Full cast gold.
Where a posterior tooth needs the most conservative and most durable restoration available, cast gold is still difficult to better. Tick Full Metal under Type of Crown and select the alloy.
Wear behaviour is the strongest argument
Gold alloys wear at a rate broadly comparable to enamel, which no ceramic material matches. In a patient with heavy function and intact opposing enamel you want to preserve, that property is the whole case for the material.
Ceramics are harder than enamel, and a ceramic occlusal surface opposing a natural tooth will abrade it over years — faster still if the surface has been adjusted and not properly repolished.
Where preserving the antagonist is a stated objective, note it on the prescription. Opposing tooth wear covers how material and finish interact.
Conservative preparation
Gold performs in thin section. Occlusal reduction of well under a millimetre is workable, where a ceramic restoration would need substantially more to avoid fracture.
For a short clinical crown, a tooth where retention is already marginal, or a case where preserving remaining structure is the governing concern, that difference can decide whether the restoration retains at all.
It also tolerates a knife edge or feather margin, which is inappropriate under ceramic and produces either an unacceptably thin ceramic margin or an overcontoured one.
Marginal adaptation and failure behaviour
Cast gold can be finished to a marginal accuracy that remains the benchmark, and it is ductile enough to be burnished at the margin — adapted after the fact in a way brittle ceramics cannot be.
It also fails differently. Ceramics fracture, often without warning. Gold deforms under excessive load, which usually presents as something noticed and addressed rather than a patient arriving with an unrestorable tooth beneath a broken restoration.
In a patient with severe parafunction, that difference in failure mode is a clinical argument rather than a nostalgic one.
Alloy choice
The Rx form offers yellow high gold, yellow low gold and white non-precious for full metal work. High noble alloys are the most biocompatible, the most corrosion-resistant and the most predictable to cast, finish and burnish.
Specifying a lower-cost alloy on a case chosen for longevity and kindness to the antagonist undercuts much of the reason for choosing cast metal in the first place.
Alloy identification certificates are provided for your records. Alloy selection compares the options on the form.
Raising it with the patient
The objection is almost always appearance, and it is usually raised before the patient has understood where the restoration would sit. A second molar is invisible in most smiles, and a patient who would refuse gold on a premolar will often accept it further back once shown.
The argument worth making is longevity and tooth preservation: less structure removed, an antagonist that is not worn by the restoration, and a failure mode that gives warning.
Alloy prices move, so the cost conversation has to happen before the case is started rather than at the fee estimate.
Inlays and onlays in gold
Cast gold inlays and onlays are among the most durable restorations available and among the least commonly prescribed, largely for reasons of appearance rather than performance.
For a posterior tooth with an intact facial surface and a failure confined to the occlusal and proximal, a gold onlay conserves substantially more structure than a full crown and protects the antagonist better than any ceramic alternative.
Retention comes from grooves, boxes and path of insertion rather than circumferential wrap — see three-quarter crowns and onlays.
Cementation
Cast gold is conventionally cemented and gains nothing from an adhesive interface, which is one of its practical advantages: it performs predictably in a field that cannot be perfectly isolated.
Zinc phosphate, glass ionomer and resin-modified glass ionomer are all appropriate. What matters more is that the preparation provides retention and resistance form, because the cement is not compensating for geometry.
Burnish the margin after seating where access allows. It is one of the few restorative materials that permits it.
What to put on the prescription
Tick Full Metal under Type of Crown and select the full metal alloy. Mark the tooth on the design chart and give the occlusal relief you want — the form offers positive or foil relief with a number of foils.
Note the antagonist and any known metal sensitivity. Specify interproximal contact form and tightness.
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Digital scans and conventional impressions are both accepted. Cases move by UPS and Purolator, and Fairmont works with practices throughout British Columbia and across Canada.