DIRECT FILLING GOLD

A seminar by:

Dr. SHWETA SHARMA

Postgraduate Student

DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

S.D.M. COLLEGE OF DENTAL SCIENCES & HOSPITAL DHARWAD MARCH 2008

DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS S. D. M. COLLEGE OF DENTAL SCIENCES AND HOSPITAL, DHARWAD, KARNATAKA, INDIA

CERTIFICATE
This is to certify that the seminar entitled DIRECT FILLING GOLD is presented by Dr. Shweta Sharma in partial fulfillment of the requirement for the degree of Master of Dental Surgery (M.D.S.) in Conservative Dentistry and Endodontics, under our guidance during the period 2005-2008.

Dr. K.H. Kidiyoor, M.D.S.

Professor & HOD Department of Conservative Dentistry & Endodontics

Dr. Priya Horatti, M.D.S.

Professor & Guide Department of Conservative Dentistry & Endodontics

DIRECT FILLING GOLD

CONTENTS
HISTORY PROPERTIES OF PURE GOLD BIOCOMPATIBILITTY TYPES ANNEALING/DEGASSING INDICATIONS AND CONTRAINDICATIONS ADVANTAGES AND DISADVANTAGES CONDENSATION CAVITY PREPARATION AND RESTORATION

HISTORY

About 3000B.C Greeks and Romans used gold foil for jewelry Between 3000 and 2000 B.C Gold jewelry was found in Sumerian, Babylonian, and Assyrian tombs

Between 1570 and 1293 B.C Gold jewelry was found in Egyptian tombs

In 1483 Giovanni dArcoli recommended gold-leaf fillings Philip Pfaff, dentist to Frederick the Great of Prussia, used gold foil to cap the pulp

Early 19th century Gold leaf as a restorative material became popular in the United States

In 1812 Marcus Bull of Hartford, Connecticut, began producing beaten gold for dental applications In 1853 Sponge gold was introduced in the United States and England to replace gold leaf In 1855-American dentist Robert A. Arthur introduced cohesive or adhesive gold

PROPERTIES
Soft, malleable, ductile Does not oxidize under normal atmospheric conditions Rich yellow in colour with a strong metallic lustre

Fuses at a temperature of 1063C and boils at 2200C. True density of pure gold is 19.0 19.3g/cm3.Measured density is in the range of 14-15 g/cm3

Brinells hardness number of pure gold is 25

C.T.E. is 14.4 10-6 /C which is close to that of tooth High thermal conductivity of 0.710cal/sec/cm2/(C /cm)

Noblest of all metals Mechanical properties affected by small amounts of impurities Can be cold worked and welded at room temperature Most efficiently sealing permanent fillings

BIOCOMPATIBILITY OF GOLD RESTORATIONS

A pure gold restoration is biologically sound Pure gold is well tolerated by gingival tissue Periodontal health of the tooth following placement of gold is questionable Pulpal health following a direct gold restoration is questionable Application of liners and bases is mandatory whenever recommended With effective remaining dentin thickness of 3-3.5mm, use of cavity varnish will suffice. With effective remaining dentin thickness of 1-2mm, it is recommended to use :

A subbase of Zinc oxide eugenol followed by a cavity varnish and a base of Zinc phosphate cement

A subbase of calcium hydroxide followed by a base of polycarboxylate cement

With an effective remaining dentin thickness of less than 1mm, there will

usually be destruction of pulp dentin organ.

TYPES
FOIL o Sheets o Pellets (hand rolled and commercially rolled)
o

Cylinders (preformed and hand rolled) Ropes Corrugated foil Laminated foil Platinized foil

o o o o

ELECTROLYTIC PRECIPITATED GOLD o Mat gold o Mat foil o Gold calcium alloy POWDERED GOLD o Goldent GOLD FOIL

o Gold foil sheets Sheets are manufactured by a process called gold beating or rolling Pure metal is melted and formed into ingots of desired size All light weight sheets are formed by beating. Heavier mallets are used initially for beating gold ingots followed by lighter ones when the gold gets thinner Heavy weight sheets are formed by rolling. Gold is passed continuously through the rolling mills until the desired thickness is achieved Gold foil sheets are bound in the form of books of 1/10 or 1/20 ounces One book contains 12 sheets and each sheet commonly has the dimensions of 4 4 . No.4 gold foil is usually used which weighs 4 grains and is 0.51ms thick Varying numbers of gold foil sheets are available like No.20,40,60,90 etc

Gold foil pellets May be hand rolled or commercially produced Pellet sizes may vary from 1/2 -1/128 which represent the portion of the No.4 gold foil used to form a pellet No.4 gold foil is removed along with its tissue paper from the book Sizes ,which are commonly used for rolling into pellets are 1/16 onwards The desired piece of gold foil is then grasped from the centre and held between the thumb, index finger and middle finger of the left hand Ends are tucked with tweezers towards the centre and rolled lightly into round balls of loosely packed mass of gold Pellets are degassed and stored in separate compartments of a gold box Gold foil cylinders This form can be both hand rolled and commercially rolled It is custom made by rolling cut segments of No.4 gold foil usually1/2,1/4 and 1/8 into desired widths Cylinders are degassed and stored in the gold foil box

Corrugated gold foil/Carbonized gold foil Manufactured by placing thin sheets of paper in between the gold foil sheets, which are then ignited The paper burns and gets charred The gold foil becomes corrugated Platinized gold foil This is a sandwich of gold and platinum with the platinum content being 15% It can be formed in two ways : 1) One sheet of pure platinum foil is sandwiched between two sheets of gold foil. These are then hammered until the thickness of one No.4 Gold foil is obtained 2) Layers of platinum and gold are rolled over together so that there occurs fusion of the two even before the beating procedure has begun Platinum increases the hardness and wear resistance of the restoration This form can be applied in stress concentration areas like incisal edges and cusp tips Laminated gold foil A combination of 2-3 foils with crystals running in different directions More resistant to the applied forces

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COHESIVE AND NON-COHESIVE FORMS

Pure gold can be classified into cohesive and non-cohesive forms Two gold surfaces can cohere by welding at room temperature only if the surfaces are atomically clean Manufacturer may supply to the dentist a gold foil which is essentially free of any surface contaminants and can be directly placed into the cavity preparation. Such a form of gold is called the Cohesive gold It is recommended to degas even the cohesive forms before placing them in the cavity preparation as some adsorption of gases like carbonic acid gas, phosphoric acid gas, hydrogen sulphide gas etc. are likely to occur during storage and transportation Non-cohesive form of gold is one in which certain non-volatile contaminants like iron,sulphur or phosphorous are permanently deposited onto surface. They do not have sufficient strength and hardness compared to their counterparts.

ELECTROLYTIC PRECIPITATED GOLD

Consists of crystalline gold powder formed by electrolytic precipitation Powder is formed into different shapes by heating at a temperature well below the melting point of gold

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 Diffusion of the particles occurs at the point of contact so that the particles coalesce and grow Mat gold/crystal gold First referred by Rule in 1937 in his analysis of gold foil This is electrolytically precipitated gold obtained by a process similar to electroplating at an accelerated rate Deposited material has a spongy structure with loosely arranged or fern like crystals During subsequent heating process, branch ends of the crystals are rounded & tend to weld themselves together Available in the form of strips of medium widths(2mm) and wide widths(3mm),which can be cut to the size that fits the cavity Mat gold being spongy in nature can be easily compacted and adapted to the retentive portions of the prepared cavity Its use is restricted to forming only the internal bulk of the restoration Mat foil Sandwich of mat gold placed in sheets of No.3/No.4 gold foil

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 Sandwich is sintered by heating to just below the melting point of gold and cut into strips of different widths Electralloy An alloy of electrolytic gold and calcium Calcium content is usually 0.1-0.5% by weight Stronger restorations are produced by dispersion hardening The product is sandwiched between two layers of gold foil for convenience

POWDERED GOLD
Is in the form of minute particles Can be obtained by atomization from a molten state or by chemical precipitation In chemical precipitation, gold is dissolved in aquaregia and precipitated by Oxalic acid,sulphur dioxide or sodium nitrate Average particle size is 15ms. Powder is gathered into a conglomerate mass having a diameter of 1-3 mms These masses are either sintered or lightly precondensed to facilitate slight adhesion between the particles and easy handling.
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POWDERED GOLD AND GOLD FOIL COMBINATION This form was introduced in 1962 by Baum and Lund Commercially available pellets of powdered gold wrapped in a gold foil are known as Goldent Powdered particles are mixed with a soft wax and held in a No.3 gold foil Gold foil acts as a container for the powdered particles and facilitates their condensation Each pellet contains approximately ten times more gold than a pellet of gold foil of comparable size Ratio is 95% powder and 5% foil Hand method of compaction is better than mechanical compaction for powdered gold

ANNEALING/DEGASSING
Annealing a gold foil refers to the removal of surface contaminants Degassing or desorptionis the preferred term Primary purpose is to produce an automatically clean surface and render the material cohesive and workable

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 Degassing is done for non-cohesive gold to remove the protective ammonia film placed deliberately on its surface by the manufacturer Degassing for cohesive gold is done to remove various contaminants like sulphur and phosphorous compounds, oxides or water vapour adsorbed on its surface during storage and packaging Temperatures in the range of 600-1300F must be produced on the surface on the surface of the gold to volatilize gases or other volatile contaminants. Two methods can be used for degassing- the alcohol flame or the electric annealer

HAZARDS FROM OVERHEATING DIRECT GOLD MATERIALS

Possibility of recrystallization and grain growth Possible incorporation of impurities from the surrounding atmosphere in the melting or just the very hot surface of gold when it is overheated, or the adhesion of those impurities to the gold surface when it is energized by too much heat for too long a time This hazard can occur in those gold materials that are supplied in sintered form. Overheating during degassing can result in an oversintered situation where the whole mass of particles will adhere to each other Complete melting of the gold surface which can make it completely noncohesive
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During mass contamination of direct gold, the pieces may tend to adhere before inserting them in the preparation

Insufficient degassing creates pitting and porosity within final restoration due to incomplete removal of protective gases making material only partially cohesive

INDICATIONS
Incipient carious lesions

Class lesions in premolar teeth and accessible development pits Class I lesions on premolar teeth Class lesions in maxillary and mandibular anterior teeth

Class V gingival lesions

Erosion areas A typical lesions : Proximal lesions on teeth adjacent to crown preparations

Vent holes in crowns and defective inlay/crown margins can be effectively repaired with direct gold Class VI lesions (cusp tips) and incisal edges Retrograde root canal filling material

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CONTRAINDICATIONS
Teeth with very large pulp chambers Severely periodontally weakened teeth Large carious lesions Handicapped, elderly or young patients Psychologically unsound patients When economics is a limiting factor Where esthetics is a prime requirement Inaccessible/poorly accessible areas Isolation unobtainable Areas of undesirable occlusal stresses Patients with a high caries index Hypoplastic areas

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ADVANTAGES
1. A permanent method for repairing teeth, and the restoration could last as long as the tooth itself
2. Does not tarnish and corrode in the oral cavity

3. Insoluble and has a coefficient of thermal expansion close to that of tooth

4. Atraumatic cavity preparation

5. No tooth discoloration around the margins 6. No cementing medium is necessary for retention of the restoration
7. Surface can be effectively polished and has long lasting smoothness

8. Pure gold is ductile and can be burnished to produce an accurate margin for the restoration.
9. Can withstand compressive forces sufficiently 10. The restorative procedure develops skills of the operator in other

dental procedures also.

11. Most efficiently sealing permanent restorative material

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DISADVANTAGES
1. Unesthetic 2. Expensive 3. Long chairside time required for restoration 4. Use limited to conservative cavities 5. High thermal conductivity could lead to postoperative sensitivity 6. Technique sensitive 7. High condensation forces may injure the tooth and supporting structures

CONDENSATION OF THE DIRECT FILLING GOLD

Condensation is the procedure used to condense and harden gold inside the cavity preparation Results in a dense porous gold restoration Objectives of compaction : Cohere two pieces of gold to each other. This process is known as welding Adapt the gold intimately to the walls and margins of the prepared cavity Cold work and harden the gold mass to increase its strength

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 To drive away air from in between the pieces of gold and gold-tooth interface PRINCIPLES OF CONDENSATION 1) Force of the blow :-Average force required to condense gold with a condenser point of 1mm diameter is 15 pounds Delivering forces from a mallet are recommended Factors which control the ultimate force delivered in a blow are :a. Weight of the hammer and the velocity with which it is brought down on the condenser b. Resistance of the substance receiving the blow c. Area of the condenser point in contact with the restoration 2) Direction of the applied force during condensation is called as the line of force Force applied with a condenser parallels the long axis of the instrument shaft While compacting in the centre of the cavity, forces are usually directed at 90 to the pulpal floor. 3) Small condenser tips (0.5-1.0mm) are usually considered adequate to achieve the desired compaction

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4) Uniform stepping of the condenser point is important to ensure hardening and welding of the entire restoration without leaving behind any voids. STEPPING is the overlapping of the previous area of the condensers stroke by half or one fourth both in individual steps and in lines of steps Stepping process can proceed in two ways :a) Moving parallel to the wall and wedging the final row between the already condensed mass of gold and cavity wall b) Moving perpendicular to the wall. The final row wedges the gold between that wall and the already condensed gold 5) Use the minimal thickness of pellet possible, provided that the condensers will not penetrate it. 6) Energy of condensation :- It is more effective to utilize a lesser amount of energy inside the cavity preparation and to increase energy of condensation gradually as the step-by-step build up proceeds to surface Factors on which resistance to condensation energy depends:a) The more tone that there is in the periodontal ligament, the healthier the periodontium will be , the more resistance there will be to the condensation energy, and the more effective this energy will be in fulfilling the objectives of condensation b) The volume of the tooth being condensed against
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c) The modulus of resilience d) Design factors e) Operator variables f) Increment size g) Technique variables 7) When inserting pieces of direct gold materials, condensation can be either from one periphery of the increment to the other, or from the center of the increment to the peripheries 8) Condensation of precipitated types of direct gold materials should be started by hand. When the material is unyielding to the hand condenser, mechanical condensation can proceed METHODS OF APPLYING CONDENSATION FORCES Condensers are instruments used to deliver the forces of compaction to the underlying restorative material. Several methods for application of these forces :a) Hand pressure- Small condenser points of 0.5mm in diameter are generally recommended b) Hand malleting- Long handled condensers and leather faced mallets(50 gms in weight) are used for this purpose
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c) Automatic hand malleting- utilizes a spring loaded instrument that delivers the desired force once the spiral spring is released d) Electric malleting(McShirley electromallet)-Intensity generated can vary from 0.2 ounces to 15 pounds and frequency can range from 360-3600 cycles/minute

e) Pneumatic

malleting(Hollenback

condenser)-

consists

of

vibrating

condensers and detachable tips run by compressed air

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 Condenser rectangular

instruments

can

be

straight,curved,angled,round,square,or

Surface of the tip can be smooth or serrated The tip can be flat faced or convex-faced Current condensers have a series of small pyramids or serrations on the face Plastic flow of gold occurs over short distances under the face of the condenser Densest structure occurs directly under the face of the condenser Condenser should traverse the entire surface of each increment as nearly as possible COMPACTION TECHNIQUE Gold foil cut to the size and shape of the cavity is spread out in a smooth concave form by hand

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Gold is adapted lightly to the cavity walls, line angles and point angles by hand pressure

Gold is held steady by a holding instrument, and a condenser of desirable size is used to begin malleting in the centre of the mass

Slowly, the condenser is moved to the periphery along straight lines using the stepping process

As it reaches the walls, the condenser is turned from 90to 45such that it bisects the line angles and trisects the point angles

While building the restoration, forces of condensation must be directed at 90to the previously condensed gold

Compaction of first layer produces a building shelf and a gold bank is developed on to it

GENERAL STEPS FOR INSERTION OF RESTORATION IN A CAVITY PREPARATION A. Three step build-up for the restoration 1. Tie formation This involves connecting two opposing point angles or starting points filled with gold with a transverse bar of gold. This forms the foundation for any restoration in direct gold
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DIRECT

GOLD

2. Banking of walls This is accomplished by covering each wall from its floor or axial wall to the cavosurface margin with the direct gold material

A wall should be banked in such a way that will not obstruct tie formation or banking of other walls in the cavity preparation

Banking

should

be

performed simultaneously on the surrounding walls of the preparation 3. Shoulder formation Sometimes, to complete a build-up, it is necessary to connect two opposing walls with the direct gold material B. Paving of the restoration Every area of cavosurface margin portion should be individually covered with excess cohesive gold foil A foot condenser is useful for this purpose

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C. Surface hardening of the restoration Highest condensation energy is used on the surface of the restoration in all directions, so as to strain harden the surface gold and to fulfill the rest of the condensation objectives at this critical area of the restoration D. Burnishing Creates a solid gold sheet marginally and on the surface Should be done with proper instruments, moving from gold to tooth surface Enhances surface hardening Adapts the material more to the margins Eliminates surface and marginal voids

E. Margination Using sharp instruments(e.g., knives and files), moving from the gold surface to the tooth surface, try to eliminate excess in small increments at a time This process is done until it is possible to visualize the original outline of the cavity preparation F. Burnishing Closes marginal discrepancies Strain hardens the surface
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G. Contouring Anatomy of restoration is made to coincide with that of the tooth Restoration is made compatible with the that of the opposing,contacting,and occluding teeth H. I. Done with knives,files or finishing burs Additional burnishing Finishing and polishing Minimal finishing and polishing is required with a properly surface hardened,marginated,and contoured restoration Some finishing may be done using precipitated chalk or tin oxide powder on soft bristle brushes or rubber cups J. Final burnishing Done to ensure closure of marginal voids and other surface discrepancies

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PHYSICAL PROPERTIES OF COMPACTED GOLD

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