Beruflich Dokumente
Kultur Dokumente
Preface
Course Schedule
4
6
9
10
Temporaries
11
14
16
41
44
46
47
Suppliers
48
Educational Materials
49
Map
50
Impression Technique
PREFACE
A few years ago, Dick Tucker and I were having lunch at the
Meany Hotel and we talked about creating a clinical course in
Seattle where dentists could learn about conservative gold castings. There seemed to be a need for such a course since the only
way a dentist could learn a good technique at that time was through
participation in a study club. Dick had taught a five day clinical course for many years at the
University of British Columbia. The ideal scenario would be to provide courses for dentists and
laboratory technicians in a private teaching facility. Hence, the concept of the Tucker Institute
was conceived.
There is no private facility yet, but this course and others like it, marks the beginning of
our journey. I hope that the information in this syllabus and your experience in the course will be
of assistance for your journey toward perfection and enjoyment of gold castings.
lunch
tooth prep B
12:30
2:00
tooth prep D
lunch
tooth prep C
1:30
12:00
9:30
tooth prep A
1:30
12:00
9:30
10:00
lab
lunch
lab
lecture
8:00-9:15
8:00-9:15 lecture
Wednesday
Tuesday
Monday
8:00-9:30 lecture
Thursday
1:30
12:00
9:30
seat casting
lunch
seat casting
8:00-9:15 lecture
Friday
1:30
12:00
9:30
closing dinner
seat casting
lunch
seat casting
8:00-9:15 lecture
You are coming to learn Richard V. Tuckers technique for gold restorations. You put
yourself at a disadvantage if you do not have all of the exact instruments and supplies that are listed
for the technique. You will spend precious time borrowing items from your fellow students. Or you
might substitute instruments or supplies that dont work as well for the technique. Based on our
experience from previous courses, a blind faith approach seems to work the best.
If you chose to maximize your experience with Dr. Tucker, I would recommend the
following preparation: read the syllabus; watch Dr. Tuckers DVD with the The Gold Inlay, Variations in Cavity Design, and The Laboratory: get the models of Dr. Tuckers preparations and then
practice cutting preparations on ivoreen teeth, trying to duplicate the models exactly as far as outline
form, proportion and preciseness.
Treatment Planning
Create a situation where you have the best chance of having a positive learning experience. Choose
a patient that is easy to work on. Choose teeth that are ideal for the restorations that you want to
learn how to do. Teeth with incipient lesions or small restorations are ideal. Try to stay away from
teeth with large restorations, poor quality tooth structure, potential carious exposures, and teeth
with access problems. It is better to take your time and do one restoration well rather than multiple
restores at a mediocre level.
When someone is finished with his preparation or seat, the mentor will ask for permission to announce that the procedure has been completed. All participants of the group can then look at the
completed procedure. You can learn a lot from observing what others have done. It is also a form of
support for your fellow participants to take the time to look at their procedure.
Mastery
In a book called Mastery, George Leonard talks about succeeding at any task. He says that mastery is not perfection, but rather a journey, and the true master must be willing to try and fail and try
again. Perhaps some of his thoughts on mastery will assist you on your journey toward becoming a
Master Dentist.
The Five Master Keys:
1. Instruction
2. Practice
3. Surrender
4. Intentionality
5. The Edge
Instruction
Find the right teacher. Why re-invent the wheel? Begin with a good
foundation. Look for those who themselves have had great teachers. Look for patients and empathy.
Look for those who interact, who praise at least as much as they critique.
Practice
Practice can be used as a verb. We practice to get to Carnegie Hall. For the masters journey, practice is not something you do but something you are. Practice is the path upon which you travel. A
practice (as a noun) can be anything you practice on a regular basis as an integral part of your lifenot to gain something else, but for its own sake.
Surrender
The courage of a master is measured by his or her willingness to surrender. This means surrender to
your teacher and to the demands of your discipline. Perhaps the best you can hope for on the masters journey is to cultivate the mind and heart of the beginning at every stage along the way. For the
master, surrender means there are no experts. There are only learners.
Intentionality
Apply full consciousness to an activity, dont just go through the motions.
The Edge
A master is one who not only pursues the refinements of a skill; he eventually pushes the edge of the
envelope.
(15-8-14) is then placed on the edge of the occlusal wall and with two or three slices toward the gingival, the axial wall is planed. The chisel meets the proximal walls to establish the bucco-axial and
the linguo-axial line angles. The bucco-gingival and linguo-gingival line angles are coincidentally
formed by the chisel chopping to the gingival wall. The 42S chisel also should smooth any flaws or
discrepancies on the occlusal wall and gingival wall while it is in hand. The same procedure isused
on the mesial areas of the tooth with the off angle chisel #43S (15-10-16) and or the enamel hatchet
#15 or #16. On both the mesial and distal areas of the tooth, the proximal walls should be planed first
so the effect of gouging the line angles with the edge of the chisel would be removed as the axial wall
is planed along this angle.
4. The gingival margins are beveled with double ended marginal trimmers #232 (10-95-19-16) for
the distal; then # 233 (10-80-10-16) for the mesial areas of the tooth. The double ended instruments
would be used for ease of operation. The marginal trimmers should be sharpened to acute angles so
the bevel on the gingival margins will be longer than that which would be produced with the more
flattened marginal trimmers. The gingival bevel should be made smooth and even with the trimmers
planing toward the proximal walls.
5. There is some difference of opinion regarding the use of a bevel on the occlusal margins4 . When
the tooth being prepared is very sound, with occlusal enamel that has not been bruised or crazed, it
may be justifiedthat just a faint contouring should be done with a medium sand disc. There would be
less concern of future breakdown of the occlusal margin however, if a bevel of approximately twenty
degrees were placed with a #56 carbide bur. The disc does serve to polish the proximal walls if they
have not been planed sharp and straight with chisels.
6. When it is necessary to cover a cusp or cusps with gold it can be accomplished
effectively with a #7404 or #7406 twelve fluted bur producing a hollow ground relief and bevel. This
finishing bur is used in almost a painting motion to establish a smooth, well defined flowing outline
to the extended cavity5 . This technique would not be used for coverage of maxillary buccal cusps as
it would display an unnecessary amount of gold and the inclined planes of the occluding teeth do not
require such coverage. In such cases after occlusal reduction has been done with the hollow grinding
bur, only a sleight discing is necessary to remove the acuteness of the margin.
It has been demonstrated that there is a relationship between surface roughness of the cavity
or the casting and consequent retention6 . It would seem unreasonable to apply this fact to posterior
inlays which present little or no retentive problems.
However, it should give cause to avoid polishing with discs the bulk of three quarter crown or full
crown preparations. It has been shown that properly placed pins serve well to increase the retentive
quality of a casting. If a tooth is destroyed to the extent that retention should be a problem the placement of the pins is the simple solution.
In view of the fundamental necessity to prepare a fine cavity to accomplish a satisfactory gold inlay, it is hoped that this paper and the technique that has been described will be of some assistance.
References
1. Brown, Milton H., Impression Procedures for Restorative Dentistry. Dental
Clinics of North America, Philadelphia, W.B. Saunders Co., 1967, p.149.
2. Bassett, Ingraham and Koser, An Atlas of Cast Gold Procedures, Uni-tro
College Press, Buena Park, Califronia, p.14.
3. Ellsperman, George E., Bellingham, Washinton, Personal Consultation.
4. Frates, F..E., Inlays, Dental Clinics of North America, Philadelphia,W.B.
Saunders Co., 1967, p. 163.
5. Tucker, R.V., Variation of Inlay Cavity Design, JADA 84: March 1972, p.
616.
6. Charbaneau, G.T., Some Effects of Caity Roughness On Adaptation of Gold
Castings. J. Dent Res. 37:95 Feb. 1958.
7. Lore, R. E. and Myers, G. E., Retentive Qualities of Bridge Retainers,
JADA 76: p. 571 March 1968.
Impression Technique
1. For one or two crowns or perhaps a quadrant of inlays, the quadrant check bite is a proven technique.
2. The metal Coe tray is used most often. When the back of the Coe tray does not allow the
patient to bite into centric occlusion comfortably, the smaller wire Emery tray is used.
3. For gingival retraction, a bulky, non-braided cord (Gingivi-Pak #3, Surgident) is pre
ferred. This cord provides good retraction depth below the preparation and good width
of the sulcus. The popular braided cord, double pack method where the first chord
remains in the sulcus during the impression generally does not provide the depth and
width desired for good impressions. Invariably the tissue seems to bleed if both chords
are removed. A 25% aluminum chloride solution (Hemodent) is used for hemorrhage
control. It seems to be kind to the tissue and leaves no film on the preparation. Ferric sulfate is
not recommended for a hemostatic agent for inlay preparations.
4. One or two cords are placed around the preparation. Two cords seem to work well
interproximally. They should be left in place for about 3 4 minutes. Prior to taking the
impression, check the fit of the tray and have the patient practice getting the feel of
biting into centric occlusion with the tray in place. Note the occlusion on the
contralateral side as a guide so you know when the patient is biting into centric
occlusion.
5. Light body polyvinyl siloxane impression material is used for the entire impression to avoid
folds that can occur at the interface of light and heavy body mixes. The potential set inhibition
due to the rubber dam or latex gloves can be counteracted by cleaning the preparation and
adjacent teeth with a cotton pellet saturated with diluted hydrogen peroxide, followed by
a thorough rinse. Hydrogen gas evolution is a by-product of the polymerization of polyvinyl
siloxane impression materials. Small voids in the stone model will result if the impression is
poured too soon. Model pour ups should be delayed 30 minutes to 2 hours depending on
the brand of material.
6. Before the impression material is mixed, the operating field should be spray washed and
dried and the cord is slowly removed. It is checked for adequate retraction and that
there is no hemorrhage. If retraction is not adequate or if there is hemorrhage, repack.
If it is satisfactory, it must be maintained dry and the impression material is mixed.
Syringe impression material into the preparation, place the check bite tray and have the
patient bite into centric occlusion. Be prepared to assist the patient into the proper jaw
position with gentle pressure on the chin. Continue to monitor and support the patient
for a few minutes to make sure that there is no distortion in the impression due to
patient movement.
7. Check the set of the material with the tip of the cotton pliers. When the material seems to be set,
allow one more minute of set time.
8. Remove the impression with a fast movement in a vertical direction to minimize
distortion and tearing.
9. If there is a question that the patient was biting in centric occlusion, a supplemental bite of BluMousse material can be taken. A new impression is generally not necessary.
DuraSeal Temporary
Armamentarium
DuraSeal acrylic
Temporary stopping (gutta percha)
Large straight brush
Woodsen hand instrument
2 dappen dishes
lighter (flame)
Indication
DuraSeal is a semi-soft acrylic that is ideal for inlays and onlays. It is easy and quick to place and
to remove.
1. A piece of temporary stopping large enough to cover the gingival 2/3 of each box form is heated
with a lighter and taken to place with a Woodsen instrument (packer/plugger combination). It
acts like a dam so that the acrylic does not touch the tissue so the stopping must be placed against
the adjacent tooth as well.
2. The stopping should not extend above the contacts to allow the acrylic to be locked in at the
contacts of the adjacent teeth. Excess stopping can be contoured and removed with a heated
instrument.
3. The DuraSeal acrylic is placed with the liquid/powder method using a fairly large brush. Build
acrylic to contour, be sure to cover all margins of the preparation. Work quickly because the
patient must bite and go through excursive movements while the acrylic is still fairly soft. The
acrylic can be molded with moistened finger-tips. No attempt is made to refine the occlusion if it
is not grossly excessive. Excess flash can be
removed with a cleoid or a heated instrument.
4. Multiple preparations can be connected with a single layer of acrylic.
5. Tell the patient they will not be able to floss.
6. There are more sophisticated methods to temporize inlays and onlays but this method is very easy
and fast both during placement and removal since no temporary cement is used. Patients seem to
tolerate this temporary well. The gingival tissue response is generally surprisingly good.
11
11
How to sprue
1. Sprue pattern on the die.
2. Using #12 shapes, cut approximately 1/8 in. long blind sprues and attach to all gingival margins.
3. Place main sprue on heaviest part.
4. On contact opposite main sprue, place 1/8 in. wax sprue. Run a wax sprue from base to this
sprue.
5. Do not distort wax pattern on removal.
6. Apply surface tension remover. (Wax It)
Investing
1. Invest immediately. Do not allow it to set on the sprue former.
2. Line the ring with asbestos or asbestos substitute.
3. Allow a few millimeters of the end of the ring to be free of liner.
4. Soak ring in water and shake off excess.
5. Use room temperature distilled water with investment.
6. Measure both water and powder accurately.
7. Spatulate 10 seconds for a thick mix and 20 seconds for a thin mix.
8. Use vacuum investor. Novocast Investment (Whip Mix) 50 grams of powder. No water
bath. Paint investment on the pattern. Fill the ring.
Water/Powder (cc) TemperatureF Ring Liner
Crown
15.5
1175
2
3/4, 7/8 Cr
18 1150
2
MODBL
18
1150
2
MOD
18.5
1150
2
DO, MO, Occ
15
1175
2
Burn Out
1. Allow the investment to set at least 1 hour.
2. Carve off end of investment in the ring.
3. Place in cool furnace.
4. Be sure furnace is calibrated.
5. Run furnace to temperature, heat rate at 3 takes about 1 hour.
Casting
1. Cast within 20 minutes.
2. Use air and gas flame ( no oxygen).
3. Do not over heat gold. Dust with flux, cast as soon as the gold rolls together.
4. Kerr broken arm casting machine is good.
5. Use a Type II gold with Brinell hardness of 95-110 with approximately 80 % gold alloy.
6. Let gold cool in ring before breaking out.
7. Brush casting clean and place in an ultrasonic cleaner. Do not touch inside with an instrument.
8. Boil in reducing solution (Prevox).
13
Finishing
1. Cut casting off sprue with separating disc.
2. Try casting on die carefully checking for open margins and proper expansion.
3. Keep a log of each casting with variables noted. e.g. water/powder ratio, casting temperature, and time of furnace temperature build-up.
4. Adjust contacts and bite.
5. Adjust contact with rubber wheel.
6. Finish casting with #.5 round bur over all occlusal fissures.
7. Use Robertson #11 standard stiff bristle brush with Tripoli over occlusal also end brush
mandrels that have been sharpened.
8. All other surfaces are finished with discs in the following order: medium garnet, fine sand
and fine cuttle.
9. Robertson soft bristle brush with rouge over the occlusal.
10. Felt wheel on mandrel with Tripoli.
11. Chamois wheel on mandrel with rouge. Do not let Tripoli get on chamois.
12. Wash polish off casting with hot water and all purpose cleaner.
(May use ultrasonic).
13. *Note: While waxing, remove as much bulk from the inside as possible with a sharp
cleoid or discoid instrument.
14. *Note: Do not finish on the die, and avoid finishing the margins.
13
After all procedures necessary to produce a gold inlay, onlay, or other type of casting have been
completed with care and understanding; the last step, the finishing of the gold if done properly will
make the difference between a serviceable restoration and that of a fine, beautiful case.
The procedures described below are predicated on the fact that the casting fits the tooth cavity,
because without a good casting no finishing technique will produce a fine case, nor even a serviceable
restoration.
The initial procedure of finishing involves the laboratory, as it is here that the difficult access
areas on the occlusal portion of the restoration are refined and polished; and the final contours are placed
on the casting To avoid destruction of the detailed anatomy in the casting, the following procedures
are suggested. All accessible surfaces, except contact areas and margins are smoothed with 1/2 inch
garnet medium, and 1/2 inch sand fine discs in that order. Then 1/2 inch cuttle fine discs are used over
all surfaces of the casting, including margins and inter proximal contact points..
All pits and fissures are smoothed lightly with a No. 3 carbide bur, contacts corrected, occlusion
corrected, then all occlusal anatomy is polished with a No. 11 standard stiff brush wheel and tripoli. If
needed the end brush mandrel may be used with tripoli in the deep areas of the casting. Finally the no.
11 soft brush wheel is used with a high polishing compound over all surfaces of the casting.
Since the restoration is finished except for the margins before cementation, the dentist confines
his efforts in the operatory to the margins only.
Following the administration of an anesthetic and proper isolation with the rubber dam, the
cavity is cleaned and then cavity varnish is applied to the dentin walls, using care not to apply it on the
margins. The restoration is tried to insure proper contact. It is not necessary to drive the restoration
to place prior to cementation. Usually it can be left a half millimeter from being completely seated, we
can be sure of proper expansion of the casting, do any necessary adjustment of the contact point, and
avoid the difficult task of removing a hard seating casting that could damage the tooth or the restoration.
A slow setting mix of zinc phosphate cement should be made on a cool glass slab. This is accomplished
by slow introduction of the powder to the liquid and powder would be added only to the point that it
would drop freely from the spatula. This is important as the casting would not have been
finished on the tooth prior to this time and the margins should be smoothed with the most coarse of the
three discs, prior to the hardening of the cement.
The interior surfaces of the casting are first covered with cement which would also be applied
to the cavity in the tooth. After having placed the casting in the tooth it would be seated hard by applying considerable pressure on an orange wood stick while being gently mallotted. The casting should
be held with pressure for a short period of time to allow
release of hydraulic pressure, which could cause the casting to lift.
With a slowly rotating mandrel in a straight handpiece, a medium grit garnet disc should be
rolled over the margins from the casting toward the tooth surface, creating a single plane between the
gold and the tooth. This also accomplishes a slight burnishing of the gold at the margin.
All margins of the gold can be operated with the straight hand piece except the
mesio-lingual margin and the gingival margins of all posterior teeth in both the mandible and the maxilla, with some unusual exception. After all other margins have been smoothed with this type disc on
the straight hand piece, the contra-angle would be used to smooth the mesio-lingual aspect. This is
accomplished with the grit side of the disc in facing the handpiece. Finishing to this point should be
done before the cement has hardened.
15
The next procedure requires little time because it is merely to polish the gold and the tooth at
the margins, not reduce them. The 1/2 inch fine sand grit disc would be used with the same handpiece
procedures as discussed above to accomplish a reduction in the size of scratches left by the medium
garnet discs.
Attention is next given to the gingival margins. The casting should fit accurately, with no excess
gold over the margin. A narrow eighteen inch finishing strip, with medium garnet grit, sharpened to
allow passage, would be passed interproximally. This is aided, as is the entire finishing of the gingival
margins, by the assistant retracting the tissue as the inter proximal rubber dam is held up, on both the
buccal and lingual aspects. A little Vaseline lubricant also is an aid to avoid catching the rubber with
the strip as it is passed over the margins.
The use of the strip smoothes the gingival gold and tooth structure to the same plane, as well as
the gingival third of the buccal and lingual cavosurface margins, which cannot be reached with discs.
Usually two or three swipes over the margin accomplishes this purpose, and care should be given to
avoid over use of the strip on the relatively soft cementum. It is observed that if gold is in excess, it
seldom can be finished properly to the tooth, since the strip seems to remove tooth structure faster than
the gold.
After use of the medium garnet strip, a similar fine cuttle strip is use in the same
manner. Again only two or three passes with the strip should suffice. This is only to remove fine
scratches and polish where it is not possible to use a disc.
If there are inaccessible areas such as in grooves or fissures, a fine white stone may be used in
those specific areas of the tooth.
A fine cuttle disc is then used to polish all accessible margins in the manner described above.
This seems to close the joint as well as polish the surfaces.
Final polishing can be done, after the proper discing with very little effort. First a slurry of
pumice in a rubber cup on a contra-angle would be used, to be followed by flushing and irrigation.
After drying the field of operation, dry tin oxide or similar polishing agent would be lightly used over
all accessible surfaces.
It should be noted that air coolant be used during all discing and during use of the strip, as well
as polishing, to avoid over-heating the tooth.
15
Inlays 3b
7/8 Crowns 3d
Full Crown 3e
Distal of Cuspid 3f
17
Rubber dam
Placement of a rubber dam is standard
procedure for this technique. It allows the operator to have the best field possible to work in.
The teeth are isolated, gingival tissue is slightly
retracted and saliva is eliminated. The tongue,
cheek and lips are eliminated from the operating
field. The patient is not concerned about swallowing any preparation debris. The quality and
quantity of restorations are enhanced.1-3
Remove previous restoration and caries
The entire existing restoration is expeditiously removed. Care should be taken not to
extend the outline beyond the existing restoration. Remove all remaining caries. The operator
should not be concerned about the preparation
taper at this stage. The remaining tooth structure
is then evaluated and the appropriate restoration
is treatment planned. It is helpful to transilluminate with a fiber optic light during the evaluation of the remaining tooth structure. Some
important treatment planning considerations are:
amount and quality of remaining tooth structure,
occlusion, significant fracture lines or enamel
crazing, parafunctional habits and gold display.
19
19
D. Gingival bevel
It is a small bevel that is .5-.75 mm wide. The
bevel should be definitive and smooth but not
too wide ( Fig. 10). There is no advantage in cutting a large bevel.
The bevel is created in thirds to prevent get Hand instrumentation sequence
ting a swale in the middle where it is easiest to
Smooth, precise preparations can be created cut. Start by cutting the buccal and lingual 1/3
with minimum effort with very sharp instruby planing toward the proximal wall. Then join
ments. Instruments should be sharpened before
the buccal and lingual segments by cutting the
each procedure. The sequence is illustrated in
middle 1/3 of the bevel last.
(Fig 9).
Gingival margin trimmers that are pre-sharpA. Pulpal and gingival walls are smoothedened by the manufacturer (Suter) at a more acute
with a 42 S off angle chisel.
angle than normal (30) are marked Tucker.
The #232 Tucker gingival margin trimmer is
B. Proximal axial line angle
used on the distal. The #233 Tucker gingival
Ideally, this line angle can be formed with one margin trimmer is used on the mesial.
or two strokes. The mesial proximal
axial line angles are placed with the 42S chisel.
Distal proximal axial line angles are placed with
the 43S chisel.
C. Axial wall
Begin by removing the little gouge on the
axial wall formed from creating the proximal
axial line angle and then smooth the rest of the
axial wall as needed. The distal axial wall is
smoothed with a 42S chisel. The mesial axial
wall is smoothed with a 43S chisel.
21
Occlusal bevel
The function of the occlusal bevel is to remove fragile enamel rods and any irregularities
in the cavosurface margin. It gives the operator
an opportunity to prepare a smooth, flowing,
esthetically pleasing outline. This bevel should
be placed with the same straight fissure bur ( #56
or #57) used for the rest of the preparation. The
bevel is placed with the bur incline of only a few
degrees more than the occlusal wall (Fig 11).
Where the existing outline is already adequate,
no bevel is needed since there are no undermined
enamel rods (Fig 12).
Disk proximal walls
A 1/2 inch garnet disk is used to straighten
the proximal walls. A #42S or#43S chisel is used
to plane the proximal walls if space is insufficient for the disk. The single plane of the proximal wall is maintained since a two plane wall is
not desirable. The disk can also be used to blend
21
Fig 13h Gingival bevel cut with Fig 13i Medium garnet disk on
Tucker
gingival margin trimmers. proximal
and occlusal walls.
23
Seating
Function
Impression
23
25
Check the set of the material with the tip of
the cotton pliers. When the material seems to be
set, allow one more minute of set time. Remove
the impression with a fast movement in a vertical
direction to minimize distortion and tearing.
Temporization
Armamentarium
Soft, fast set acrylic (Dura Seal)
Temporary stopping (gutta percha)
Large straight brush
Woodsen hand instrument
2 dappen dishes
Lighter (flame)
25
Water/Powder (cc) TemperatureF Ring Liner
Crown
15.5
1175
2
3/4, 7/8 Cr
18 1150
2
MODBL
18
1150
2
MOD
18.5
1150
2
DO, MO, Occ
15
1175
2
There are more sophisticated methods to
temporize inlays and onlays but this method is
very fast and easy during both placement and
removal since no temporary cement is used. Patients seem to tolerate this temporary well. The
gingival tissue response is generally surprisingly
good.
Lab
The skill in which an operator can prepare
teeth and seat castings is a very important part
of this technique but unless quality castings are
fabricated in the laboratory, it is impossible to
create consistently excellent restorations for our
patients. A basic understanding of the laboratory
procedures is essential to be able to critique castings and to communicate with your lab if refinements are necessary. It is not within the scope
of this chapter to discuss lab procedures in detail
but casting expansion will be covered because it
is an important concept to understand.
Gold shrinks approximately 2.4% of its
mass as it is cast and goes from a liquid to a
solid.15 If nothing is done to compensate for
this gold shrinkage, inlays will fit loosely with
marginal gaps and crowns will not seat to place
(Fig 24). The term expansion is used to describe
methods used to compensate for gold shrinkage.
Is the gold shrinkage clinically significant?
The occlusal inlay in (Fig 25 ) is an example
of an inlay that is too small for the preparation
Seating
27
Just prior to cementation, all of the composite buildup should be removed. A high speed #2
round bur can be used to section it. The preparation is cleaned and a desensitizing agent like
Gluma 3 is placed on the dentin.
A slow setting mix of zinc phosphate cement
is prepared by adding small increments of powder slowly to the liquid over a period of about
two minutes until the mixture will just drop
freely from the spatula. Cement is placed both
in the casting and the preparation. The casting
is seated and then considerable pressure is placed
with a pointed orange wood stick. The orange
wood stick is lightly mallet and held for several
seconds until the hydraulic pressure of the cement has dissipated. Excess cement can now be
removed.
The Finishing Sequence
Disks (1/2): medium garnet, fine
sand, fine cuttle (Fig 27).
Powders: slurry of flour pumice,
aluminum oxide with alcohol (15
micron), aluminum oxide dry (1
micron)(Fig 28).
Note: Continuous air should be blown
on the casting during disking to dissipate
the heat generated in the gold.16
Enamel and gold are reduced to the same
plane and the margins are burnished with medium garnet disks prior to hardening of the cement. The disks should always be rotated from
27
Esthetics
If conservative gold restorations are
properly designed and finished, gold display can
be minimal or nonexistent. A tooth can be functionally restored for a lifetime while the esthetics
of the original tooth can be maintained
29
Fig 32 Color discrepancy of a porcelain crown as natural teeth darken with age.
(Figs 30, 31). If a tooth cannot be restored esthetically with a conservative gold restoration,
then a porcelain restoration might be the best
treatment of choice. Keep in mind, however, that
the color of a porcelain restoration will eventually not match the rest of the dentition as teeth age
and become darker (Fig 32). So a conservative
gold restoration is often the ideal long-term
Fig 33 Magnification.
esthetic treatment.
Magnification
The use of magnification for this type of
dentistry is very helpful. Our ability to deliver
quality restorations is enhanced with the use of
some type of magnification. A range of 2 - 3.5
diopters is recommended (Fig 33).
Lower onlay
Invisible Onlay
Both cusps have been reduced and counter beveled. The counter bevel on the buccal functional
cusp is larger than the non-func
tional lingual cusp.
Upper onlay
Proper reduction of the cusps is shown for an
upper onlay. A counter bevel is placed only on
the functional lingual cusp to minimize gold
display.
Indication
This preparation is a modification of the
traditional onlay preparation to minimize
gold display on the occlusal buccal margin
of upper bicuspids.
Armamentarium
1. #56 fissure bur
2. Brasseler 7404 bur
3. Fine cuttle disk
Preparation synopsis
1. The lingual incline of the buccal cusp
is reduced steeply from the cusp tip
to the level of the pulpal floor.
2. The increased thickness of gold
protects the cusp and allows the gold
to be thinned on the buccal so it
cannot be seen.
3. More of the labial portion of the buccal cusp
remains when compared to the traditional upper onlay.
Preparation sequence
1. The lingual incline reduction of the
buccal cusp is done with a #56 bur.
2. A fine cuttle disk is used to place a
microscopic counter bevel on the
buccal cusp.
3. The lingual cusp reduction and
counter bevel are cut in the typical
manner.
31
Onlays
Fig 34a to 34l
Lower Onlay
Upper Onlay
Fig 34g Lingual counter bevel Fig 34h Micro-bevel buccal cusp Fig 34i Upper onlay completed.
with 7404 bur.
with fine cuttle disk.
Esthetic Onlay
Fig 34j Buccal occlusal Fig 34k Micro-bevel buccal cusp Fig 34l Esthetic onlay completed.
reduction to pulpal floor.
with fine cuttle disk.
31
Indication
This preparation is indication when the tooth
needs to be bound together or when the tooth
is badly destroyed but there is still a good
mesial buccal cusp.
Armamentarium
1. 57 fissure bur
2. 860-012 diamond
3. 860-014 diamond
4. 42 S and 43 S off angle chisels
5. Medium garnet disk
6. Fine cuttle disk
Preparation synopsis
1. A definitive occlusal center line angle
is created as the occlusal is reduced.
2. A minimal taper of the preparation
results in parallel walls.
3. The mesial hollow grind is cut to
draw slightly to the lingual. It allows
Indications
Lower molar full crown preparations where old
restorations or caries would require proximal
margins that are deep gingivally.
Preparation synopsis
1. A gentle buccal to lingual hollow grind curve
on both mesial and distal walls provide ad
equate resistance form.
2. Retention is enhanced by the long mesial
and distal walls of the hollow grind that
resulted from the increased gingival depth of
the preparation. They are also cut quite
parallel.
Armamentarium
1. 57 fissure bur
2. 860-012 diamond
33
3. 860-014 diamond
4. Brasseler 7404 bur
5. Fine cuttle disk
Preparation sequence
1. The occlusal reduction is done with a 57
bur. A sharp line angle is created in the
center of the occlusal.
2. The 860-012 diamond may be used to
break the contacts initially.
3. The larger 860-014 is used to cut the bulk
of the preparation.
4. The 7404 bur is used to finish the buccal
margin to provide a sharp smooth finish
line that provides adequate bulk of gold
for casting and finishing.
5. A fine cuttle disk is used to smooth the
occlusal line angles.
Crown with Shoulder
Indication
Lower molar full crown preparations without
extensive proximal involvement where a deep
hollow grind would be inappropriate.
Armamentarium
1. 57 fissure bur
2. 860-012 diamond
3. 860-014 diamond
4. Fine cuttle disk
Preparation synopsis
Additional retention and resistance
form is created by making a buccal wall
more parallel to the other walls by plac
ing a buccal shoulder.
Preparation sequence
1. The preparation is cut in the typical manner for a traditional full crown except for
the buccal wall.
2. The shoulder is cut with a 57 bur and
blended into the interproximal with the
860-014 diamond.
Brasseler 7404 Bur Preparation Variations
This bullet shaped bur produces a very smooth
hollow ground margin that allows good definition and bulk of gold at the margins.19
Hollow Grind Marginal Ridge
Indication
Thin, weakened distal marginal
35
OL Upper Molar
Synopsis
The marginal ridge can be expediently
included into the preparation without a
distal box or hand instrumentation.
Buccal Extension (Bale)
Indication
The finger-like extension on the buccal of
molars is placed when there is extensive
breakdown of the lingual cusp. It allows
the casting to engage the stronger buccal
tooth structure, reducing the stress on the
lingual.
Preparation Synopsis
1. The extension must have adequate
length and should not taper too much
to the lingual.
2. Adequate depth is necessary for
enough bulk of gold to prevent the
casting from bending and distorting.
Indication
OL groove on upper molars.
Preparation Synopsis
1. The entire cavity is cut with the 7404.
2. This simple preparation will have
a rounded pulpal floor and no line
angles.
3. Draw is created by the shape of the
bur only.
35
Preparation synopsis
1. A Midwest 7404 is used because it has
the ideal shape of more taper.
2. The depth of the pot hole is at least 2
mm. It is often more since we like to cut
through the entire depth of the buildup to
dentin.
3. The entire composite buildup is removed
prior to cementation.
Impression
1. Break off the end of an anesthetic needle
to remove the bevel with out closing the
lumen.
2. Place the needle in the pot hole and inject
impression material.
3. The needle allows air to escape and thus
decreases voids.
Slot Inlay
Indication
Restoration of the distal of a cuspid
with a small lesion or a small existing
restoration.20
Preparation synopsis
1. Hand instrumentation results in sharp
internal line angles.
2. Two plane labial and lingual walls enhance retention.
3. An internal bevel adds retention and aids
in seating of the casting during cementation.
4. A small definitive gingival bevel is
placed.
Preparation sequence
1. Open the cavity with the 169L bur and
establish the labial and lingual extensions
and the gingival wall. The cavity looks
like a crescent at this time.
2. Use the 169L bur to enhance the axial
line angles labially and lingually for retention. This creates the two-plane labial
and lingual walls.
3. Use the narrow 45 S off angle chisel
to place the proximal axial line angles,
which create sharp retentive walls.
4. Using the #233 margin trimmer place an
internal bevel on the gingival wall . Slide
down both the labial and lingual walls
to define the line angles and sharpen the
point angles.
5. Smooth the axial wall with the 44 S off
angle chisel since it will be rough from
instrumenting the internal bevel.
6. Place a small definitive gingival bevel
with the 232 Tucker margin trimmer.
7. A 55 fissure bur is used for the occlusal bevel which removes unsupported
enamel, smoothes the outline, and creates
a funnel which aids in seating.
Armamentarium
1. 169L fissure bur
2. 44 S and 45 S off angle chisels
3. 232 and 233 gingival margin trimmers
4. Tucker 232 and 233 gingival margin
trimmer
5. 55 fissure bur
37
Indication
Restoration of a large carious lesion or large
existing restoration with a lingual dove tail.20
Indication
Large cavity needing additional
retention and resistance form.20
Armamentarium
1. 56 fissure bur
2. Brasseler 7404 bur
Preparation synopsis
1. No hand instruments are used for this
preparation.
2. The preparation consists of a lingual
dovetail and a distal hollow grind.
3. It has an easy draw to the lingual because
there are no sharp internal angles.
Preparation sequence
1. Place the lingual dovetail with a 56 fissure bur. It draws perpendicular to the
lingual cavosurface with equal depth in
all aspects.
2. The Brasseler 7404 is used to place the
distal hollow grind. The hollow grind is
parallel to the labial surface. The axial
wall taper is kept to a minimum.
3. Place a light occlusal bevel with the
7404.
Armamentarium
1. #6 round bur
2. 169 L fissure bur
Preparation synopsis
1. 50% of distal hollow grind preparations
need a pin.
2. The pin is placed as far away from the
primary retention of the dove tail as possible.
Preparation sequence
1. A counter sink is placed with a high
speed #6 round bur.
2. The pin hole is placed with a 169 L bur to
a depth of about 1.5 mm and is parallel to
the lingual draw of cavity.
Conclusion
Although gold castings are relatively technique sensitive, and demanding on the operator,
when this type restoration is well done it offers
a great satisfaction to the patient in the form of
comfort and permanence. It is the desire of the
authors that more students and dentists acquire
the knowledge required to perform this type
service for their patients and perform this type of
dentistry routinely.
37
39
3. Hold the gold in the cavity with the Woodbury-Myer holder and con
dense with the direction of force directly into the cavity. Condense
each pellet initially with hand pressure and then condense using the
mallet.
4. Fill the cavity to the bevel with powdered gold so that there is only
about .5 mm left to fill.
5. The rest of the cavity is now filled with cohesive gold because it is
denser and will have less porosity. The condensation force is now
directed toward the enamel bevel. This will make the gold tight to the
walls as well as protect the fragile enamel during condensation.
6. As the gold is added to build up the contour, excess gold is removed beyond the margin with
a gold knife. It can be difficult to remove later and we may lose the relationship of where the
margin actually exists.
7. Verify if the cavity is filled by using an explorer from gold toward the tooth. If we do not
feel an edge of tooth, the cavity is filled.
8. Use a Varney foot condenser to finalize the condensation. It takes out the hills and valleys a
bit and smoothes the gold to one plane a little more.
Finishing
1. Always blow air when finishing gold with disks because the heat generated can damage the
pulp.
2. Remove the bulk of gold with a medium garnet. Care should be taken around the margins
with this disk because the enamel is quite friable and we do not want to bruise the enamel
with too coarse of a disk.
3. Next use the fine sand disks. Use a cleoid to remove any surplus flecks of gold since the
disks will continue to carry the gold over the margin.
4. Use a beaver tail burnisher to burnish and work harden the gold a bit.
5. Follow with the fine sand again to remove any irregularities produced as the gold was work
hardened.
6. The last disk is the fine cuttle. It does not require much effort because of the step-by-step
finishing sequence we have used.
Polish
1. Using a ribbed rubber cup, begin polishing with #4 pumice. Do not use pumice too long
because it removes tooth structure and gold at different rates.
2. We now use aluminum oxide 15 microns. The final finish is with the 1 micron aluminum
oxide.
39
References
1. Gergely EJ. Rubber dam acceptance. Br Dent J 1989;167:249-252.
2. Reuter JE. The isolation of teeth and the protection of the patient during endodontic treatment.
Int Endod J 1983;16:173-181.
3. Christensen GJ. Using rubber dams to boost quality, quantity of restorative services. JAm Dent
Assoc 1994;125:81-82.
4. Tucker RV. Class 2 inlay cavity procedures. Oper Dent 1982;7:50-4.
5. Jorgensen KD. The relationship between retention and convergence angle in cemented veneer
crowns. Acta Odontol Scand 1955; 13:35-40.
6. Kaufman EG, Coelho DH, Colin L. Factors influencing the retention of cemented gold castings. J
Prosthet Dent 1961;11:487-502.
7. Dykema RW, Goodacre CJ, Phillips RW. Johnstons Modern Practice in Crown and Bridge
Prosthodontics, ed 4. Philadelphia, WB Saunders Co, 1986, p 24.
8. Shillingburg HT, Hobo S, Fisher DW. Preparations for Cast Gold Restorations. Chicago, Quintessence Publ Co, 1974, p 16.
9. Tylman SD, Malone WFP. Tylmans Theory and Practice of Fixed Prosthodontics, ed 7. St Louis,
CV Mosby Co, 1978, p 103.
10. El-Ebrashi MK, Craig RG, Peyton FA. Experimental stress analysis of dental restorations. Part
IV. The concept of parallelism of axial walls. J Prosthet Dent 1969; 22:346-353.
11. Parker MH, Cameron SM, Hughbanks JC, Reid DE. Comparison of occlusal contacts in maximum intercuspation for two impression techniques. J Prosthet Dent 1997; 78:255-259.
12. Noonan JE, Goldfogel MH, Lamber RL. Inhibited set of the surface of addition silicones in contact with rubber dam. Oper Dent 1985; 10:46-48.
13. Cook WD, Thomasz F. Rubber gloves and addition silicone materials. Current note no. 64. Aust
Dent J 1986; 31:140.
14. Kahn RL, Donovan TE, Chee WWL. Interaction of gloves and rubber dam with poly(vinyl siloxane) impression material: A screening test. Int J Prosthodont 1989; 2:342-346.
15. Hollenback GM, Skinner EW. Shrinkage during casting of gold and gold alloys. J Am Dent Assoc 1946; 33:1391-1399.
16. Cooly RL, et al.Heat generation during polishing of restorations. Quintessence Int 1978 Dec;
9(12):77-80
17. Skinner EW, Phillips RW. The science of dental materials. 6th ed. Philadelphia: WB Saunders;
1967.p.473-74.
18. Keenan MP, et al. Effects of cast gold surface finishing on plaque retention. J Prosthet Dent
1980 Feb; 43(2):168-173.
19. Tucker RV.Variation of inlay cavity design. J Am Dent Assoc 1972 Mar; 84(3):616- 620.
20. Tucker RV. Gold restorations of the distal aspect of cuspid teeth. Signature 1996:4-9.
41
41
The Shooshan pins provide sufficient retention for an extensive inlay such as a large distal
lingual inlay on a maxillary cuspid. However, if the casting will rely entirely on its pins for resistance and retention, then a larger pin type may be desirable. In this case, the pin hole locations are
marked with a #6 round bur countersink. The pin holes are then made with the same constant finger
rest technique, substituting a 169-L or 170-L (depending on size)tapered fissure bur for the twist
drill.
The impression of these pin holes is made directly with the impression material, using the
air vent technique, as follows. The tip of a dry 27 gauge anesthetic needle is broken off with a small
plier insuring that the lumen remains open. One such needle is prepared for each pin hole. The
needles are placed to the depth of the pin holes, and as the impression material is forced along side
the needles, the air in the bottom of the pin hole will flow out the hollow needle allowing the impression material to completely fill the pin hole. The needle is then slowly withdrawn as more impression material is injected beside it. After all needle air vents have been removed, the remainder of the
preparation is injected with impression material and the impression is completed.
During the wax up, a size 700 tapered plastic pin* is placed into each pin hole. The wax is
then carefully flowed around the protruding end of each plastic pin and down into the counter sink
area. This technique will give a more substantial pin for use in higher stress applications.
There are times when even the 700 tapered fissure pin is not substantial enough, so a variation called the 700 tapered fissure slot is used. There are various applications but it might be used
in a distal occlusal inlay where there is insufficient tooth remaining in the isthmus area to provide
a good dovetail. Rather than cut an approximal box in the untouched tooth structure of the mesial
surface to keep the casting from being displaced distally, a 169-L or170-L (depending on size) bur is
used to place a slot in the pulpal wall just inside the mesial marginal ridge. This slot should extend
buccal lingually about 2-3 millimeters depending on the size of the preparation, and to a depth of 2.5
millimeters. This will provide ample resistance and retention form as well as allowing us to leave
the mesial surface of the tooth untouched. The slot thus formed is of relatively large dimension, and
can easily be reproduced by placing the tip of the impression syringe in the bottom of the slot as the
impression material is injected, or the needle technique could be used. After the die is recovered
from the impression, trimmed, and lubricated, wax can be flowed directly into the slot with a small
instrument during the fabrication of the wax pattern. The larger crossectional area of the slot should
allow the wax pattern to be removed without breakage or distortion of the slot portion. The finished
castings provide sufficient strength and retention without involving the remaining good approximal
surface.
The fourth pin type, the Tucker pin, was developed by Dr. Richard V. Tucker in Ferndale,
Washington. In order to understand its use, one must first visualize a tooth which has suffered a
great amount of destruction of the pulpal wall. This great void inside the tooth is filled with composite to provide a buildup yielding optimum dimension to the internal of the casting.
*Mfg. by N.W. Dental Supply, 590 Clearwater Suite C, Post Falls Idaho 83854
Concept by Dr. Maurice Chechik, Vancouver, British Columbia, Canada
43
If the final preparation needs more resistance and retention form, a 7404 bur is used to place
a pin hole to the full depth of the composite buildup. The 7404 bur which is manufactured with a
fairly straight, rather than rounded profile**, works well for making this pin hole. When the impression is made, the syringe needle air vent technique described previously, may be required to avoid
trapping an air bubble in the depth of the pin hole. The pin is waxed directly on the die as in the
case of the 700 tapered fissure slot. Before the casting is cemented in the tooth, the entire composite
buildup is completely removed. This large internal void is then filled with zinc phosphate cement
and the casting, which also is covered on the internal surface with cement, is seated. The cement
locks into the internal of the tooth and at the same time, locks around the 7404 pin. In this way we
are able to get additional resistance and retention without sacrificing any
additional tooth structure. Because of its large size, the Tucker pin is only placed in the buildup material, and never in tooth structure.
This completes some options for increasing resistance and retention form through the incorporation of pins in our gold castings. A first choice would be the Shooshan pin because of its
conservative nature. Secondly, the 700 tapered fissure pin would be chosen if additional strength is
required. Thirdly, the 700 tapered fissure slot would be indicated where there are great demands to
resist mesial or distal displacement, and finally, the Tucker pin could be used when more resistance
and retention form is required and there is a buildup of sufficient volume to contain the pin.
Incorporating these pin types in your castings will allow you to place more
conservative and longer lasting cast gold restorations.
43
45
Basic Items
Bibs & clip
Suction tips
Saliva tips
Topical anesthetic
Anesthetic syringe, needles
Anesthetic carpules
Cotton swabs
Dental floss
2x2s
Cotton rolls
Cotton pellets
Cotton roll holders
Articulating paper
Autoclave bags
Patient hand mirror
45
Models
*porcelain crucible
*Gold (type B)
*small brush
*dowel pins
Finishing
*mixing bowl
*Prevox
*spatula
Tripoli
jewelers rouge
heatless stones
*microfilm (Kerr)
tooth brush
Hollenback carver
matches
Waxing
*undercut wax
Suppliers
Accubite Dental Supply
WOW articulators
800-248-2746
GC America
Fugirock die stone
800-323-7063
Acculab
Scales (.01 g)
800-656-4400
Jensen Industries
Casting gold, gold foil, DVD
800-243-2000
E.C. Moore Co
Disks and madrels
1-800-331-3548
Micro Abrasives
Polishing powders (aluminum oxide)
1-800-426-6046
Brasseler
Burs
1-880-841-4522
Moyco
Polishing strips
1-800-221-1344
CT Enterprises
Pin kits
360-676-0305
Pepper Dental
Micropol (rubber polishing points)
888-4189
Columbia Dentoform
Ivoreen teeth
718-482-1569
Pfingst
Twits drills (.6 &.9 mm)
908-561-6400
Delar Corporation
Surfactant
800-669-7499
Emery Dental
Slim check bite trays
800-637-6611
Whipmix
Novocast investment
800-625-5651
47
Educational Materials
Richard V. Tucker DVD
This DVD contains all three of Dr. Tuckers videos:
The Gold Inlay
Basics for gold inlays and onlays that include preparations, impressions and finishing.
Variations in Cavity Design
Covers most of the preparations and variations that Dr. Tucker teaches.
The Laboratory
Lab basics and problem solving. A must see for dentists.
The cost of the DVD is $150. Order from:
Jensen Industries
1-800-243-2000 Ext 233
Ask for Ann Pellegrini
Ivoreen teeth
Plastic teeth to practice cutting preparations. Upper and lower first molars and second bicuspids
seem to be an adequate selection as well as some upper cuspids. Order from:
49
stadium
Montlake Blvd
parking
University Hospital
Pacific Pl
Dental School
N E 45th
520
N E Pacific St
I-5
Patient Parking
entrance
Turn right of
f of the elevator.
.
49
PLACEMENT
An easy method is to take the dam, frame, and clamp to place as one unit. Pick your clamp and
pre-fit to the tooth if necessary. Attach the top of dam to the frame by placing tension between the
top two nibs and then the bottom portion is attached with tension between the bottom two nibs. This
allows plenty of play in the dam where the clamp will be attached. Attach the clamp to the dam
and frame via the wings on the clamp. Look through the hole in the clamp and place. Release the
dam over the wings with cotton pliers or an explorer. Stabilize the dam initially by flossing the front
tooth first and then work back to the molars. The dam is tucked around the teeth resulting two layers
of dam around each tooth. This helps retract the tissue and seal the dam to minimize saliva. The
technique is to invert the dam with an explorer or tissue packer while pulling gingivally on the dam.
Each tooth is simultaneously dried with air to facilitate the procedure. Re-adjust the dam to the
frame as necessary.
51
Basic setup
1
Initial placement