Beautiful stuff. This is what is missing in todays graduates. Doing quality gold work is where the skill and artistic talents of dentists comes out. It is where the true rewards of being an artistic dentist is attained. I did a class three foil on an upper cuspid for my state board and it is still one of my proudest restorations. Where is the satisfaction today when computers do most of work.
Recently stumbled across this channel. Fantastic content. I’m a recent dental school and residency graduate, and I’m in my first year of private practice. Very helpful videos! Your techniques are very good and something to strive for in my practice. I also love how you explain the instruments and how to use them properly - something that wasn’t always done well in school. I’ve subscribed and sent this channel to a bunch of colleagues. Keep up the good work! I also saw you offer CE, I’d love to make the trek across the country from the east coast sometime, would be a lot of fun.
I jumped onto this vid after watching Dr. Tucker's Inlay/Onlay tutorial. I have to say that he'd probably be proud to see your video. You presented quite clearly, and this is sadly becoming a lost art. However, in my heart, this is "the best dentistry."
what about caries... caries might not be exactly 1.5mm deep, could be very deep. would you still begin with 1.5mm to the basic outline and remove mm by mm until all caries are removed? - first year dental student
Great question! The video outlines the ideal prep, but also gives the optimal guidelines even in clinical cases where caries and existing restorative materials are present. After a proper diagnosis, the existing restoration and caries are removed, then the tooth is blocked-out usually with an RMGI base or Composite material to full contour, after which the preparation begins in the same manner as described.
Thank you so much for your videos, especially cast gold---love cast gold! Which bur do you use to make the pin retentions and then what do you use to pick the pins up in the impression so the lab can then add this to the casting?
Usually, a 168 or 169L but sometimes a non-depth limiting twist drill (the Shooshan technique, which requires analogs for the impression) and I'll demo the vented needle technique in an upcoming video for the impression. The lab waxes into the pin hole on the die or uses a plastic analog.
thanks for the upload doc, from ,my experience i saw few gold indirect restorations that stayed more than 20 years of service,even in a challenging mouths(oral hygiene) and looked decent. well nowdays due to technology,esthetics,and the price of gold i think those procedures are less common. although gold is not a britle rather ductile metal, fracture may occur but less common, but the choice of inlay is much less common,due to the wedging effect on the tooth,and that u need a minimum reduction of istmus- worth mention teeth are not typodont premade acrylic. worth mentioned2: ruiz has an interesting book about indirect restorations, most likely ceramic with a contemporary design preparation another reason -maybe philosophic why those restorations are not made anymore is due to - Planned obsolescence, this is why there is a light bulb that can hold 100 years, but they are not manufactured anymore-due to economy reasons. what type of provisional used? that doesnt dislodge between treatments? and that u dont need to drill so u dont ruin the cavity design for the restoration, is it certain composite with spot etch?(telio\tempit) looking foreward to ceramic venners case. cheers
Hi Doc, great comments and questions! The Tucker Technique is so much more than this simple video, as you must know. In my practice patients travel across the country to receive castings - such a pleasure to perform these. Temporary technique is simple - see Stevenson DuraSeal Temporary TH-cam video. I was Chair of Restorative at UCLA for 17 years, wrote the textbook chapter on gold in "Summitt's Fundamentals of Operative Dentistry: A Contemporary Approach", so I can answer just about any question you have - I hope! BTW - the average life expectancy for a gold casting is far beyond 20 years...plenty of clinical studies report this. So, when considering the cost of replacement dentistry for a tooth restored with a ceramic inlay only vs gold, gold wins by a mile - Go LONG I say! Longevity, what a concept.
Thank you Dr Stevenson for posting this and other videos. It brings back fond memories of of my dental school clinical requirements Georgetown University School of Dentistry in 199 and 1980. . In my senior year in operative dentistry we were required to complete 80 "surfaces" of cast gold indirect restorations and we were required to do all the lab work associated with those treatments. The repetition and relentless critique from the clinical instructors gave me great confidence when I graduated. We were also required to fabricate some of these gold restorations making a wax pattern sprued directly from the tooth. I learned after I graduated that my training was not common. When I took my California board examination in 1981 I placed a DO on tooth #12 and that restoration is still going strong after being cemented with Fleck's ZOP cement.
Thanks for the comment Edward. I still cast my own today and even place direct filling gold. My courses on these topics are very popular with the current graduates...interesting.
after watching this.... this is why i spend the extra $5k to get compleatly put under general anisthetic.... i have the biggest phobia of dentists. tbh im at the point where i would prefer to have them all ripped out and replaced with implants
I've had terrible dental work. It has affected me not only financially but physically. I'm so bad at being the "squeaky" wheel... but seeing this makes me think that we still have real DDS's out there. My teeth have sent me to the ER. I asked to go to my car before transfers between rush and Loyola but was threatened with AMA because of the severity of the infection. We need more knowledgeable professionals and less buisness people when it comes to dentistry. makes
These look really nice, I like how you explain a lot of the process and thought that goes into it. Do they strengthen the tooth like a ceramic inlay/onlay does? Do they still get decay under them like other fillings?
Ceramic inlays only temporarily strengthen teeth - this has been shown in numerous studies. Gold inlays "brace" the enamel and support it but do rely on remaining tooth structure for durability, like all restorations. Gold onlays are stronger than inlays and more conservative than full crowns. Recurrent decay is very unlikely with precise fitting gold restorations - bacteria actually don't grown as well under gold compared to bonded restorations.
HELLO DOCTOR STEVENSON AND RICHARD ,THANK YOU SO MUCH ABOUT YOUR PROGRAM AND VIDIO EXACTLY THEY HAVE A COMPLET INFORMATION AND I JUST CAN TELL YOU THANK YOU SO MUCH ... FIERS OF ALL HAPPY NEW YEAR I WISH YOU HAVE BEST LIFE.....FROME HASSAN
Richard, your operations are meticulous and your instructing style is excellent! I'm so glad you are putting this on TH-cam so others can learn it. It gives me some inspiration to learn to make videos. Perhaps a video on the casting technique!??
Hi Dr, one question; how do you check that you have removed enough from the occlusal surface when prepping for different types crowns? Is there any way of using a silicone matrix to control prep depth accurately? Thsnx alot!
Take a hands-on course first, then join an operating study club where a mentor helps you for many many years. We have a terrific course for gold - the best way to get started: stevensondentalsolutions.com/shop/dental-gold-restorations-cast-and-foil-nov-1-3-2024/
You are not alone! A recent study looking at over 200,000 composite fillings found the mean survival was 13.3 years, and much lower in high decay rate and grinding/clenching patients. Gold lasts 3X that in similar studies.
Also...among the many things I take interest in, I would consider dentistry simply to preserve these masterful techniques and provide these gold options to patients into the future. As an artist myself in other mediums, I can clearly see this is most certainly an art form that is admirable. I recently just watched your video on EZ-Gold and could not find much information on it aside from one research article by Temple University from 1996. Is EZ-Gold more of a process or procedure vs a product that is available to purchase for dentists? That is to say, do you take the powdered gold, .01% organic wax, and gold foil and make these in house forming the balls yourself, or is it purchased pre-made?
How much time can they last with proper hygiene? I'm tired of my composite fillings on the back of my teeth failing after so little time, even though I try to have the best diet possible (without sugar at all) and brush/floss 3 times a day.
Best teacher ...I wish to be your student ..BUT STILL I m ...becoz I always study and Use your videos for practical understanding ..Thanku u so much sir ....
Phenomenal information. I'm going into my dentist's office of 20 years tomorrow to discuss a gold inlay and with this video I'm much more informed about aspects of the procedure.
I always hear my dentists say that they no longer do these golden inlays, not themselves but in a general sense. Why is that? Is it because of the cost of gold? Insurance? I don't understand, why they always says these are now rare.
Most dentists don't really know how to perform these restorations at the highest level - which is required. The use of specialized hand instruments and rubber dam are essential. Inlays and Onlays take significant technical skills and great lab support. They are no more expensive than ceramic to the patient and last significantly longer. Most dentists fall into the trap of thinking they know but they simply don't know what they don't know. I provide these to numerous patients who travel great distances to receive them. Being a member of a cast gold study club is a must, where a mentor teaches you things that are never taught in dental schools.
@@StevensonDentalSolutions Thank you, I now have a better understanding of how hard golden inlays are to make and install. I've had mine for over 20 years and have never bothered me since. I just wish they weren't so rare now.
Stevenson Dental Solutions are these any dangers of mercury toxicity with these? Also why are they considered to be much more expensive because of gold content considering it’s such a small piece of gold?
It's not the amount of gold that is placed - it's the amount of tooth it saves and the tremendous skill and time required to place these lifetime restorations that determines their value. They have no known health risks.
heyy doc, a bit of a tip here: next time try to mute the bur sound, or put some music instead, the buzz from the handpiece on headphones is killing my ears
I have hands-on courses on gold every other year and we always seek a patient for this - the next course is December 2022. But if you can come to my study club, I can mentor another great doc to perform the work - we meet 8 times a year, once a month
Hi I havea question. I had a large filling done with composite but I am still suffering with sensitivity to hold and cold. I have a feeling the filling may not have bonded properly. If I have the filling redone with gold would this reduce chance of still having sensitivity...?
Yes, as long as it is performed very well, the gold seals beautifully - good seal = less leakage = less pain. Some initial cold sensitivity is common but quickly resoles.
Usually about 12-2000 per tooth depending on region and type of gold used. BTW - very few dentists know how to do this technique at the highest level...
Dear Dr Stevenson - very neat, well explained. Your comment on leaving a slightly larger draw angle in the gingival asp of the box. (B&L) This was shown to have an insignificant reduction in retention while greatly facilitating the seating of the final prosthesis.
Do you have a video regarding temporization prep and cementation of the gold? Do you use just IRM or similar temp material during the fabrication process?
![[Full Episode] The Restaurant War Thailand ศึกพ่อค้าซ่าแม่ค้าแซ่บ Episode 2 | 29 ก.ย. 67](http://i.ytimg.com/vi/r3lfLNH6Ke4/mqdefault.jpg)
Beautiful stuff. This is what is missing in todays graduates. Doing quality gold work is where the skill and artistic talents of dentists comes out. It is where the true rewards of being an artistic dentist is attained. I did a class three foil on an upper cuspid for my state board and it is still one of my proudest restorations. Where is the satisfaction today when computers do most of work.
Amen
Thank you Dr. Stevenson!! That's been great information I learned.
Can you please upload a video about Gold foil preparation & restoration?
Recently stumbled across this channel. Fantastic content. I’m a recent dental school and residency graduate, and I’m in my first year of private practice. Very helpful videos! Your techniques are very good and something to strive for in my practice. I also love how you explain the instruments and how to use them properly - something that wasn’t always done well in school.
I’ve subscribed and sent this channel to a bunch of colleagues. Keep up the good work!
I also saw you offer CE, I’d love to make the trek across the country from the east coast sometime, would be a lot of fun.
HI Doc - thank you and I'm always happy to make videos on special topics per my subscribers. Stay tuned, Best, Rich
I jumped onto this vid after watching Dr. Tucker's Inlay/Onlay tutorial.
I have to say that he'd probably be proud to see your video.
You presented quite clearly, and this is sadly becoming a lost art.
However, in my heart, this is "the best dentistry."
Thank you Doc. Dr. Tucker was an amazing person.
what about caries... caries might not be exactly 1.5mm deep, could be very deep. would you still begin with 1.5mm to the basic outline and remove mm by mm until all caries are removed? - first year dental student
Great question! The video outlines the ideal prep, but also gives the optimal guidelines even in clinical cases where caries and existing restorative materials are present. After a proper diagnosis, the existing restoration and caries are removed, then the tooth is blocked-out usually with an RMGI base or Composite material to full contour, after which the preparation begins in the same manner as described.
Thank you so much for your videos, especially cast gold---love cast gold! Which bur do you use to make the pin retentions and then what do you use to pick the pins up in the impression so the lab can then add this to the casting?
Usually, a 168 or 169L but sometimes a non-depth limiting twist drill (the Shooshan technique, which requires analogs for the impression) and I'll demo the vented needle technique in an upcoming video for the impression. The lab waxes into the pin hole on the die or uses a plastic analog.
Thanks for the response.@@StevensonDentalSolutions
I'm addicted to these videos! 😁
A healthy addiction I think...
thanks for the upload doc, from ,my experience i saw few gold indirect restorations that stayed more than 20 years of service,even in a challenging mouths(oral hygiene) and looked decent.
well nowdays due to technology,esthetics,and the price of gold i think those procedures are less common.
although gold is not a britle rather ductile metal, fracture may occur but less common, but the choice of inlay is much less common,due to the wedging effect on the tooth,and that u need a minimum reduction of istmus- worth mention teeth are not typodont premade acrylic.
worth mentioned2: ruiz has an interesting book about indirect restorations, most likely ceramic with a contemporary design preparation
another reason -maybe philosophic why those restorations are not made anymore is due to - Planned obsolescence, this is why there is a light bulb that can hold 100 years, but they are not manufactured anymore-due to economy reasons.
what type of provisional used? that doesnt dislodge between treatments? and that u dont need to drill so u dont ruin the cavity design for the restoration, is it certain composite with spot etch?(telio\tempit)
looking foreward to ceramic venners case.
cheers
Hi Doc, great comments and questions! The Tucker Technique is so much more than this simple video, as you must know. In my practice patients travel across the country to receive castings - such a pleasure to perform these. Temporary technique is simple - see Stevenson DuraSeal Temporary TH-cam video. I was Chair of Restorative at UCLA for 17 years, wrote the textbook chapter on gold in "Summitt's Fundamentals of Operative Dentistry: A Contemporary Approach", so I can answer just about any question you have - I hope! BTW - the average life expectancy for a gold casting is far beyond 20 years...plenty of clinical studies report this. So, when considering the cost of replacement dentistry for a tooth restored with a ceramic inlay only vs gold, gold wins by a mile - Go LONG I say! Longevity, what a concept.
Thank you Dr Stevenson for posting this and other videos. It brings back fond memories of of my dental school clinical requirements Georgetown University School of Dentistry in 199 and 1980. . In my senior year in operative dentistry we were required to complete 80 "surfaces" of cast gold indirect restorations and we were required to do all the lab work associated with those treatments. The repetition and relentless critique from the clinical instructors gave me great confidence when I graduated. We were also required to fabricate some of these gold restorations making a wax pattern sprued directly from the tooth. I learned after I graduated that my training was not common. When I took my California board examination in 1981 I placed a DO on tooth #12 and that restoration is still going strong after being cemented with Fleck's ZOP cement.
Thanks for the comment Edward. I still cast my own today and even place direct filling gold. My courses on these topics are very popular with the current graduates...interesting.
Great job / video ! This is such a rare precious priceless dentistry art in America!!
Yes, indeed!
after watching this.... this is why i spend the extra $5k to get compleatly put under general anisthetic.... i have the biggest phobia of dentists. tbh im at the point where i would prefer to have them all ripped out and replaced with implants
I just got my back molar tooth for 1185 dollars. I cant wait to get the gold cap on 8/4/22 i am so glad i will have a permanent gold tooth
Awesome!
I've had terrible dental work. It has affected me not only financially but physically. I'm so bad at being the "squeaky" wheel... but seeing this makes me think that we still have real DDS's out there. My teeth have sent me to the ER. I asked to go to my car before transfers between rush and Loyola but was threatened with AMA because of the severity of the infection. We need more knowledgeable professionals and less buisness people when it comes to dentistry. makes
Thank you, agreed.
These look really nice, I like how you explain a lot of the process and thought that goes into it. Do they strengthen the tooth like a ceramic inlay/onlay does? Do they still get decay under them like other fillings?
Ceramic inlays only temporarily strengthen teeth - this has been shown in numerous studies. Gold inlays "brace" the enamel and support it but do rely on remaining tooth structure for durability, like all restorations. Gold onlays are stronger than inlays and more conservative than full crowns. Recurrent decay is very unlikely with precise fitting gold restorations - bacteria actually don't grown as well under gold compared to bonded restorations.
I literally just watched this video randomly
HELLO DOCTOR STEVENSON AND RICHARD ,THANK YOU SO MUCH ABOUT YOUR PROGRAM AND VIDIO EXACTLY THEY HAVE A COMPLET INFORMATION AND I JUST CAN TELL YOU THANK YOU SO MUCH ...
FIERS OF ALL HAPPY NEW YEAR I WISH YOU HAVE BEST LIFE.....FROME HASSAN
I'm saving to get mine done!!! I wish you all were on the East Coast 😭
Me too! Thanks!
Richard, your operations are meticulous and your instructing style is excellent! I'm so glad you are putting this on TH-cam so others can learn it. It gives me some inspiration to learn to make videos. Perhaps a video on the casting technique!??
Thanks Eric! Coming soon...Rich
I know it's kinda off topic but does anybody know of a good place to stream newly released movies online?
@Matias Edward Flixportal :)
@Miguel Kannon thanks, I went there and it seems to work =) Appreciate it !!
@Matias Edward you are welcome :)
Hi Dr, one question; how do you check that you have removed enough from the occlusal surface when prepping for different types crowns? Is there any way of using a silicone matrix to control prep depth accurately? Thsnx alot!
Many ways - depth cuts, both vertical and horizontal, matrices, scanning with evaluation, etc. Great question!
Good job man keep going ❤️🇪🇬🇪🇬
Will do!
Very nice. The margins (including the box) must be beveled and flared to allow for final burnishing. Almost done. Fight on.
USC style - this is Tucker style - Go Huskies!
How can a dental student begin down the right road to perform these types of restorations for future patients?
Take a hands-on course first, then join an operating study club where a mentor helps you for many many years. We have a terrific course for gold - the best way to get started: stevensondentalsolutions.com/shop/dental-gold-restorations-cast-and-foil-nov-1-3-2024/
I liked my amalgam more. I hate plastic teeth. I want gold 😂
You are not alone! A recent study looking at over 200,000 composite fillings found the mean survival was 13.3 years, and much lower in high decay rate and grinding/clenching patients. Gold lasts 3X that in similar studies.
This is what I want
Is a Proximal Box always necessary? Or just under certain circumstances? Sorry, average non student viewer here, may be a dumb question. Thanks
Also...among the many things I take interest in, I would consider dentistry simply to preserve these masterful techniques and provide these gold options to patients into the future. As an artist myself in other mediums, I can clearly see this is most certainly an art form that is admirable. I recently just watched your video on EZ-Gold and could not find much information on it aside from one research article by Temple University from 1996. Is EZ-Gold more of a process or procedure vs a product that is available to purchase for dentists? That is to say, do you take the powdered gold, .01% organic wax, and gold foil and make these in house forming the balls yourself, or is it purchased pre-made?
Only when decay exists or when replacing an existing restoration which would connect the new inlay.
which lab do you use in the LA area for gold restorations?
www.master-milling.com ask for Lucy and specify that they use Argen HP77 gold
Excellent gold work. I still believe gold is the best when indicated.
What cement do you use?
Thanks
Traditional Glass Ionomer or Zinc Phosphate when I'm really going retro.
Damn it... had me watching intently until the drill started... nightmares have slid back in place.... f@@k
Hi
Is it possible to make gold onlay after root canal treatment ?
Yes, absolutely - often the best choice as it protects the occlusal yet saves the axial walls.
@@StevensonDentalSolutions
Thank you, Doctor. What is the lifespan of root canal after placing a gold crown?
How much time can they last with proper hygiene?
I'm tired of my composite fillings on the back of my teeth failing after so little time, even though I try to have the best diet possible (without sugar at all) and brush/floss 3 times a day.
Under the best conditions, they will last a life time. 50-60 years is not uncommon.
Great video !!!
Thank you! Dr. S
Best teacher ...I wish to be your student ..BUT STILL I m ...becoz I always study and Use your videos for practical understanding ..Thanku u so much sir ....
My pleasure.
Phenomenal information. I'm going into my dentist's office of 20 years tomorrow to discuss a gold inlay and with this video I'm much more informed about aspects of the procedure.
Excellent! Best wishes. Dr. Stevenson
why not just gold amalgam?
hi doctor！with proper care，how many years can gold inlay last？I am only 22 years old but I have 3 tooth need to be treated😣
The best run clinical studies show that 35-40 years or more is typical when done well. Hope you go for it!
I always hear my dentists say that they no longer do these golden inlays, not themselves but in a general sense. Why is that? Is it because of the cost of gold? Insurance? I don't understand, why they always says these are now rare.
Most dentists don't really know how to perform these restorations at the highest level - which is required. The use of specialized hand instruments and rubber dam are essential. Inlays and Onlays take significant technical skills and great lab support. They are no more expensive than ceramic to the patient and last significantly longer. Most dentists fall into the trap of thinking they know but they simply don't know what they don't know. I provide these to numerous patients who travel great distances to receive them. Being a member of a cast gold study club is a must, where a mentor teaches you things that are never taught in dental schools.
@@StevensonDentalSolutions Thank you, I now have a better understanding of how hard golden inlays are to make and install. I've had mine for over 20 years and have never bothered me since. I just wish they weren't so rare now.
@@limbosvi6983 Me too!
Stevenson Dental Solutions are these any dangers of mercury toxicity with these? Also why are they considered to be much more expensive because of gold content considering it’s such a small piece of gold?
It's not the amount of gold that is placed - it's the amount of tooth it saves and the tremendous skill and time required to place these lifetime restorations that determines their value. They have no known health risks.
heyy doc, a bit of a tip here: next time try to mute the bur sound, or put some music instead, the buzz from the handpiece on headphones is killing my ears
Yes - thank you!
Remember that....we gotta do it in indirect vision;)
yep
Not many dentists use gold now do they? But it’s strong andlasts a long time
Dat drill though lol😆
You are 100% correct! Few faculty even know how to teach gold. It definitely has a place in the excellence-oriented practice!
Can I volunteer my teeth for a gold inlay?
I have hands-on courses on gold every other year and we always seek a patient for this - the next course is December 2022. But if you can come to my study club, I can mentor another great doc to perform the work - we meet 8 times a year, once a month
Can u tell me please what is the indication and contraindication ???and please Dr tell me what is the measurment of prep from all prep please Dr
That's a long answer. May I suggest a chapter from a book that I wrote instead? Summitt's Operative Dentistry, Chapter 20, in the 4th edition.
@@StevensonDentalSolutions Thx dr😍😍
Hi I havea question. I had a large filling done with composite but I am still suffering with sensitivity to hold and cold. I have a feeling the filling may not have bonded properly. If I have the filling redone with gold would this reduce chance of still having sensitivity...?
Yes, as long as it is performed very well, the gold seals beautifully - good seal = less leakage = less pain. Some initial cold sensitivity is common but quickly resoles.
@@StevensonDentalSolutions Thanks for replying! I will start saving up to have this done. 😊
@@ShootingStar466 Great
that was really helpfull one
Cool - thank you for watching!
How long gold teeth work?
Sometimes a lifetime!
Сколько стоит зуб и золотой амальгамы
ЗОЛОТО стоит около 1500 долларов за зуб
какой тип фиксации таких реставрациях?
yes
Are these toxic like the mercury fillings?
No
Not true, do your research, gold has been in use for centuries
Rachel TheOldSchoolDiva are you blind? Can’t you see it was a question?
Ooooo pretty
How much would this cost ?
Usually about 12-2000 per tooth depending on region and type of gold used. BTW - very few dentists know how to do this technique at the highest level...
@@StevensonDentalSolutions should a full coverage gold crown be preferred over gold onlay after a RCT on molar
Excelente preparación! Saludos cdmx
Thank you Doc!
awesome Doc.
How much is a gold inlay/onlay out of pocket?
About the same as a crown
@@StevensonDentalSolutions why would it cost about the same as a crown
@@pootis1699 Time is more, effort is higher, expertise is essential, and lab fees are the same or higher.
@@StevensonDentalSolutions im guessing your time and expertise are major factors in the gold restoration rather than the cost of gold
@@pootis1699 Correct! The amount of gold is relatively low about $150-$250...
Dear Dr Stevenson - very neat, well explained. Your comment on leaving a slightly larger draw angle in the gingival asp of the box. (B&L) This was shown to have an insignificant reduction in retention while greatly facilitating the seating of the final prosthesis.
Thank you - the best fitting castings have an "easy draw"...Then more friction due to more surface area in contact.
Whats the cost range for the gold inlays
About $1200-2000 per tooth
@@StevensonDentalSolutions $200~250 in south korea..gold inlay indirect restorations(mo do ol 2 surfaces)
Just for your interest.........
Do you have a video regarding temporization prep and cementation of the gold? Do you use just IRM or similar temp material during the fabrication process?
I use DuraSeal and dental stopping for inlays and occasionally on onlays.
Do you have location in CA. I need my teeth fixed
rgsdds.com
This is what I want help me out $lancebeezy