Best material for inlay/onlay

[Jojobirdy13]

Hi

I require a inlay and onlay on my 1st lower right molar (I only have 1 pre molar due to extractions for braces in my teens).

This will be a big restoration as the tooth is big and my dentist recommends emax stating this material now lasts the same as gold but from what I have read I think gold is best.


Pros emax- aesthetic, claims to be strong and cheaper option than gold.


Cons emax- has longevity been proven? Is the material kind to tissue and opposing enamel? Is there risk of material letting further decay slip in?


Gold pros: proven longevity, kind to tissue and enamel and conservative restoration


Gold cons: wont show when I smile as I have a overbite but my onlay will sometimes be on show when I talk or open mouth (I do currently have amalgam filling but the onlay in gold will this be more noticeable?), cost is a bit more expensive but if lasts long term is this better option?


My question is, which would you have in your mouth on your 1st pre molar?

 

[honestdoc]

Thanks for asking these are great questions. It shows how much you appreciate the work. I would personally put gold in most of my teeth but I'm old school and I'm not as aesthetically conscious as most. The reason I like gold is that 1) you don't have to drill as much because thin gold won't fracture, 2) gold has the most accurate margins where gold meets the tooth with minimal micro-gaps where bacteria and contaminants could leak through, and 3) gold is softer and friendlier to opposing teeth in which it won't wear against unlike ceramics which could many times damage the opposing teeth.

Many dentists are now "metal" free or environmental, naturopathic, cosmetic, etc. When dentist claim they are "metal" free, it is misleading because restorations have barium sulfate additives to show up in x-rays or otherwise it will look like a black hole. Your dentist could argue against me because many don't do gold anymore. Gold is actually cheaper because it is less labor intensive than ceramics and prices reflect it on my dental lab scripts.

 

[Jojobirdy13]

Thank you so much for your reply. This helps out a lot and I really appreciate your knowledge and experience.

Whilst aesthetics are a bonus I’m trying to look at what would be the best option for my molar and opposing enamel.

So for the inlay and a onlay that i require,the cost is £475 for emax but £600 for gold. Does this sound about right? I do think that my dentist did not expect my request for gold when white restorations are the most popular.

He has advised white would be better as partially on show. My other option is mixed alloy but all research tends to point that gold is the best.

With a gold resprtation am I looking for a particular percetange or carat of gold within the material?

If I was to opt for a gold now would I need to stick to gold if I required a restoration on the opposing or adjacent teeth? Just in case I require further work in the future as gold resortations are harder to come by.

Thanks again

 

[honestdoc]

There are 3 types of cast alloys. First is high noble which is the most expensive and the highest gold content of over 40% (Over 60% noble metals of gold, palladium and/or platinum). This is the softest most friendly for inlays and onlays. Second, is noble which has over 25% noble metals. This is base metal which is under 25%.

In the US, ceramic is more expensive because it is more labor intensive. You can request Noble alloy which is over 25% noble content (less expensive than high noble). Anything under is too hard alloy for inlays.

For future work, it is difficult to answer. Obviously ceramic will wear down opposing teeth and gold. You might consider bite guard to minimize wear.

 

[Busybee]

Thanks for asking these are great questions. It shows how much you appreciate the work. I would personally put gold in most of my teeth but I'm old school and I'm not as aesthetically conscious as most. The reason I like gold is that 1) you don't have to drill as much because thin gold won't fracture, 2) gold has the most accurate margins where gold meets the tooth with minimal micro-gaps where bacteria and contaminants could leak through, and 3) gold is softer and friendlier to opposing teeth in which it won't wear against unlike ceramics which could many times damage the opposing teeth.

Many dentists are now "metal" free or environmental, naturopathic, cosmetic, etc. When dentist claim they are "metal" free, it is misleading because restorations have barium sulfate additives to show up in x-rays or otherwise it will look like a black hole. Your dentist could argue against me because many don't do gold anymore. Gold is actually cheaper because it is less labor intensive than ceramics and prices reflect it on my dental lab scripts.

I used to love my gold onlay on a back molar. It was the only onlay I had for many years and was incredibly strong. I had no problems with the tooth but over the years a gap opened up at the margin. Dentists didn't want to touch it, one cleaned it out and filled the gap, but that crumbled and I've finally had it redone in zircon. The tooth was full of decay inside. I was shocked because I am meticulous with my hygiene. But of course there's no way I could have kept it clean as you cannot get underneath a gap like that. It's amazing that I had barely no symptoms and no actual pain at all.

So my impression is that that only happens with a metal onlay. Can it warp? I have another gold one and it has been great at fixing a cracked molar. Again really strong, just like a very healthy natural tooth. So I hope that the same thing doesn't happen. Ceramic just doesn't feel as strong, in the sense that it has less give.

I was reading today about the elasticity of different dental materials vs the dentine and I guess that's probably why they feel so different. The science behind it is very interesting, choosing dental materials must be just like deciding what to use for major engineering projects!

 

[honestdoc]

Choosing dental materials for me involves various thought processes. I have consideration of the materials spectrum of esthetics vs functionality. Highly esthetic materials may have deficient functionality/longevity properties and vice versa. Modern materials have improved. One of my favorite material is Glass Ionomers due to their natural dentinal bonding and desensitizing. Their past drawback is their lack of strength. Fortunately modern GIs such as Fuji Equia are approved for posterior final restorations. There is a new class of materials that are bioactive. Previously the body tolerates bio-compatible materials. With bioactive, the body thrives with them. Cementum has been shown to grown on Activa restorative materials. I favor the most conservative options and consider pros & cons of different appropriate materials.