DIRECT FILLING GOLD

Presented By:
Dr. A. Vimal Kumar

CONTENTS:
Introduction
History of Direct filling gold
Properties of pure gold
Various forms of gold
Gold foil
Electrolytic precipitate
Granular gold
Removal of surface impurities:
Annealing and degassing
Compaction of direct filling gold
Advantages, disadvantages, indication,contraindication
Modes of condensation
General principles of cavity preparations
Class I, II Cavity design
Class III cavity design
Class V cavity design
General steps for Restoration of direct gold
Review articles


INTRODUCTION:
Direct golds are gold restorative materials that
are manufactured for compaction directly into the
prepared cavities.(Sturdevant)





Superior restorative material for small defects and
lesions in teeth.
Longevity a result of biocompatibility and marginal
integrity.
Four principal conditions for high quality
Direct Filling Gold:

Appropriate gold form
Using material only when indicated
Perfect dry and clean field provided
Proper manipulation
History of Direct Filling Gold:
First evidence GREEK and ROMAN culture about 3000
B.C
Sumerian,babylonian, assyrian tombs between 2000 and
3000 B.C
Giovanni dArcoli first evidence of use in dentistry as
GOLD LEAF FILLINGS in 1483

Philip Pfaff (1715-1767), Dentist to
FREDRICK the great of Prussia, used gold
foil to cap the pulp.
Sponge gold to replace gold leaf in 1853
in U.S., U.K
In 1855 Robert . A . Arthur cohesive or
adhesive gold
PROPERTIES OF PURE GOLD:
Soft, malleable ,ductile with percentage elongation of 12.8 %
Rich yellow in colour
Melting point 1063
0

,
boiling point 2200
0
True density 19.3 gm/cm
3
. Apparent density range 14-15 gm/cm
3
Brinnels hardness number 25. On work hardening 58-82.
C.T.E is 14.4 x 10
-6
/
0
c close to tooth 11.4 x 10
-6
/
0
c.
High thermal conductivity of 0.710 cal/sec/cm
2
(/
0
C/cm)



Noblest of all metals. No tarnish or corrosion
Impurities affect mechanical properties. 0.2% lead
makes gold very brittle.
Ca, Pl, Pt improves the properties.
Two pieces of gold unite without applying heat, Cold
welding property.
DFG s most efficient sealing permanent fillings.
Types of Direct Filling Gold
Gold foil

A. Sheets ( Cohesive or Non Cohesive)
B. Pellets (hand rolled & preformed)
C. Cylinders
D. Corrugated foil
E. Platinized foil
F. Laminated foil
Electrolytic precipitated gold
Mat gold
Mat foil
Gold calcium alloy


Powdered gold
Goldent
Gold Foil
Also called fibrous gold .
Available as sheets , pellets , cylinders , ropes and
precondensed laminates of varying thickness.

A. Gold foil sheets: Thickness as low as 0.6micro
metre.
Standard No.4 gold foil weighs 4
grains. (0.51 m thick)
No. 3 gold foil weighs 3 grains
(0.38 m thick).
Supplied as cohesive and non cohesive gold.
Cohesiveness depends on the atomically clean
surface.
Adsorbed gas prevents atomic contact prevents
cold welding.
Ammonia treated foil is called as non cohesive
gold.


Gold foil pellets:

Hand rolled or commercially produced from a no. 4 gold foil
sheets.

Small sections of the gold foil sheets (1/32, 1/64, 1/128) are cut
and rolled into pellet form.

Gold foil cylinders:

Hand rolled or preformed.

Usually larger segments of sheet (1/2,1/4, 1/8) are cut and
rolled into cylinders.

.



E. Corrugated gold foil: thin sheets of paper placed
in between the gold foil sheets and igniting them.





F. Platinized gold foil: sandwich of gold and platinum
with the platinum content being 15%.
Two methods of producing it







Platinum increases the strength and wear resistance.
Used for areas of stress concentration like incisal edges and
cusp tips.

F. Laminated gold foil:
A combination of two or three foils with
crystals running in different direction is called a
laminated gold foil.
Since the crystals run in all direction,
laminated gold foil are stronger and can be used in
stress-bearing areas like cusp tips and incisal edges.
Electrolytic precipitated gold
Crystalline gold powder formed by electrolytic
precipitation.
The powder is made into different shapes by
sintering at an elevated temperature well below
the melting point of gold.

A. Mat gold : Crystalline electrolytically precipitated gold
that is formed into strips.
Used for building the internal bulk of the
restoration because of ease of compaction.
Not recommended for the external surface of
the restoration as it become pitted.

B. Mat foil : Sandwich of electrolytically
precipitated gold powder between two sheets
of No. 3 gold foil which is sintered and cut into
strips.

C. Gold calcium alloy :
One form of electrolytically
precipitate which is alloyed with 0.1% calcium.
Commercially available as Electralloy
RV.
Stronger restorations by Dispersion
strengthening .
Powdered gold
Combination of chemical precipitation and atomization
with an average particle size of 15 micro metre.
Particles are mixed together in wax and cut in to
pieces and wrapped in gold foils as pellets.
This is available as Goldent or Williams E-Z Gold.
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
Proximal lesions on teeth adjacent to crown preparations
Vent holes in crowns and defective inlay/crown margins
Class VI lesions (cusp tips) and incisal edges
Retrograde root canal filling material

CONTRAINDICATIONS


Teeth with very large pulp chambers
Severely periodontally weakened teeth
Large carious lesions
Handicapped, elderly or young patients
Psychologically unsound patients
Economical factor
Esthetics factor
Inaccessible/poorly accessible areas
Isolation unobtainable
Areas of undesirable occlusal stresses
Patients with a high caries index
Hypoplastic areas

ADVANTAGES

A permanent method for repairing teeth
Does not tarnish and corrode in the oral cavity
Insoluble and has a C.T.E close to that of tooth
No tooth discoloration around the margins
No cementing medium is necessary for retention of the restoration
Surface can be effectively polished and has long lasting smoothness
Ductile , burnished easily.
Withstand compressive forces sufficiently
Efficiently sealing permanent restorative material



DISADVANTAGES
1.Unesthetic
2.Expensive
3.Long chair side time
4.Use limited to conservative cavities
5.High thermal conductivity
6.Technique sensitive
7.High condensation forces (tooth damage)


Manipulation of direct filling gold

There are two processes involved;
Degassing
compaction

Degassing [annealing]
1. Heating over an open alcohol flame:





2. Heating in a mica tray over the alcohol flame:


3. Heating in an electric annealer :

The gold is heated to 850
0
F for ten
minutes and then allowed to cool before
it is placed in the cavity.
Hazards during degassing.
Certain Principles to be followed for
compaction of direct gold
Force of condensation should be at 45
0
to the cavity walls
and floors.








The force of condensation must be at 90
0
to previously
condensed gold.
1. always start at a point on one side and proceed in a
straight line to another point on the opposite side, then
back to the original side on a different straight line.
2. The condenser should overlap at least 1/4
th
of the
previously condensed area. This process is called
stepping. (maximum adaptations ,reduction of voids.)
3. Minimally sized increments of gold should be used.
Modes of condensation:
Hand instrument condensation- Initial
confinement of the material within the cavity
preparation.







Pneumatic condensation- Vibrating condensers
energized by compressed air.
Electronic condensation- Most efficient and controlled way
of condensing materials the vibrating condenser heads have
Intensity - 2 oz. to 15 lbs
Frequency - 360 to 3600 cycles/minute.







Hand condenser and mallet- It requires a trained
assistant

General principles of cavity preparations
for direct gold restorations
1. The outline form : Include all structural defects
Margins placed on sound tooth structure.
Smooth and esthetically pleasing.


Resistance form : Flat pulpal floors .
Smooth and flat walls.
Enamel walls must be supported
by sound dentin.
Minimal cavity width
1. Retention form : Parallel or slight occlusal convergence of the
facial and lingual walls.
Depth -0.5 mm into dentin.
Sharp internal line angles


1. Convenience Form : Requires suitable access and a dry field.
Minimal cavity width.
Sharp internal line and point angles

Use of Liners and Bases:
Remaining dentin thickness 3.0-3.5mm no
base needed.
Thickness - 1-2 mm
ZOE sub base, followed by varnish and zinc
phosphate base.
Calcium hydroxide sub base, polycarboxylate
base.
Less than 1 mm Gold restoration contraindicated
Class 1:Cavity preparations for direct gold
restorations
The outline form is kept as small as possible while providing
convenience for instrumentation and restoration.

Simple circular design, oblong, or triangular for a pit.
No. 330 bur.

Pulpal depth is 0.5mm in to dentin.

Walls extended minimally.
Outline form for a class 1 pit cavity in
a mandibular premolar
Parallel walls.

Mesial , distal walls diverged occlusally

Flat pulpal floors.

Retentive undercuts placed with No. 331/2 Bur at a slow speed or

using angle formers.


Occlusal cavosurface margin beveled not more than 0.2mm in width

40-45 degree metal margin
Variation for powdered Gold
Roundening line angle , point angles
Butt cavosurface margin
Class 2:Cavity preparation
No. 330 bur(pear shaped). The outline includes entire defect
and should be in the form of straight lines and definite
curves.
The proximal box same as that of amalgam cavity but
conservative.
All walls extended minimally.
The cavity width < 1/5 the intercuspal distance.
1. Facial and lingual walls only extend
into the contact area.
2. Breaking contact -not necessary.
3. Gingival margins should just clear
the contact area and not extend
subgingivally.
4. Cavosurface margins beveled at
30-40 degree
Gingival floor showing reverse bevel
All line angles except axiopulpal
line angle are kept very sharp.

A reverse bevel is placed on the
gingival floor towards the axial
wall.
Triangular retentive grooves in
facio axial and linguo axial line
angla with base towards gingiva.
Class 3:Cavity
preparations

Various designs :
Ferrier design
Loma Linda
Ingraham
Lund and Baum
Woodbury
Minimal tooth separation (0.25mm 0.50mm) is necessary
Done with a ferrier separator.

FERRIER DESIGN:

Indicated for small carious lesions on proximal surfaces when
thick labial, lingual and incisal walls remains.

Facial approach recommended. Used in distal surfaces of
anterior teeth.

Triangular outline using no.1 round bur.

331/2 inverted cone bur extends outline.

From the proximal facial aspect, the facial wall follows facial
contour of the tooth and meets gingival margin in a slight
obtuse angle




The gingival margin kept below free gingiva, and is straight
faciolingually. Meets the facial wall in obtuse angle, and the
lingual wall in acute angle.

The lingual wall is straight gingiva 2/3
rd
and curves abruptly in
the incisal 1/3
rd
to meet the incisal angle.
The incisal margin extends just incisal to the contact area and
meets the facial and lingual walls in a smooth curve.

The axial wall -0.5mm into dentin.

RESISTANCE FORM: Flat axial wall,buccal,lingual divergent
wall

RETENTION FORM: Acute axio gingival line angle(Small angle
formers) and an incisal undercut placed into dentin directed
facio incisally.(bibeveled hatchet)


CONVENIENCE FORM: Finally wedlestaedt chisel bevel the
cavo surface margins. This ,removes any unsupported enamel and
allows esthetic blending.
LOMA LINDA DESIGN:
Lingual acces
Indicated in esthetic areas
round bur used with lingual approach
Labial and gingival walls- base of 33
1/2
bur
Lingual wall-side of same bur
Outline- triangular with rounded corners
No lingual wall, but lingual margin
Gingival margin same as Ferriers
Cavosurface bevels, flares not needed (Butt Joints)
Three retentive grooves 1) Incisal point angle,
2) Linguo gingival DEJ,
3) Facio axio- gingival point angle



Incipient proximal region with esthetic concern
Oral hygiene,low caries/plaque index essential
Outline form Parellelogram
Labial, incisal margin not visible externally
Gingival margin clears contact area with minimal extension
Lingual margin extends beyond lingual marginal ridge
Axial walls flat, right angle to labial wall
Retention grooves inciso axial and gingivo axial line angles, with
decreased depth towards labial surface
Lesion entered with No: 1 round bur followed by NO: 168 bur
Retention grooves with inverted cone bur
Bevels placed on all margins with GMT



INGRAHAM DESIGN
Class 5 : Cavity preparation
Proper isolation is necessary.
The no. 212 clamp is modified before placement
Most commonly used design FERRIERS
Outline - trapezoidal in shape.
NO:33 bur used to begin
Same bur Occlusal,gingival,mesial,distal,axial walls
Occlusal wall is longer and straight.
Gingival wall is shorter than the
occlusal due to narrowing of tooth
gingivally. This parallels the
occlusal wall.
The mesial and distal walls parallel
the proximal line angle of the
tooth and diverge facially meeting
the occlusal and gingival margins in
sharp angles.
The axial wall is located in dentin
and is 1mm deep occlusally and
0.75mm deep gingivally.
VARIATIONS IN CLASS V CAVITY
DESIGN


CURVED OCCLUSAL
OUTLINE DISPLAYING
LESS GOLD


CURVED GINGIVAL
OUTLINE WHEN
GINGIVAL TISSUE IS
STRONG AND
ADHERENT


PARTIAL MOON
SHAPED (CRESCENT
SHAPED) CAVITY
PREPARATION.
BASIC
TRAPEZOIDAL
FORM WITH

UNILATERAL
STEP,

BILATERAL STEP,

UNILATERAL
MOSTACHE
EXTENSION,

BILATERAL
MOUSTACHE
EXTENSION

CLASS V CAVITY WITH
PAN HANDLE
EXTENSION
General steps for direct gold
restorations
1. Build up of 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 tie forms the foundation for any
restoration in direct gold.

2. Banking of the walls : Consist of converging each
wall from its floor or axial wall to cavo surface
margin with a direct gold material. It should be
done simultaneously on the surrounding walls of
the preparations.







3. Shoulder formation : This consist of connecting two opposing
walls with the direct gold material to completely fill the
restorations.

Paving of the restorations
To overfill the preparation every area of the cavosurface
margins should be individually covered with excess
cohesive gold foil. This is condensed with a foot
condenser
Surface hardening of the restoration
The rectangular condenser is used with the highest possible
condensation pressure in all directions on the surface
of the restoration to strain harden the surface gold.
Burnishing
This is done with suitable burnisher moving from the gold
to the tooth surface. This enhances the surface
hardening and also produces good marginal adaptation
of the gold.
Margination
This step uses gold knives to remove excess gold from the
gold surface to the tooth surface.
Burnishing
It helps to eliminate marginal discrepancies and
to strain harden the surface.
Contouring
This step uses knives,files, or finishing burs to
create proper occlusal anatomy. Burnishing is
done again after contouring.
Finishing and polishing
Can be done using tin oxide powder on soft bristle
or rubber cups.
Final burnishing
This is done after polishing to make surface of
restoration smooth and free from voids.
Review of articles:


Microleakage of DFGs in class V restoration using
thermal cycling (Baucher JG) Quint INT 16:765,1985
(Welsh EL:Nuckles DB, Microleakage of DFGS)

Microleakage does occur with DFG, But incidence
comparatively low, thus technique sensitivity play a
major role.
3) Craig RG, Powers IM: Biocompatibility testing
of DM (IN: Rest. Dent. Materials) ed 11, St. Louis Mosby 2002


Placement of condensed Gold restoration
causes moderate to severe pulpal inflammation
10-20 days postoperatively,but after 35 days
only mild response and reparative dentin may
form . Thus, biologically sound
4) Hodson JT: Structure and properties of gold
foil and mat gold : J DENT. RESTORATION 42:575,1963


Showed that in clinical usage theoritical density
of Direct Gold is never attained.
5) Lambert RL: Stopfgold: A new direct filling
gold, Operative Dental 19 (1) 16-19,1994:


Introduced in 1989, considerably different from
other direct gold products and final restoration
had greater density than other forms of granular
gold with shear strength comparable to that of
Gold foil.


Conclusion:

Though Gold is biocompatible, and produces a efficient
sealing and has good marginal integrity, its unaesthetic
appearance, longer chair time, proper isolation,
technique sensitivity, high force required to condense
the gold foil, all results for its limitations and hence the
future of this Direct gold is definitely fading and to be
precise it has already faded with the advent of the
superior , esthetic composites and other restorative
materials.
BIBLIOGRAPHY
Sturdevant, Art and science of operative dentistry
Phillips science of dental materials
Charbeanu
Sikri
Marzouk, Modern theory and practice
Ramya Raghu