Figure 11-1 This was the initial status of the case in 1996, before orthodontic treatment and maxillary and mandibular surgery.

Figure 11-2 Before and after.

Figure 11-3 Gold inlays on teeth 2, 3, 21, and 30.

Figure 11-4 The checkup performed in 2005 (i.e., nearly 10 years later).

Figure 11-5 In a complex case like this, having a gold occlusal surface can ensure stability over time.

Figure 11-6 When decay extends deep into the interproximal zone, after restoration of the biologic width a gold margin that lies on a chamfer situated entirely on root cementum can provide a good marginal seal for a long time.

Figure 11-7 The clinical crown-lengthening procedure is performed with the patient under anesthesia.

Figure 11-8 The rubber dam is placed in the same session, followed by preparation of the buildup and the inlay.

Figure 11-9 The inlay can be cemented a few days later, creating the optimal condition for perfect tissue healing.

Figure 11-10 Checkup 4 weeks later.

Figure 11-11 Checkup 9 years later.

Figure 11-12 In the presence of a large cavity that extends to the radicular cement, a gold inlay is an excellent solution. The radiographic image shows invasion of the biologic width.

Figure 11-13 Removal of the old amalgam filling. Perfect isolation of the operative field was not achieved initially because of inflammatory hypertrophy of the papilla caused by the faulty filling. Subsequently the retraction action of the heavy rubber dam permits the required isolation. The buildup technique allows for a more conservative preparation. As opposed to Case 2, here the margin does not invade the biologic width, and therefore a clinical crown-lengthening procedure is not required.

Figure 11-14 A, Radiograph after cementation. The comparison with the initial radiograph (Figure 11-12) shows that the invasion was caused by the faulty amalgam restoration. B, Radiographic checkup 5 years later.

Figure 11-15 A, Checkup with magnification of the buccal margin. B, In the radiographic checkup the remineralization of the interproximal distal cortical bone is evident.