former. Care must be taken not to gouge
wall may be modiied also to curve mesiodistally to include the the axial wall. When its use is indicated, the gingival bevel is
gingival extent of advanced caries. he entire axial wall should not prepared with the Wedelstaedt chisel or a hoe (see Fig. 17.26E).
be extended pulpally to the depth of the lesion when deep cervical
abrasion, abfraction, or erosion is treated; rather the axial wall is Restoration
positioned normally, leaving a remaining V notch at its center to Restoration of the Class V preparation begins with application of
be restored with gold. When failing restorations are removed and cavity varnish (if desired), after which a piece of degassed E-Z
restored with direct gold, the preparation outline is partially dictated Gold is placed into the preparation. he gold is degassed in the
by the previous restoration (Fig. 17.24). alcohol lame and carried to its place in the preparation with the
passing instrument. Parallelogram foil condensers or other suitable
Instrumentation serrated condensers are used to force the gold irmly against the
he No. 33 1 2 bur is used to establish the general outline form of axial wall and to wedge it into the line angles. One instrument
the preparation. he end of the bur establishes the distal wall (Fig. may be put aside (and the other is used as a holding instrument
17.25A); the side establishes the axial depth and the occlusal, to prevent movement of the entire piece of gold), and compaction
gingival, and mesial walls (see Fig. 17.25B). When access permits, can begin by delivering heavy compacting forces to the gold.
the end of the bur may be used to establish the mesial and gingival After stabilization of the gold, completion of compaction of
the initial mass of gold begins in the center of the mass with
a 0.5-mm-diameter, round, serrated condenser nib. Careful,
methodical stepping of the gold proceeds outward toward the
external walls (to wedge the gold in the tooth and remove internal
voids). As soon as the gold is stabilized, a holding instrument is
no longer necessary. As the walls are reached, a line of force of
45 degrees to the axial wall is used to drive the gold into the line
angles and against the external walls. he entire surface of the
gold is condensed twice to complete the compaction of the gold.
Additional increments of E-Z Gold are added until the preparation
is illed to at least half its depth. E-Z Gold pellets are used to
complete the restoration, covering the margins irst, and to complete
compacting in the center of the facial surface. Pellets of gold foil
also may be used to complete the outer one half of the restoration
(Fig. 17.27).
If gold foil is used for the outer half of the restoration, compac-
tion proceeds with medium-sized pellets at the mesioocclusal or
distoocclusal line angle and then across the occlusal wall. he
• Fig. 17.23 Completed Class V gold restoration. Incisal margin curved entire wall and occlusal cavosurface margin are covered with
to follow contour of gingival tissue for best esthetic result. compacted gold foil (see Fig. 17.27A). To ensure that gold protects

A B

• Fig. 17.24 A, Failing Class V amalgam restoration. B, Replacement direct gold restoration.
e80 C HA P T E R 1 7 Direct Gold Retoration

the margin from blows of the condenser face, care should be malleted over the entire surface to make it smooth and assist in
exercised when the condenser approaches any enamel margin. Next detection of any poorly compacted areas (see Fig. 17.27C).
the gingival, mesial, and distal walls are covered, which leaves the Finishing begins with application of a beaver-tail burnisher to
restoration concave (see Fig. 17.27B). It is essential that all cavo- work-harden and smooth the surface (Fig. 17.28A). Petroleum
surface margins be covered at this time, before the inal convex jelly may be applied to the dam to avoid abrasion from disks; it
surface of the restoration is formed. also may be applied to the disks. Gross excess contour, if any, is
Medium and large pellets (sizes 1 43 and 1 32 ) are compacted in removed with a ine garnet disk applied with a Sproule or other
the center of the restoration to complete the formation of the suitable mandrel in a low-speed handpiece (see Fig. 17.28B). Excess
appropriate contour. A slight excess contour is developed and is gold is removed from the cavosurface margins with the discoid-cleoid
removed later when the gold is inished and polished. Any small instrument (using pull-cut strokes) or the gold knife (using only
remaining deiciencies in the surface contour are illed with small push-and-cut strokes from the gold to the tooth) (see Fig. 17.28C
pellets. A Varney foot condenser (or other large condenser) is and D). When removing the excess gold over the gingival margin,

D
D M
M 331/2

212
A

D
M
D M

B C 212

• Fig. 17.25 Use of No. 33 12 bur in straight handpiece for initiating Class V preparation. A, The end
of the bur is used to establish the distal wall. B, The side of the bur is used to establish the occlusal wall.
C, The end of the bur prepares the mesial wall, if access permits. D, The end of the bur is used to
establish the gingival wall, if access permits. The use of a No. 33 12 bur in the straight handpiece for
initiating Class V preparation.
 CHAPTER 17 Direct Gold Retoration e81

D M

F 212
E

G
• Fig. 17.25, cont’d E, Preparation of the gingival wall with the side of the bur. F, Preparation of the
mesial wall with the side of the bur. G, The end of the bur may be used to establish the initial axial wall
depth in dentin.

care is exercised not to remove cementum or “ditch” the root of the 20th century and is still used today.18 It has the advantage
surface (especially when using rotary instruments). of not only conserving the tooth structure but also providing access
When the inal contour has been obtained, cuttle disks may for compaction of gold foil directly against all preparation walls
be used in decreasing abrasiveness (i.e., coarse to medium to ine) and cavosurface margins. his results in a dense, esthetically pleasing
to ready the surface for inal polishing. hese disks and the cleoid result (if careful attention is given to management of the outline
are helpful in removing very ine ins of gold from margins. Polishing design). his preparation is instrumented primarily from a facial
is performed with ine pumice followed by tin oxide or white approach, although lingual instrumentation may be used in maxillary
rouge (applied with a soft, webless rubber cup). Care also is required teeth. he preparation may be modiied for mandibular anterior
at this stage to avoid ditching cementum with the polishing abrasive. teeth, the distal surface of maxillary canines, and the distal surface
he abrasives are used dry so that the ield may be kept clean, and of some lateral incisors.
the exact position of the rubber cup can be seen at all times (Fig.
17.29). Tooth Preparation Design for Maxillary Incisors
After polishing has been completed, the No. 212 retainer and he marginal outline is the most important. From a facial view,
rubber dam are removed. Removal of the retainer is best accom- the gingival four ifths of the facial margin is straight and (generally)
plished with the forceps irmly locked into the notches on the parallel with the contour of the tooth (Fig. 17.30). he facial
retainer. he retainer jaws are opened from the tooth with the margin forms a gentle curve in its incisal one ifth to blend with
forceps and carefully removed occlusally (without scratching the the incisal margin. When viewed from a proximofacial aspect, the
restoration or the surface enamel of the tooth). he gingival sulcus facial outline follows the general contour of the adjacent tooth
is rinsed and examined to ascertain that it is free of debris. Soft (Fig. 17.31) and meets the gingival outline in a slightly obtuse
tissue is massaged gently before the patient is dismissed. angle. his juncture may be curved slightly to enhance esthetics.
he gingival margin is crucial to the entire preparation. Its
faciolingual length dictates the remainder of the preparation. Where
Cla III Tooth Preparation and Retoration possible, the gingival margin is established just apical to the crest
Many styles of Class III preparations are advocated for use with of the free gingiva to enhance the esthetic result. It is straight
direct gold. Some preparations are based on the lingual approach faciolingually and is approximately at a right angle to the long
and are restored with E-Z Gold. Others may be instrumented axis of the tooth. It meets the facial margin in a sharply deined
from either the facial or the lingual surface and use gold foil as obtuse angle that may be rounded slightly (as previously described),
the restorative material. he outline form selected must provide and it meets the lingual margin in a sharply deined acute angle.
adequate access for placing the restoration and developing an Viewed from the lingual aspect, the lingual margin generally
acceptable esthetic result. he preparation design presented in parallels the long axis of the tooth (Fig. 17.32). It may diverge
subsequent sections was irst described by Ferrier in the early years slightly proximally from the long axis, however, to parallel more
e82 C HA P T E R 1 7 Direct Gold Retoration

8
-4-
10
A 212

212

B
9
/2 -
21
/2 -
61

D E
• Fig. 17.26 Use of hand instruments in Class V tooth preparation. A, The small hoe planes the prepa-
ration walls. B, The Wedelstaedt chisel reines the occlusal wall and the margin. C, The small hoe creates
an acute axiogingival line angle in dentin. D, The explorer is used to remove debris from the completed
preparation. E, The chisel blade bevels the gingival cavosurface margin, when indicated. (E, From Howard
WC, Moller RC: Atlas of operative dentistry, St. Louis, 1981, Mosby.)
 CHAPTER 17 Direct Gold Retoration e83

A B C

• Fig. 17.27 Completion of compaction where gold foil is used to overlay the E-Z Gold. A, Condensa-
tion of foil proceeds to cover the cavosurface margins. A slight excess of gold has been condensed over
the mesial half of the occlusal cavosurface margin. B, All cavosurface margins are covered with a slight
excess of gold. The restoration, at this stage of insertion, is concave. C, After additional foil pellets are
compacted in the central area to form a convex restoration surface with slight excess, a foot condenser
is used to conirm condensation.

A B

C D

• Fig. 17.28 Finishing the Class V restoration. A, Burnisher work-hardens surface. B, A small, ine garnet
disk removes the excess gold contour. C, The gold knife’s secondary edge used with push-stroke (arrow)
removes excess gold from the gingival margin. D, After inal surfacing with a cuttle disk, any remaining
marginal excess is removed with the cleoid carver.

A B

• Fig. 17.29 A, A soft-rubber cup is used to apply polishing abrasives. B, The explorer is used to
remove any remaining polishing powder from site of completed restoration.

nearly the proximal contour. It meets the gingival margin in he incisal margin is placed incisally to the contact area to
a sharply deined angle that is nearly 90 degrees when viewed provide access to the preparation; however, it is not extended enough
from the lingual aspect (Fig. 17.33), but it is acute when viewed to weaken the incisal angle of the tooth. It forms a smooth curve
from the proximal aspect. he lingual margin is straight in its that connects the facial and lingual margins of the preparation.
gingival two thirds, but then it curves abruptly to meet the incisal To provide a suitable resistance form, the internal aspects of
margin. the preparation are precisely instrumented. he gingival wall
e84 C HA P T E R 1 7 Direct Gold Retoration

A C
• Fig. 17.30 Class III direct gold restoration. A, The model of the preparation shows the esthetic mar-
ginal outline (a). B, Central incisor (b) before distal preparation. C, Completed Class III restoration.

• Fig. 17.32 Lingual view of Class III preparation.

• Fig. 17.31 Proximofacial view of Class III preparation.

because of the length of the preparation incisogingivally and because
of the diiculty of access in compacting the gold.
is flat faciolingually. The axial wall is flat faciolingually and Provision for the convenience form is made by the abrupt
incisogingivally, and it is established 0.5 mm into dentin. he incisolingual curve (which permits introduction of a condenser
resistance form also is created by establishing sharp, obtuse axio- directed toward the gingival wall), by adequate clearance of all
facial and axiolingual line angles in dentin. he facial and lingual margins from the adjacent tooth, and by placement of sharp internal
walls diverge only enough to remove undermined enamel, and point angles suitable for beginning compaction of gold. he
yet they provide irm, lat walls against which the gold can be facioaxiogingival and linguoaxiogingival point angles may be
compacted. enlarged slightly to assist in initial stages of foil compaction, if
As in the Class V restoration, retention form is provided only desired.19
between the gingival and incisal walls. In the Class III preparation, he inishing of enamel walls requires placement of a facioin-
the dentinal portion of the gingival wall (as in the Class V gingival cisolingual cavosurface bevel, which determines the inal marginal
wall) slopes apically inward to create an acute axiogingival line outline. his bevel is made with hand instruments and is established
angle. In the Class III preparation, the incisal portion is undercut totally in enamel. It is designed to create maximum convenience
(Fig. 17.34). his undercut is placed in dentin, facioincisally, to form, to remove all surface irregularities and any unsupported
create a mechanical lock between the incisal and gingival walls. enamel, and to establish a more esthetically pleasing result (Fig.
his increased retention form in the Class III preparation is required 17.35; see also Fig. 17.30).
 CHAPTER 17 Direct Gold Retoration e85

Modiications of Class III Preparations appears as a slice. his modiication provides clearance from the
he distal surface of maxillary canines may require a modiication mesial marginal ridge of the irst premolar and provides considerable
in preparation design for convenience in gold compaction. Because convenience form to allow compaction of gold on the gingival
a highly convex surface is generally present, it is often desirable wall directly from an incisal position. his type of preparation also
to create a “straight-line preparation” in which the facial outline is appropriate for the distal surface of highly contoured lateral
incisors (Fig. 17.36).
he mandibular incisors require a modiied Class III preparation
because of their small size and because access from a lingual position
may be exceptionally diicult. he lingual wall is created in one
plane, and extension of the lingual and the incisal walls is limited.
he axiolingual line angle is a right or slightly obtuse angle. Care
is taken to avoid lingual overextension of the lingual wall because
this can result in the removal of dentinal support for lingual enamel,
rendering the preparation unrestorable by direct gold. he outline
form is extended lingually only far enough to include the lesion
and to allow access for inishing of the gold. Incisal extension is
restricted because the proximal contact area between mandibular
incisors is often near the incisal angle. Extension incisally past the
contact may weaken this critical area of the tooth; a mechanical
A B separator may be necessary to obtain clearance between teeth. his
• Fig. 17.33 Lingual marginal outline of Class III preparation. A, View of
provides access for tooth preparation and gold compaction. Facial
lingual outline. Note the sharp linguogingival angle. B, Proximal view of extension is similar to the maxillary preparation (Fig. 17.37).
preparation. Note that the linguogingival angle is sharp and acute in this Internally, the incisal retentive angle for the mandibular Class
view. (A, From Stibbs GD: Direct golds in dental restorative therapy. Oper III preparation is placed directly incisally, rather than facioincisally
Dent 5:107, 1980.) as in maxillary teeth. his modiication is made to conserve the
thickness of the tooth structure at the facioincisal angle, where
wear of mandibular anterior teeth frequently occurs. Lingual
approach Class III restorations may be made using E-Z Gold. In
such cases, the lingual “slot” type of preparation is made with
rounded internal line angles.

Separation of Teeth
Separation of teeth frequently is needed for instrumentation or
inishing procedures performed on Class III direct gold restorations.
he Ferrier separator is a convenient instrument for accomplishing
this separation. It is applied and stabilized with compound (similar
to stabilization of a No. 212 retainer) (Fig. 17.38). he jackscrews
• Fig. 17.34 View of incisal retention in Class III preparation. The under- of the separator are activated with the separator wrench to draw
cut is placed in dentin but does not undermine enamel. the teeth slightly apart, creating a maximum space of 0.25 to

A B
• Fig. 17.35 Class III preparation internal form and facial marginal outline. A, Incisal view of cross section
of preparation in plane x shown in B. Facial and lingual cavosurface bevels are shown placed in enamel.
B, Facial view of the facial marginal outline of the preparation. (From Stibbs GD: Direct golds in dental
restorative therapy. Oper Dent 5:107, 1980.)
e86 C HA P T E R 1 7 Direct Gold Retoration

0.5 mm. It is desirable to provide only this minimum separation Restoration

and to remove the separator as soon as possible (preventing damage he separator is used to obtain a separation of 0.25 to 0.5 mm.
to periodontal structures). Compaction of gold foil begins at the linguoaxiogingival point
angle (Fig. 17.46). A small (i.e., 0.4 mm) monangle condenser is
Instrumentation used to compact the gold, which is held by a small holding instru-
he No. 33 1 2 bur (or a suitable Wedelstaedt chisel) is used to begin ment. Pellets size 1 64 or 1128 are used in the beginning of the
the preparation (Fig. 17.39). he bur is angled from the facial to restorative phase. he line of force is directed over the facial surface
position the gingival outline and the facial wall. A Wedelstaedt of the adjacent tooth and into the linguoaxiogingival point angle
chisel establishes the lingual extension, and the No. 33 1 2 bur (see Fig. 17.46B). As soon as ample gold has been compacted into
deines the linguogingival line angle (Fig. 17.40) and completes the linguogingival area to cover the linguogingival shoulder,
the gingival loor preparation. he outline form is completed by compaction continues across the gingival wall (Fig. 17.47) and
beveling the cavosurface areas with a Wedelstaedt chisel. Next the into the faciogingival angle. he ofset condenser (with a facio-
dentinal part of the gingival, lingual, facial, and incisal walls is gingival line of force) is used to ill the facioaxiogingival point
planed. A small hoe (i.e., 6 1 2 - 2 1 2 -9) is used for the lingual and angle (Fig. 17.48). Compaction of gold at the linguogingival area
gingival walls (Fig. 17.41). An angle former is used to plane the is conirmed with the oblique-faced monangle condenser (i.e.,
facial dentinal wall (Fig. 17.42). An axial plane (i.e., 8-1-23) smooths 0.5 mm) from the linguoincisal position (Fig. 17.49). Failure to
the axial wall, and a bibeveled hatchet (i.e., 3-2-28) establishes the provide dense gold in this linguogingival area at this stage may
incisal retentive angle with a chopping motion (Fig. 17.43). Small result in a void at the linguogingival angle and subsequently may
angle formers are used to complete the sharp facioaxiogingival and lead to restoration failure.
linguoaxiogingival point angles and the slightly acute axiogingival he bulk of the restoration is compacted with 1 43 - or 1 32
angle (Fig. 17.44). he point angles may be enlarged further with -sized pellets, mainly from a facial (occasionally from a lingual)
the No. 33S bur (i.e., end-cutting bur) for additional convenience direction (Fig. 17.50). he line of force is maintained in an
form. he Wedelstaedt chisel may be used again to complete the axiogingival direction with the 0.5-mm monangle or oblique-
inal planing of the cavosurface margins (Fig. 17.45). faced monangle condenser (see Fig. 17.50B). This requires

• Fig. 17.36 Direct gold restoration of a clinical Class III preparation of • Fig. 17.38 Separator placed before clinical Class III preparation for the
straight-line design on the distal portion of the maxillary lateral incisor. mandibular incisor.

A B

• Fig. 17.37 Mandibular Class III preparation. A, Facial view. The facial margin is similar to that in the
maxillary preparation. B, Linguoproximal view.
 CHAPTER 17 Direct Gold Retoration e87

A B C

D E

• Fig. 17.39 A, Preoperative view of the extracted maxillary central incisor that has been mounted in
dentoform. Distal surface to be treated with Class III cavity preparation and restoration of compacted
gold. B, Preoperative lingual view. C, Facial approach initial entry is made with No. 33 12 bur. D, Initial bur
entry. E, The Wedelstaedt chisel begins to establish the facial outline form.

A B

• Fig. 17.40 Lingual view of preparation instrumentation. A, The Wedelstaedt chisel planing the lingual
enamel wall. B, An inverted cone bur is used to establish the sharp linguogingival shoulder.
e88 C HA P T E R 1 7 Direct Gold Retoration

A B C

• Fig. 17.41 Use of small hoe facial approach in tooth preparation. A, The hoe planes the lingual dentinal
wall from the incisal aspect to the gingival aspect. B, The hoe also planes this wall from the gingival aspect
to the incisal aspect (arrow). C, The hoe planes the gingival cavosurface (arrow).

A B C

• Fig. 17.42 Use of the angle former to plane the facial dentinal wall. A, Angle former before placement
in the preparation. B, Angle former in the preparation. C, The angle former is directed apically (arrow) to
plane the facial dentinal wall.

A B C

• Fig. 17.43 A, Axial plane before placement in the preparation. B, Bibeveled hatchet before placement
in the preparation. C, The bibeveled hatchet is used to establish the incisal retentive angle.
 CHAPTER 17 Direct Gold Retoration e89

a b

A B

C D
• Fig. 17.44 A, Angle former before use in the preparation. B, The angle former is moved faciolingually
(a) to establish an acute axiogingival line angle (b). C, The offset angle former thrust faciogingivally estab-
lishes an acute facioaxiogingival point angle. D, Completed incisal, gingivoaxial retention form.
(D, From Stibbs GD: Direct golds in dental restorative therapy. Oper Dent 5:107, 1980.)

A B

• Fig. 17.45 A, The Wedelstaedt chisel may be used again to plane margins. B, Completed facial margin
of Class III tooth preparation viewed from the facial position.
e90 C HA P T E R 1 7 Direct Gold Retoration

A B C

• Fig. 17.46 A, The irst pellet of the gold foil is placed from the facial aspect into the preparation. Note
the separation of teeth by 0.25 to 0.5 mm. B, Compaction of the pellet into the linguoaxiogingival point
angle. The line of force is directed linguoaxiogingivally, while the holding instrument is placed from the
lingual position. C, The holding instrument (a) prevents dislodgment of foil during compaction.

• Fig. 17.47 The holding instrument (a) remains in position as the gold foil is condensed across the
gingival wall toward the facial portion of the preparation.

A B

• Fig. 17.48 A, Offset condenser before placement in the cavity preparation. B, Compacted gold foil
covering the gingival wall and the cavosurface.

that the incisal surface of the growing restoration always slope so that the gold is near the incisal angle (Fig. 17.51). Second, the
apically, with the gold on the axial wall ahead of the proximal incisal area is illed by compacting 1128 -size pellets with the right-
surface of the restoration. During the compaction procedure, angle hand condenser (Fig. 17.52). Third, pellets of foil are
the vector of the line of force always should be toward the compacted into the incisolingual and incisal areas with the ofset
internal portion of the preparation to prevent dislodgment of the condenser. his ills the incisal portion, making a complete turn
restoration. from lingual to facial (Fig. 17.53A). he entire incisal cavosurface
he next step is the restoration of the incisal portion of the is covered with gold (see Fig. 17.53B).
preparation, referred to as “making the turn.” It is accomplished Additional gold compaction inishes the facial one third of
in three phases. First, suicient gold is built up on the lingual wall the restoration, and then the Varney foot condenser is used to
 CHAPTER 17 Direct Gold Retoration e91

“after-condense” over the contour of the restoration. More separation

is generated by slight activation of the separator, before inishing
and polishing the restoration. A sharp, gold foil knife is used
to remove excess in the contact area, permitting a ine inishing
strip or steel matrix strip to pass through. A pull-cut Shooshan
ile or gold knife may facilitate removal of excess gold facially
(Fig. 17.54). Initial contouring of the contact area is performed
with long, extra-narrow, extra-ine cuttle inishing strips to gain
access to the proximal surface. Next, a wide, medium cuttle strip
may be used for rapid removal of excess gold. Final contouring
• Fig. 17.49 Lingual view. The monangle condenser conirms compac- continues with the medium and fine, narrow strips. Finish-
tion of gold at the linguogingival aspect of the restoration. ing is performed with the extra-narrow, extra-ine cuttle strip

A B
• Fig. 17.50 A, The monangle condenser is used to build the bulk of gold in the gingival half of the
preparation. B, Gingival half of the restoration in longitudinal section. The line of force (a) is directed
axiogingivally during compaction of gold to prevent dislodgment of the restoration.

A B
• Fig. 17.51 A, The condenser is directed over the facial surface of the adjacent tooth, while the gold
is built toward the incisal aspect. B, The gold is compacted from the facioincisal aspect to cover the
lingual cavosurface; however, compaction direction must continue to have a major vector (arrow) toward
the axial wall to prevent dislodgment. At this stage, the compacted foil on the axial wall must be well
ahead (incisally) of the “growing” proximal surface.

A B

• Fig. 17.52 A, The right-angle hand condenser begins to press the gold into the incisal retention.
B, This condenser forces the gold deeply into the incisal retentive undercut.
e92 C HA P T E R 1 7 Direct Gold Retoration

A B
• Fig. 17.53 Completing the compaction of gold into the incisal region of the preparation. A, The offset
bayonet condenser condenses the gold into the incisal retention with mallet compaction. B, The incisal
cavosurface is restored with gold foil condensed with the small monangle condenser.

• Fig. 17.54 A sharp, thin-bladed gold knife removes excess gold from
the facial surface.

• Fig. 17.56 Completed maxillary Class III gold foil restoration.

• Fig. 17.55 Fine cuttle inishing strips polish the proximal surface of the • Fig. 17.57 Completed mandibular Class III gold foil restoration.
gold foil restoration.

(Fig. 17.55). Care is taken to inish only the facial or lingual areas removed. Final polishing is accomplished with a worn, extra-ine
with the strip and to avoid lattening the contact area. he gold cuttle strip. Polishing powder may be used. Omitting this step
knife or discoid-cleoid instrument can be used to remove the inal results in a satin inish that is less relective of light and perhaps
excess gold from the cavosurface margins. he separator is then more esthetically pleasing (Fig. 17.56).

Summary
Direct-illing gold is useful in restorative dentistry. If carefully (Fig. 17.57). Direct-illing gold contributes to the art and the
manipulated by a dentist, this restorative material may provide science of restorative dentistry.
lifetime service to patients and promote their oral health
 CHAPTER 17 Direct Gold Retoration e93

Reference 11. Smith GE: he efect of condenser design and lines of force on the dental
compaction of cohesive gold [Master’s thesis], Seattle, 1970, University
1. Dwinelle WH: Crystalline gold, its varieties, properties, and use. Am of Washington.
J Dent 5:249, 1855. 12. Black GV: he nature of blows and the relation of size of plugger
2. Ferrier WI: he use of gold foil in general practice. J Am Dent Assoc points force as used in illing teeth. Dent Rev 21:499, 1907.
28:691, 1941. 13. Baum L: Gold foil (illing golds) in dental practice. Dent Clin North
3. Hollenback GM: here is no substitute for gold foil in restorative Am 199:1965.
dentistry. J South Calif Dent Assoc 33:275, 1965. 14. Ivoclar-Williams Company: E-Z Gold instructional brochure, Amherst,
4. Lambert RL: A survey of the teaching of compacted gold. Oper Dent NY, Ivoclar-Williams.
5:20, 1980. 15. Smith GE: Condenser selection for pure gold compaction. J Am
5. Stibbs GD: Direct golds in dental restorative therapy. Oper Dent Acad Gold Foil Oper 15:53, 1972.
5:107, 1980. 16. Hodson JT, Stibbs GD: Structural density of compacted gold foil
6. Trueman WH: An essay upon the relative advantage of crystallized and mat gold. J Dent Res 41:339, 1962.
gold and gold foil as a material for illing teeth. Dent Cosmos 10:128, 17. homas JJ, Stanley HR, Gilmore HW: Efects of gold foil condensation
1868. on human dental pulp. J Am Dent Assoc 78:788, 1969.
7. Ingersol CE: Personal communication, 1982. 18. Ferrier WI: Treatment of proximal cavities in anterior teeth with
8. Lund MR, Baum L: Powdered gold as a restorative material. J Prosthet gold foil. J Am Dent Assoc 21:571, 1934.
Dent 13:1151, 1963. 19. Smith GE, Hodson JT, Stibbs GD: A study of the degree of adaptation
9. Hodson JT: Structure and properties of gold foil and mat gold. J possible in retention holes, convenience points and point angles in
Dent Res 42:575, 1963. Class III cavity preparations. J Am Acad Gold Foil Oper 15:12–18,
10. Hodson JT: Compaction properties of various pure gold restorative 1972.
materials. J Am Acad Gold Foil Oper 12:52, 1969.