Why your dentist would always choose a gold inlay
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An inlay describes a filling that is pre-made outside the mouth and in many instances they are the best way to restore a lost tooth.
When a tooth needs a filling as a result of decay, fracture or the loss of an old filling, it can be restored in three different ways, using an amalgam metal filling, a white filling or an inlay.
Amalgam metal filling
Amalgam metal fillings have been around for well over a 100 years. They are an economic option and last a long time - say 8-15 years, sometimes longer - but they are not at all aesthetic. They also contain mercury which some people don’t like the idea of.
The second type of filling that can be placed is a white filling. White filling material science has improved dramatically of the last 20 years and the materials we now use are very good.
Obviously this type of filling looks better than a metal filling, however, the drawback with a white filling is their placement. It is very technique sensitive which means they take considerably longer to do which consequently increases the price. Another drawback is that for large fillings they do not last as well as a metal filling, perhaps only 5-8 years.
The third way to fill a tooth is by using an inlay. This is where the filling is made outside the mouth by a dental technician and then cemented into the tooth. The filling can be made of gold or porcelain.
What are the advantages of an inlay over the other types of filling?
It depends on what type of material is used.
A gold inlay is casting of a gold alloy and as such is very strong. This means gold inlays last the longest of any filling - 10-20 years at least and in some cases much longer. The downside to them is that they are notably more expensive because of the cost of the gold, the dental technician’s costs and they involve two appointments with your dentist.
A porcelain inlay is obviously much more aesthetic and they can be made to look like a real tooth. They last a long time but not quite as long as a gold inlay as the materials can fracture in some circumstances. Like a gold inlay, they still involve two appointments and as such are similarly expensive due to the dental technician’s construction costs.
What is the inlay process?
The process for an inlay as mentioned above involves two appointments. At the first visit after the anaesthetic injection, the cavity in the tooth is cleaned out and prepared. A mould of the tooth and those opposing it in the other jaw is then taken and sent to a dental technician who makes the inlay. A temporary inlay is made by the dentist and cemented in using a temporary cement while the permanent one is made. The patient returns about two weeks later, and the new permanent gold or porcelain inlay is cemented in place and the bite checked.
So why would you choose to have an inlay?
For larger fillings, they can definitively last a very long time, especially gold ones. If you don’t like having fillings done then choosing an option that lasts a long time may be good for you. You may not consider gold very aesthetic but at the back of the mouth, no one will ever really see it. If the cavity is more visible, a tooth coloured porcelain would be suggested instead.
An inlay should only be suggested by your dentist if your mouth is healthy enough.
Do be aware though that an inlay does not mean the tooth is immune from decay. Your dentist will only suggest the inlay option if they think you have a relatively low decay rate. You can reduce your individual susceptibility to decay by using a high fluoride toothpaste and by obviously cutting down on your sugar intake.
A final thought… Dentists don’t like having fillings either! Many (including me) will always go for the longest lasting option when we need a back tooth to be restored and that is, of course, a gold inlay.
Written by Ben Pearson, GDC 64059, BDS (Bristol), MSc (Eastman), practicing periodontist and dentist in Exeter