Direct filling gold

Direct filling gold

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 Direct filling gold

Contents
 Introduction
 History
 Classification
 Characteristics of Gold.
 Factors influencing Selection of Gold.
 Uses of Gold.
 Forms of Direct Filling Gold.
 Indications of Direct Filling Gold.
 Contraindications of Direct Filling Gold.
 Advantages of Direct Filling Gold.
 Disadvantages of Direct Filling Gold.
 Heat treatment of Gold
 Condensation or Compaction.
 Biocompatibility of Gold Restorations.

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Definition: “Direct golds are those gold restorative materials that are manufactured for compaction
directly into the prepared cavity”.

History
• Giovanni and Arcolani made the earliest recording of its use.
• Joannes Arculanne in 1400.
• German book published in 1530.
• Fourchar in 1785.
• Chappan A. Marks stated that it was not until the year 1800 that the use of gold for filling teeth was
common among dentist.
• Introduced in America by Robert Woofendale in 1785, after his return from England.
• Marcus bull of Harford, conneticut was the first to prepared gold for dental use.
• In 1853 sponge gold was introduced in dentistry.
• Dr. WH Swinnelle of New York described the advantages of contour gold restoration in 1854.
• D. Robert Arthur suggested the use of cohesive foil in 1855.
• Corrugated gold was discovered in 1871 after great Chicago fire but has questionable value in dentistry.
• EZ gold (The new goldent) was introduced by Lloye Baum in late 1920’s since direct filling gold
restorations have become easier to place.
• A new type of DFG was introduced by Diehl and Ringel stein in 1989.
• This material was first available in Germany but more recently has been introduced in United States
under the name stop F Gold.

CLASSIFICATION
A) According to Skinners
• Divided into 3 categories
• Foil – also k/a fibrous gold
• Electolytic precipitate – also k/a crystalline gold
• Powdered gold
I. Foil
• Sheat
• Cohesive
• Non cohesive

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• Ropes
• Cylinders
• Laminated foil
• Platinized foil
II. Electrolytic precipitate
Mat gold
Mat foil (Mat gold and gold foil)
Gold calcium alloy
III. Powdered gold
Encapsulated gold powder
B) According to Marzouk
Direct gold can be classified into 2 main categories
1. Precipitated gold
2. Gold foil
Precipitated gold
1. Powdered gold
2. Mat gold
Gold foil
1. Plain gold foil
2. Corrugated gold foil
3. Platinum gold foil
4. Laminated gold foil
C) According to Sturdevent
Direct filling gold is of 6 types
1. Gold foil
2. Platinized gold foil
3. Crystalline gold – 3 forms
a. Mat gold
b. Mat gold wrapped in gold foil
c. Mat gold alloyed with calcium and wrapped in gold foil (electraloy RV) and powdered gold.
D) According to Gilmore
The types of direct gold are:

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1. Sheet foil in book form from which hand rolled cohesive pellets can be made.
2. Sheet foil in book form treated with ammonia gas from which non cohesive cylinders can be made.
3. Commercially rolled gold foil pellets
4. Mat gold
5. Goldent
6. Electralloy
E) According to Mc Ghee
2 types:
1. Fibrous gold: Made after the method of beating and rolling
2. Crystalline gold: Made by chemical precipitation or electrodeposition.

CHARACTERISTICS OF GOLD
• Most noble of all metal.
• Most ductile of all the metals.
• Most malleable of all the metals.
• It has rich yellow color with strong metallic lusture.
• Melting temperature is 1063°C and boiling temperature 2200°C.
• Density of pure gold is 19-19.3g/cm3.
• Brinell hardness no. of pure gold is 25.
• Coefficient of expansion is 14.4 that is near to 11.4, the coefficient of crown of tooth.
• High thermal conductivity 0.710 cal / sec. / cm2.
• It is chemically inactive and is not affected by heat, moisture or most solvent.
• Good tensile strength. It is capable of holding a weight of seven tons per square inch according to
Hierus.
• It readily dissolves in combinations of Nitric and Hydrochloric acids. It also dissolves by other
chemicals such as potassium cynide and solution of bromine and chorine.
• 0.2% lead makes gold very brittle. Bismuth and mercury have also shown to have adverse effect on
gold.

FACTORS INFLUENCING SELECTION OF GOLD

• Physical condition of the patient
• Mentality and will power of the patient

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• Age
• Strength of periodontal membrane and state of development of the root.
• Extent and rapidity of caries and oral hygiene of the patient.
• Sensitivity of the dentin
• Strength of cavity walls
• Character of occlusion
• Accessibility of the cavity
• Skill of the operator
• Esthetic condition

USES OF GOLD
• Different forms of gold are widely used as a direct filling restoration.
• Alloys of gold are widely used in the cast form than the wrought form for crowns, inlays, bridges,
partial denture bates and retentive clamps.
• Whenever steel pins are used for enhancing the retention, there is a possibility of there corrosion in
the long run and their failure. So overcome this disadvantage, electroplating of pins is done with gold, such
gold pins offer better corrosion resistance.
• In grossly destroyed teeth, if sufficient structure is not present, a cast post and core is prepared to
provide the base for crown preparation. Such custom made preparation done with gold alloy offers
advantages for strength and reinforcement.
• Attaining a moisture free area in the periapex is a difficult task, but this can be achieved if DFG is used
as a retrograde filling material.
• Gold foils has also been applied in the cases of incomplete oro-antral fistula closure when surgical
procedure have not been successful.
• Palatal gold veneers are made with minimal or no tooth preparation in cases of palatal erosion.

FORM OF DIRECT FILLING GOLD

Gold foil
• Produced by beating or rolling.
It is available in books of sheets separated by pages of thin paper. The books contain 1/10 or 1/20
ounces of gold.
Pellets of gold foil are generally rolled from 1/32, 1/43, 1/64 and 1/128 sections cut from No.4 sheet
of foil. The book of foil is marked and cut into square or rectangles.

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Each piece is placed on clean finger tips and the corner are tucked into the center, then it is lightly
rolled in pellet form.
Stored in gold foil box which is divided into labelled sectioned of various size of pellets.

GOLD FOIL IS SUPPLIED IN FOUR FORMS:

Plain gold foil: It is product of cold working procedure without any modification.
Corrugated gold foil: It is manufactured by placing thin leaf of paper between 2 sheets of gold foil
after which the container containing the paper leaves and gold foil is ignited.
Platinum gold foil: It is old type of gold foil, produced in 2 ways.
Advantages.
Disadvantages.

Laminated gold foil

• It is produced by combining 2 or 3 leaves of gold, each of different ingot which have been cold
worked in different direction.
• The laminates are now available as performed but can be made in the dental office by placing a
number of sheets on top of each other and then cutting the laminates of desired size.
Gold foil cylinders
It is produced by rolling cut segments of No. 4 foils into desired width, usually 3.2mm, 4.8mm and
6.4mm using a modified no. 22 tapestry needle. An alternating method is to use no. 60 or No. 90 gold
foil.
Extrapliable gold foil
It was produced to make gold more cohesive. This material is produced by wrapping a loosely
formed, regular gold rope with an extra sheet of gold foil.
The rope is then used as it is or cut into pellets.

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It can also be heated and condensed in the same manner as other gold.
Uses: Class I and Class V restorations.

Cohesive and Non cohesive gold

Free of surface contamination.
The ability of two gold surface to cohere by welding at oral temperature is dependent on atomically
clean surface.
Gold like most metals attract gases to its surface and any absorbed gas film prevents the intimate
atomic contact required for cold welding.

Diagram: Cohesive Gold Foil

The ammonia treated foil is k/a semi cohesive foil. This is converted to cohesive by heat treatment.

Non-cohesive foil are those in which contaminant like sulphur, iron or phosphorous are permanently
deposited on the surface.
Types of cohesive gold foil
Soft type of cohesive foil
 Annealed before trimming and treated in ammonia fumes to reduce cohesion.
 ammonia gas is driven off either by annealing in the flame of alcohol lamp or over an electric
annealer to restore its entire cohesion.
Dead soft type foil:
 Not annealed. Softer and much less cohesive than the soft type.
 It is softer and much less cohesive than the soft type but may be reduced cohesive by careful
annealing.
Extra or special soft foil:
 It has been dehiberately alloyed with a trace of silver to binut its cohesiveness by careful
annealing.
Platinized soft gold foil:
 alloyed with platinum.
 indicated on the incisal edge of anterior teeth as a protection against abrasion class IV
preparations.
 It is moderately cohesive when annealed, but its working qualities are little harsh.
 The commonest form of gold foil cohesives used is No.4 soft type gold foil.
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Advantages of cohesive gold as restorative material

Insoluble in oral fluids
Good adaptation to cavity walls, if properly worked.
Perfect weldability in cold slate.
Great density, crushing strength and edge strength.
Low tendency to molecular change, since it is free from objectionable shrinkage on expansion.
Capability of receiving and maintaining high polish.
No intercementing substances is required.

II. ELECTROLYTIC PRECIPITATE

Mat gold
 Precipitated through electrodeposition and it is accumulated in the form of strips or cones. These
strips are cut by dentist into desired sizes.
 Mat gold is placed in a mold at room temperature to become compelled and is then sintered in an
oven.
 Advantages: It is sponge and adapts well to cavity walls.
 Uses: It is used for building up the internal bulk of the restoration.

Mat Gold
MAT FOIL
Sandwich of mat gold between sheets of No. 3 / 4 gold foil.

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Sandwich is sintered by heating below melting point of gold and cut into strips of differing widths.
Advantages:
 Ease of placing gold in retention forms and
 Reduction in placement time especially in larger preparation.
Disadvantage:
 Greater tendency for voids which shows as pills on outer surface and restoration.
Electralloy:
Combination of gold and calcium.
Calcium content is 1%.
Advantage: Product form provides stronger restoration.
Disadvantage:
 Inharmonious colour
 High conductivity
 Difficulty of manipulation
STOP F GOLD
It is a new direct filling gold material available in market since 1989.
Advantage
 Final restoration exhibits greater density than other form of granular gold.
 50% increase in shear strength when compared to gold foil.

POWDERED GOLD
Also k/a EZ gold –
It is a blend of atomized and precipitated powder embedded in a wax like organic matrix.
It is available in pellets of various sizes which are enclosed in gold foil wrappers and packaged for
use.
Prior to its condensation the matrix is burned away leaving only pure gold to be packed in the cavity.
Use: In small Class I and V lesions.

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Diagram Powdered Gold

GOLDENT
Combination of powdered gold and gold foil.
The ratio is 95% powder to 5% foil. It is provided in cohesive form.
Advantages:
 The envelope holds the powdered particles during condensation, making handling easier.
Uses:
 It is used in many types of restoration. It can be purchased in assorted 1/10 ounce plates.

INDICATIONS OF DFG
1. Incipient carious lesions

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 Class I lesion in premolar teeth and other accessible developmental pits.

 Class V gingival lesions
 Class III lesions in maxillary and mandibular anterior teeth.
 Class II lesion in premolar teeth when the lesion is small enough to allow a conservative
cavity preparation
 Class II lesions on mesial proximal surfaces of molars.
2. Erosions
3. Hypoplasias
4. Teeth with no enamel crazing and microcracks.
5. Atypical lesions,
6. Lesions in which enamel margins can be located on sound tooth structure.
7. Lesions in vital teeth.
OTHER USES
 For restoring access opening for endodontic therapy.
 Faulty margin restoration can readily be accomplished with direct gold instead of amalgam.
CONTRAINDICATIONS
 In handicapped, elderly or very young patient unable to sit for longer appointment.
 Physiologically unsound patient.
 Teeth with large pulp chamber.
 Periodontally weakened tooth.
 Large carious lesion.
 Chalky or melted enamel could contraindicate the use of gold.
 Poor patients.
 High caries index.
 Hypoplastic areas.

Advantages of Direct Filling Gold

 Long lasting restoration.
 Do not tarnish or corrode in the oral cavity.
 Insoluble and has coefficient of thermal expansion close to that of tooth.
 Atrauamatic
 No tooth discoloration

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 Direct gold adapts well to the cavity wall in addition no cementing medium is necessary for
retention of restoration.
 Ductility.
 Easy to polish.
 High wear resistance.
 Low tendency of molecular change.

Disadvantage
 Unesthetic.
 Expensive.
 Patient discomfort.
 Limited to small cavities.
 Manipulation is difficult
 Technique sensitive.
 High condensation force may injure the tooth and supporting tissues.

Heat treatment of Gold:

 Degassing or Decontamination.
Purpose of decontamination process –
 To drive the impurities off the surface, this making the surface ready for cohesion.
 So keep the surface devoid of any impurities until complete cohesion occur during building of
restoration.
2. Heat treatment of gold
Gold is kept in closed container when not in use and should not be exposed to contaminate.
All 3 types of gold must receive heat treatment just prior to condensation. This is done to degas the
surface of gold and render it cohesive.
Some of the gases may be driven off by heat while other are irreversibly attached.
Reversible gases (oxygen and ammonia) can be readily removed by heat in the range of 900°F to
1300°F.
Care should be taken not to strike matches in the vicinity of the gold less the sulphur and
phosphorous flames contaminated the gold surface.
Degassing can be accomplished in 3 ways:
1. By an open alcohol frame or piece method of desorption or flame desorption.

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1. Most practical method of annealing

2. accomplished using simple alcohol flame and gold foil carrier.
3. Acetone free denatured alcohol must be used to avoid possible contamination from the
source.
4. The wick of the lamp should be pointed and ¼” long.
5. Gold is picked up with a point of the carrier brought to the hot cone of the flame first long
enough to change it to dull red colour.

6. Middle zone of the flame is used (high energy reducing zone). Each piece of zone is held for
2 to 5 seconds before inserting in the cavity preparation.
7. For fibrous gold foil this is instantaneous.
8. Encapsulated powder gold has a flammable indicator. Pellet is held in the flame until
indicator burns off and gold appears dull red.
9. Alloyed filling gold or mat foil are held until the dull red appearance is observed.
10. All the pieces must be cooled temporarily before carrying to the oral cavity.
11. Pliers should not be used for piece method since there mass results in uneven diagnosis.

Advantages:
• Less wastage
• Ability to select gold of desired size and shape.
• Elimination of chance of contamination of gold between annealing and use.
• A mica over a flame:
 Bulk annealing.
 Mica trace are used to hold the gold over the flame.

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 5 minutes.
• Advantage:
 Less time than piece method.
• Disadvantage:
 Sticking of gold pellets.
 Unequal heating.

3. Electric degassing or tray desorption:

It is accomplished by an electric annealer.
Electric heater controls the time and the temperature.
The surface of heater is divided into small compartments.
The estimated number of pellets of gold required for the restoration is placed on the surface of the
annealer at 650°F.
5 minutes.
Powdered gold pellets takes 15-20 seconds whereas gold foil and electrolytic pellet require only 1-2
second.

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Advantage :
 Convenient method.
 No need of assistant.

Disadvantages:
 More wastage.
 Danger of over annealing.
 Sticking of pellets.
 Inability to select from annealed gold a piece of desired size that fix the cavity.
 Greater exposure to condensation.
 Air current affecting heat uniformity.
 Over sintering.

Hazards of overheating:
1. Recrystallization and grain growth.
2. Incorporation of impurities.
3. Adherence of whole mass of the particle to each other instead of only surface items.
4. Complete melting of surface of the gold making it completely non-cohesive.
5. Premature cohesion.

Underheating:
1. Incomplete removal of impurities making material partially cohesive leading to pitting and porosity.
2. Incomplete cohesion.

COMPACTIONS OF DFG
“Condensation is a procedure used to condense and harden gold inside the cavity preparation”.
Objectives:
 Gold is compacted by wedging the initial pieces between dentinal walls.
 Weld gold pieces together to ensure complete cohesiveness of their space lattice.
 Voids should be avoided from critical areas the margins and the surface to prevent
microleakage.

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Bridging

 Strain hardening of the gold.

 Adapt gold material to the cavity walls and floors.
 Elastically deform the dentin of the cavity walls and floors.

TYPES OF CONDENSATION
 Hand instrument condensation:
 The condensation energy produced by this method is not always sufficient.
 initial increment of material within the cavity

Automatic hand malleting:

 Spring loaded instrument that delivers desired force once the spiral spring is released.

 Hand condensor and mallet.

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 Electronic condensation:
 McShirley electro mallet.
 Accommodates various shapes of condensor points and has a mallet in the handle
itself.
 Most efficient and controlling way.
 The vibrating condenser heads can have an intensity or amplitude from 12 to 15
pounds and frequency of 360 to 3600 cycles / min.

Pneumatic condensation:
 Introduced by Dr. George M. Hollenback
 Pneumatic mallets consist of vibrating condensor and detachable tips run by compressed air.
 Air is carried through thin rubber tubing attached to the handpiece.

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 Rheostat controls the air pressure and adjust the frequency and amplitude of condensation
stroke.
 Pneumatic mallets available both in straight and angled handpiece.

GOLD CONDENSORS
DFG condensor have faces that are serrated with pyramidal shape configuration. This system has 3
functions:
 Increase the surface area of condenser face.
 Act as surgger, thus creating lateral forces which will help in fulfilling the objectives of
condensation.
 Establish some triangular indentation in the condensed piece of gold, so that the succeeding
increment of gold may be interlocked and immobilized in these indentations.

DIFFERENT SHAPES OF DFG CONDENSER

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The Blackwood burg, Ferrier and Loma Linda instrument set are frequently used to condense regular
cohesive gold restoration.

Round condensor
 Baynet condenser
 Used in initial stage of restoration.
Parallelogram and hatchet condenser
 Parallelogram condensor is perpendicular while hatchet is parallel to shank
 Used for preliminary condensation to create the bulk of the restoration.
Foot condensers
 Used mainly for cavosurface condensation surface hardening of restoration as well as bulk
build up.

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Parallelogram condensor

Hatchet condensor

Foot condensor
PRINCIPLES OF CONDENSATION
 Exert 15lb/sq inch of force on the condenser nib less force is needed for small condenser nibs
than for larger ones.
 Force of condensation must be 45° to cavity walls and floors
 Force of condensation must be directed at 90° to preciously condensed gold.
 Stepping procedure for compaction of gold should be carried out.

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 Use the maximal thickness of pellets possible provided that the condenser will not penetrate
it. The thinner like cross-section of each increment the easier is the condensation. This will
prevent crazing of E rod.
 Energy a condensation.
 When inserting DFG condensation should either from one periphery of the increment to the
other or from the center to the periphery.
 The condensation of precipitated types of direct gold should be started by hand.

PHYSICAL PROPERTIES OF COMPACTED GOLD

 Transverse strength is chosen as being most representative of chemical applications.
 It is a reflection of 3 types of stress –
 Compressive
 Tensile
 Shear
 Any failure can occur from an area of weakness. In DFG’s the failure usually occurs from
tensile stress because of incomplete cohesion.

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 Hardness may not be valid measure of the effectiveness of particular restorative material for
its intended purpose of preserving the tooth.
 It may however mediate the overall quality of compacted gold. Low hardness probably
indicates the presence of porosities.

General Steps for Insertion of Direct Gold Restoration in a Cavity Preparation

The following can serve as a general outline for the procedure of inserting direct gold materials into a
cavity preparation:
A. Three step build-up for the restoration
1. "Tie formation"
This involves connecting two opposing point angJes or starting points filled with gold with a
transverse bar of gold. Such a "tie" forms the foundation for any restoration in direct gold.
Resistance to displacement should be tested before proceeding to the next step.

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2. "Banking of walls"
This is accomplished by covering each wall from its floor or axial wall to the cavosurface margin
with the direct gold material. A wall should be banked in a way that will not obstruct tie formation or
banking of other walls in the cavity preparation.
"Banking" should be performed simultaneously on the surrounding walls of the preparation.

3. Shoulder formation
Sometimes, to complete a build-up, it is necessary to connect two opposing walls with the direct gold
material.
These three steps should completely fill up the cavity preparation, but the build-up should continue
until the preparation is overfilled.

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B. "Paving" of the restoration

Every area of cavosurface margin portion should be individually covered with excess cohesive gold
foil
“Foot" condenser is useful.
C. Surface hardening of the restoration
Instrument is moved all over the surface of the restoration in our direction to strain harden the surface
gold and fulfill the rest of the objectives of condensation.

D. Burnishing
Done with proper instruments from gold to tooth surface.
Creates a solid gold sheet marginally.
Enhance surface hardening.
Adapt the material more to the margins.
Eliminates surface and marginal words.

E. Margination
Knifes and files are used from gold surface to the tooth surface.
Small increments should be removed at a time
Do not try to remove more material at a time as it may cause displacement of the whole restoration.
Done to visualize original outline of the cavity.

F. Burnishing
Follows margination to close marginal discrepancy.
Strain harden the surface.

G. Contouring
Create the proper anatomy of restoration that coincide the tooth.
Accomplish using knives, files and finishing burs.
If contouring involves margin they should be reburnished before final contouring.

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H. Additional burnishing

I. Finishing and polishing

Precipitated chalk, tin oxide on soft bristle brushes are used.

J. Final burnishing
This is done to ensure closure of marginal voids and other surface discrepancies.

BIOCOMPATIBILITY OF GOLD RESTORATION

• It causes irritation to pulp dentin organ.
• Factors:
 Condensation energy.
 Thermal energy.
 Frictional heat of finishing and polishing.
 Galvanic current.
• Effect of direct gold restoration at different effective depth
 With an effective depth of 3 to 3½ mm a normal pulp will undergo a healthy reparative reaction.
 Less than 1mm there will be destruction of pulp dentin organ. Initial sign is cracking of pulpal or
axial wall.
• Protective bases necessary for pulp dentin organ:
 Effective depth 3 to 3 ½ - healthy reparative reaction.
 <1mm – destruction in the pulp dentin organ.
 3mm or more – no intermediary base required.
 2mm or more – cavity varnish applied on walls and floors.
 1-2mm – subbase of calcium hydroxide or ZOE indicated.
The decline of gold restorations:
• Patient factor.
• Operator factor.
• Material factor.
• Patient factor:
• High cost

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• Comfort.
• Necessity for extra visits.
• Esthetics.
• Galvanic pain.
• Allergy.
• Fear about personal safety.

Operator factors:
 Necessity for higher skill.
 Lure of cosmetic dentistry.
 Need for more chairside time.
 Possible pulpal and periodontal damage.
 Possible damage to enamel margins.
 Extra care during degassing.
 Suspicion about pil levage.

Material factor:
 Economy.
 Non-availability.
 High thermal conductivity.
 Possible galvanic effect.
 High density of gold alloys.
 Softness of pure gold.
 Colour of gold.
 Evolution of newer materials.

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CONCLUSION
• No metal or combination of metals search dentistry so well and in a wide range of application as does
the gold and its several types. Without gold as a restorative material the practice of dentistry would be
changed significantly as no other material serves as its complete satisfactory substitute.
• So as a clinician it is our duty to have good knowledge and idea about its manipulation and cavity
preparation.

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