8: Gold crowns

Chapter 8 Gold crowns

General considerations

Indications for full coverage gold crowns

These are listed in order, the first being the most common:

When a plastic restoration has a history of repeated failure within a short defined time interval (Figure 8.1A). This would include failed adhesive restorations used in the management of tooth wear.
To minimize the real risk of tooth fracture, for example after endodontic treatment (Figure 8.1B). Many authorities consider that an overlay/onlay may be the most appropriate restoration for a tooth that has been root-treated.
To include design characteristics to accommodate a metal-based removable prosthesis (Figure 8.2). Such an indication per se may be difficult to justify and the decision to crown the tooth will take other factors into consideration, such as its restorative status. The patient must be made aware that any oral health gain must outweigh the removal of tooth tissue and resources required to provide such restorations.

Contraindications to full coverage castings

Contraindications to providing such restorations include a lifestyle which adversely influences oral health; these are relative and can usually be overcome should the patient so wish. This must be supported by evidence of change such as quitting smoking, modifying the use of erosive drinks, dietary changes to reduce the frequency of sugar consumption or improved home care. Other ‘dental’ contraindications such as ‘active’ caries, ‘active’ periodontal and periradicular disease have been discussed in Chapters 13.

A targeted preventative and preparatory phase is at the heart of a treatment plan which includes the provision of successful laboratory fabricated restorations. If this has not been carried out as part of the treatment plan, apart from the dentist not discharging their moral and statutory covenant/contract, a prosecuting barrister may claim, for example: ‘My client would not have consented to this crown if they had been informed beforehand of the subsequent necessity for endodontic therapy…or regenerative periodontal procedures etc.’

Partial coverage castings may be the restoration of choice in certain circumstances. For example, if full coverage preparation removes the bulk of the remaining tooth structure.

Steps in tooth preparation for a gold crown

General considerations

Occlusal design

Burs and instruments

In this subsection, only selected areas will be discussed. In the UK it is conventional to prepare teeth for crowns and bridges using medium-grit diamond burs (Figure 8.3). This is in contrast to other countries where tungsten carbide burs are more commonly used. There is no clinical evidence to show that preparations cut with one or another type of bur result in restorations with a superior outcome.

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Jan 9, 2015 | Posted by in Operative Dentistry | Comments Off on 8: Gold crowns
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