Gold Restorations: Why, When, and How with Lane Ochi – PDP236

Teaser:
Well, Mrs. Smith. What is your desire, longevity, or pretty? The beauty is that when they looked at the occlusal margins, the ones they could finish, the state acceptability was- 

Jaz’s Introduction:
In this world of lithium disilicate, and zirconia, is there a place for gold? Many years ago, it was agreed that nothing beats gold. Gold is the best because it gives you absolutely brilliant longevity. It’s kind to opposing tooth structure and you can burnish the margins. What does that actually mean? We’re actually going to cover it in this episode. What does it mean? Is there a place for Gold in 2025 and beyond?

I’ll tell you, the last time I did a gold restoration about three years ago, I had to sell my left kidney to pay the technician. Gold is expensive. Are the benefits of gold worth that expense? Or perhaps, just perhaps, there’s a viable alternative to gold, what you’ll find out today.

Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. This is a slightly different one. We did this live. This was a rare live podcast with one of my heroes and mentors, Dr. Lane Ochi, one of the geekiest and kindest dentists I know. And to see him communicate with us on Protrusive Guidance, our network.

And every time we all get stuck and we’re like, oh, what do we do with this query? Or something like really obscure and geeky about material science or how things were done back in the day and we’d always tag Lane. Dr. Ochi is an absolute pleasure to have you as part of the community, and thanks for doing this live with us.

So for those who are now listening on Spotify, Apple, or watching on YouTube, just bear in mind that I do lots of shout out when I do a live on Protrusive Guidance. It’s very much responding to the chat, engaging, serving. So you’re gonna hear lots of names being shouted out.

Dental Pearl
Now, every Protrusive episode we give you a Protrusive Dental Pearl. This one is already spilling the beans. It’s giving the secret away of this podcast. It’s gonna blow your mind, right? Many, many years ago, this is probably the first meeting I ever went to, like maybe 13 years ago, it was the British Society of Restorative Dentistry Meeting. Maybe I’ve told this story before to you guys.

I’ve been speaking to you guys for six years now. I can’t even keep track anymore of what I’ve told you and what I haven’t told you. Anyway, back then, we are moaning about the price of gold. Now I had a check, and actually since that meeting, the price of gold has doubled. So here we are in 2013, moulding about how expensive gold is, and now the price has doubled 12 years later.

So we asked the restorative specialist, what should we be using? And so what this specialist said back then, which always stuck with me, is to consider the use of a milled cobalt chrome. That’s right. A milled cobalt chrome for your indirect restoration such as crowns and onlays. So since then when I’ve got second molars and I’m tight for space, I’ve been doing non precious metal crowns and onlays and I’ve been pretty happy with how they fit and especially with how much they cost.

And did you know that something like cobalt chrome is so kind to enamel. So any opposing enamel, it is so kind to it, but is this like a forbidden cheat code and there’s a good reason why we perhaps shouldn’t be using this? Well, stay tuned my friends, because I asked this question to Dr. Lane Ochi and let’s see later in this episode, what he had to say.

But as far as the Pearl is concerned, that specialist believe in it. I believe in it. In fact, recently if you’re on Protrusive Guidance, you would’ve seen me do a live, I treated a crack tooth case and I walked you through exactly why and how I prepared this for a cobalt chrome restoration. I show you the entire prep, the cementation, and this is available with CPD CE quiz. We are a PACE approved education provider, as you know.

So if you’re curious about metal restorations for compromised second molars, when you’re lacking that space, check it out in the Premium Clinical Video section of the app. And speaking of the app, I just wanna do a shout out to Dr. Jamie Adamson.

Jamie said on the app, thank you, Jaz, for the availability of your VertiPrep course. Fitted my first anterior VertiPrep crown today and just plunked it on loving the soft tissues especially. Appreciate your commitment to helping the Protrusive community. Well, Jamie, to you and everyone who’s started to do VertiPrep since doing VertiPreps for Plonkers, thank you for implementing what you’re seeing online.

So I always worried when I created VertiPreps for Plonkers because I was like, can you actually learn VertiPreps online? Do you not need a hands-on? And honestly, with the loop mounted footage that I have, or it is very possible and we proved it.

Dozens of you have been posting your preps and your cases and so we discussed the lab protocols, materials, troubleshooting, and because we have all that and the images and full protocol videos, it’s as good as shadowing someone. In fact, I had a student shadow me recently and she’d actually shadowed many dentists before.

And the same thing that happened to me is that when I’m shadowing someone, I’m like over their shoulder. I’m trying to see what they’re doing. I’m trying to like make notes and what’s really carefully how this dentist is doing something so I can learn the nuances. But it’s actually very difficult to see what the dentist is doing.

So what I do when anyone shadows me is I sit them on the sofa opposite. I give them an iPad on my laptop and I switch on my loop mounted camera and they can see everything and I’m speaking to them as I’m doing the procedure and they are absolutely gobsmacked at the end. It’s like, wow, what a powerful learning experience because your vision is so clear.

That’s why my friends, you can learn VertiPreps online. You can learn Sectioning and Elevating online. You know this already because I know you go on YouTube and you type in certain procedures that you’re about to do, whether it be delicate layering of anterior bonding or certain steps and dentures.

The University of YouTube already exists and does a good job. I’m just here. Pack a punch and contribute to this education. And the best of it happens on Protrusive guidance. A quick shout out to three individuals from PG who I just wanna give a lot of love for. You guys are just mentoring and helping out and contributing to such a huge scale.

Mohammad Mozaffari, Richard Coates. Richard also did a podcast recently about finances, like how should we budget our finances? That’s a private podcast only available on the app, but you can check it out.

And also Harpardeep Kaur Ratia, our friend from California, you three in particular, have just honestly upheld the values of the nicest and geekiest dentist in the world. Alongside our guest today, Dr. Lane Ochi. So thank you. And now let’s get to the main interview and catch you guys in the outro.

Main Episode:
It’s so great to see you again. How’s life? How are you? Tell us about just, just a flavor of life as it is at the moment.

[Lane]
Life is wonderful. It’s so fun. To, dabble in dentistry as an educator still. I am an associate for one of my mentees in helping them learn how to let go and bring in their own associates so they could spend more time with their family. And it also is a deep appreciation of why I really wanted to step away from full-time clinical dentistry to be a full-time grandfathers, it’s just this whole life balance.

I’m glad I was young enough to make this decision to enjoy, so I’m probably the happiest I’ve ever been. So thank you for asking.

[Jaz]
That’s exactly why I asked. because I knew you were gonna say that. I’ve been seeing these images of you and your grandkids and honestly your fitness levels and how much you’re trying to maintain that.

It’s an inspiration, so I think it’s a great to live up to like everyone knows you here, even on the podcast for everyone knows you. So many of us came to join you live when London, when you came recently.

But just for a few people, can you just give us like a one minute highlight of like, imagine your career clinical dentist career was made into like a, an Instagram reel of 60 seconds. What would be in the highlights?

[Lane]
Yeah, that’s easy. You’re looking at the ultimate beneficiary of mentorship. So, I have been so blessed that so many doors were opened. And the doors were opened by generous souls like you. I mean, we don’t have enough anchors and mentors that invite people to come and learn, and that’s, you know, that’s basically it in a nutshell.

So, God bless you, thank you so much for everything you do. 

[Jaz]
I mean, it is a real shame ’cause those of you who don’t know you just stumbled on, you’re a new grad and you’ve never seen Lane before, like if you just type in his name in Google see is an amazing plethora of educational things he’s done like even online that came later in his career.

But what I’ve seen and what I’ve heard, and you have actually just even on Dental Town, the amount of forum interactions and amount of people who you’ve mentored is just amazing. And that theme of mentorship will keep coming up every time we meet. And you are the original Dental Geek. So an absolute pleasure to have you again laying your old nickname.

We’ve got so many questions for you. Gold, right? We’re gonna talk about Gold. So before you joined, I dunno if you were there for that bit, I asked everyone in the chat, how many Gold restorations has everyone placed since COVID and I set about five, and most of the answers were zero. Miles said, yes, he has placed Gold he didn’t say how many, I don’t think.

But the numbers are low. Okay. Now, because as a new grad, I was not really taught how to do Gold. I was more PFM and then I had to kind of learn it and to fair I kind of was making up a little bit, reading Shillingburg, and trying to my patients, like the whole thing about burnishing the Gold margins.

There’s so much to talk about today, but the place to start is, maybe it’s a terrible place start, but is this is our conversation is this podcast the last goodbye for Gold. Is this like a farewell to gold? Or, would this conversation, can we see a indication for gold still in 2025 and beyond?

[Lane]
I think this is, you know my, one of my favorite ways to start a lecture is if you’re gonna quote me, please date me. Honestly, I think we’re gonna see a resurgence in Gold. Zirconia is not turning out to be the product that we wanted it to be. It does break, and unfortunately, even three Y it’s not self-healing.

It just turns out that the crack propagation occurs very slowly. It is by its very nature, probably going to fracture in areas where we don’t have a lot of room, meaning the lower second molars, upper second molars.

And as that happens, you’re always gonna find a subset of patients and doctors who want value longevity over aesthetics, especially second molars.

And with that, I think, the beauty of Gold is exactly the polar opposite of Zirconia Gold strength is that it’s weak, meaning it wears, it adapts. Our bite is constantly changing. So the most bite forces we know is our second molars. So I think as the profession moves on, as we mature, as our patients get educated with us, that we’re gonna find a place for Gold again.

Because people just don’t like replacing broken things every 5 to 10 years. They just don’t, I mean, those are from Dental School. I mean, talking other dental students we didn’t know S from Shinola yet they’re here 45, 46 years later. Cemented with crap water-based zinc, oxy phosphate, cement.

[Jaz]
Well, that was one of my questions, like, okay, so you’ve answered it already. And I love how you really explained the properties goals very, very simply. The whole self-healing, use the word zirconia, not being self-healing, but really we’re trying to say gold has those properties, it adapts with us. And, and the longevity and the data supports Gold long term.

And you said an interesting thing that it was done by students, so inexperienced operators with cements which are not as good as the cements we have today, yet in your mouth, they’re still there, still functioning well.

And in your career as you were doing, like, did you find, you had a phase where you tried some new ceramics and then they failed, and then you tried other materials and you were fine that they failed, but perhaps you were just seeing Gold just standing the test of time. What kind of recollections do you have written in terms of longevity of materials? 

[Lane]
So you know how long disilicates have been around? Can I ask. You know, when they were introduced. 

[Jaz]
Does anyone know in the chat, does anyone know in the chat when disilicates were introduced?

Because my guess, where they were popularized was like early two thousands, but you are probably gonna tell me they’ve been way before that.

[Lane]
1980 Dicor disilicates. And I have Dicor machine in my garage. I was one of the first people to purchase it based on the recommendations of the ceramic expert at the time, Ken [inaudible]

And they all failed miserably within like three years. So I kept the machine to remind me that, we have to be careful not to be beta testers. There’s a reason Legacy concepts are called Legacy concepts because they’ve stood the test of time. I mean, how long has gold been used for in our profession? I mean, generations. And it still has, why do we still call it the gold standard? I mean, because it works. Longevity is there.

That’s why, why can you, if you, if we ask ourselves, you know, more modern materials, right? Why do we make a distinction between bonding and plonking on things with cement?

So typically, my learning curve was with all ceramics. I bond by cuspids forward, I plonk and cement molars. And I based my material selection based on how I wanna do things. So Gold’s no different

[Jaz]
Nowadays I see those who are using Gold. I remember attending a Jason Smithson lecture and he was actually treating student, a dentist student.

And the young dentist said, “Hey, this Gold you’re about to do for me, can you bond it?” So that scenario of the lower second molar where I will go for metal for cost reasons, I have been shying away from Gold. And we’ll come to that okay, we’ll come to that and alternatives in cobalt chrome and that kind of stuff, which I have been using rightly or wrongly, and I’ll get your advice on that.

But when we have an option, like we’ve got a gold, we can either cement it or we can bond it. Is there any advantages? Because now young dentists are comfortable with bonding. We’re doing our lithium disilicate, we’re enjoying our rubber dam. In those scenarios, could the bonding give us additional benefits?

[Lane]
If I reflect on my first use of the word legacy. Because we use such crummy cement, you know zinc oxyphosphate is 10 times weaker under compression and shear than our resin based cements today. So our cements are far superior.

And the thing is, is that our preparations for Gold were designed with intent to have resistance features, right? So, you try on a lot of these indirect restorations in Gold. Sometimes you couldn’t even take them off without cement.

So we’ve probably modified our preps a little bit. I know I’ve modified my bonded preparations to take advantage of some of these resistance features like I do like potholes and isthmuses, and I think we’ve had a conversation about that in the past.

But MDP is a very interesting product. It will bond metals and so I would not discount resistance and retention features. But yeah, we can bond gold and you know, Panavia is a wonderful cement. It gives us enough working time because I heard you while you were trying to get me up and live, asking about burnishing.

That was the beauty of zinc oxide phosphate cement. We could manage the setting time by what we call delayed mixing and using a cold cement slab. So we had plenty of time to work with our margins. Well, resin, glass, ionomers, panavia all give us the same amount of working time, so we have much better products that can be utilized in the way that you mentioned.

So we can bond metal, absolutely. 

[Jaz]
I think you’re saying all the, for me, what I was expecting to hear is that the word space, when you’re tight in space and you’re cramped for space, those small clinical crowns, that’s exactly when I’ve been turning to good old metal again, not gold for cost reasons.

We’ll come to that, but I find the, sometimes, if I can’t put my slots and grooves in, or if I just have a doubt that okay, perhaps I wasn’t able to deliver as much retention and resistance form option to bond is quite attractive using MDP using Panavia. So I’m glad you’re not against it for any reason.

I don’t know I worry about it going against the initial intentions of how Gold was classically used and I was thinking, “Hmm, is this like a forbidden cheat code that we shouldn’t be using?” 

[Lane]
Not at all. So again, every question in our discussion begets another observation. The reason that we can’t get away with subtractive milled restorations on short preps is that we can’t mill it fine enough to get in there.

The simplest thing and one of the beauties of our modern cements are their film thickness is so thin because the thicker the film once our cement film thickness goes past about 50 microns, the retention of a crown, the sheer force strength, the sheer strength of the cement drops off the table.

So subtractive milling unfortunately won’t get into all that fine detail on grooves and boxes and potholes. So again, this is where lost wax or milling differently. This is kind of an interesting thought, and I didn’t think I’d mention this, but we know from studies and a very good one was done by Russell out of one of my residents the San Antonio Grad Pros program looked at cast Gold restorations and milled Gold restorations for marginal fit.

And it turned out that untouched, the milled Gold restorations fit better than the wax invested in cast Gold restorations. But when you cleaned up the inside of a cast restoration, it fit better than a milled one. But the mills were pretty darn close internally as well as marginally. 

And so one of the cost savings we can look at is not only using lower percentage gold, or even non precious based metals, that they can be milled and the cost goes down because there’s less labor, there’s no loss of material. Technology and legacy are slowly coming together. They really are. 

[Jaz]
Well said. And so this brings us very nicely to, I did a live webinar recently where I just talked about how I treated this particular scenario of a second molar small clinical crown that was cracked. And as I have been opting for a base metal, I’ve been opting for a cobalt chrome milled.

And I was told by a mentor many years ago that this is what he believes in. Because the price of Gold is getting extortionate. And well, he’s been getting good results and we know that cobalt chrome is kind to opposing metal and feel free to lay in to give me a slap on the wrist. And tell me that Jaz, perhaps you shouldn’t be doing this for whatever reason.

I’m happy to change my ways, especially if you tell me to. What do you think? Because when I lasted a Gold restoration, my lab bill was approximately 400 pounds, and so that’s a lot. And it’s probably, I don’t know double that now based on gold, based on the pure gold weight, right?

So that’s a lot. So these cobalt chrome onlays, which fit really well. I’ve been happy with them. How my lab are making it, it was about 160 pounds. So what do you think about this choice I have made? Should I stop? 

[Lane]
No, not at all. At $3,300 an ounce, that was Gold spot price this morning. US dollars, it hit 35 what, last week? So it is, unless you are willing to charge your clients the gold difference, and they’re willing to pay it, then it’s really kind of off the table. Now we can drop down, and still be in the precious metal world, I mean, we can have noble metals, less gold, more platinum, and more palladium, but you’re still faced with the same costs.

There’s nothing wrong with non precious at all. I mean, I think it’s great as a metal. It sucks as a metal to support ceramics, unfortunately, with non precious for those of you who don’t know, we bond, we have to create an oxide layer on our metal. For the ceramics to bond to.

And if you look at ceramic failures on PFMs and you see metal, it’s typically a non precious metal. And what happens is the oxide layer just continues to grow over time until it gets so thick that it breaks off. But as a metal itself, as for an onlay partial veneer gold, or got partial veneer crown, it is a wonderful material.

The only downside to it is that we can’t burnish the margins as well as you could with high noble Gold. But you know, our ability to capture tooth detail, iOS or PVS and machine, you really don’t have to touch your margins. If you’ve captured a good impression, digitally. Or with conventional analogue impression material.

[Jaz]
That’s extremely reassuring. Now, Lane burnishing with the base metal option, like the cobalt chrome that I’ve been using. Firstly reassuring that if we do all our impression work scanning and we get good quality data, we can get good margins that don’t need to be touched. But with Gold, the whole burnishing, firstly, what actually is it and was it always necessary or was it when you felt as though, I’m going to do it here because I want to improve the margin that wasn’t good enough.

[Lane]
You really wanna hear the answer to this? But there are over 280 something ways that the crown won’t fit. It’s quite fascinating. And the burnishing came around from the concept of the MU angle, which is a bevel on a shoulder. And the logic is that as crown horizontally seated, if you had a bevel angle, it would seat.

Faster than the horizontal component. Well, that’s fine in physics, but nobody took into consideration loot cement between the tooth and the crown. So you actually ended up with a restoration because we were prepping bevels, because that’s what we were taught. 

Depending on how old you are as a dentist, as the crown seeded, it didn’t really fully seed on the bevel, so you had to burnish it to make it fit.

And burnishing simply is taking advantage of the physical properties of Gold and manipulating it and pulling it from the Gold onto the tooth. And so it was an ends to a means because we did not understand all the interactions and our choices. And the other problem, again, with zinc oxyphosphate cement, even the most careful mixing, its film thickness is very unpredictable.

There’s no measurement. You just feel, and so it’s temperature. So our castings didn’t always fully see, so we needed an out. And that’s where using higher percentages of Gold, this is where type 3 was typically used for onlays, type two for inlays because it’s softer.

So we can manipulate the Gold. And it worked well, but you also had to understand what you were doing. And just like when you teach us how to finish our composites, we spin composite onto tooth. Well we have to make sure we do the same thing with Gold. We would take [inaudible] sand paper discs, course medium to fine and we would rotate it from the gold onto the tooth.

So we’re pulling, burnishing and making up for all the little errors that went along the way. Remember, I referred back to Johnson that the cast restorations required work to fit as well as a milled restoration. 

[Jaz]
I’ll tell you something really embarrassing. When I was a baby dentist, I must have placed my first or second gold restoration and like one of the few in my career.

And I’d heard, oh, you can burnish the margins. I had no idea what this meant. So I asked my nurse for a burnisher a ball burnisher and I just rob because I thought, okay, maybe this is what they mean, right? And there we are. So it didn’t mean that at all. I didn’t see a difference. I was like, what the hell is this? What’s all this fuss about? But obvious the actual, you’re dragging. 

[Lane]
You’re just dragging the Gold. And you know what? This where the first marginal fit, clinically acceptable margins came from. It came from Christensen. And if you don’t remember the study, Gordon just prepped a bunch of MOD onlays on by cuspids, fabricated restoration cemented them.

He finished anything on, we’ll call it the occlusal bevel. So anything near the occlusal, he finished the proximal bevels, but he didn’t touch the gingival bevels and made sure his evaluators couldn’t see the gingival bevels. So, the most evaluators noted that a margin at the gingival where they couldn’t feel it was clinically acceptable at about, 50 microns plus or minus the standard deviation.

But the beauty is that when they looked at the occlusal margins, the ones they could finish, the acceptability was about two microns. 

[Jaz]
Wow. 

[Lane]
When you can finish, get at it, you can finish it, it is evident. And that was, again, the beauty of gold is it adapts to occlusal changes.

It’s soft enough that you can pull it and adapt it, you know, to the tooth. So it was again, an ends to a means. But now that we’ve eliminated a lot of these uncertainties, by milling. You have to remember what we were doing back then. You know, what were our impression materials?

PBS was nowhere to be seen. Additional silicones were nowhere to be seen. What were we using? Hydrocolloid, you know, polysulfide. These are terribly inaccurate materials. 

[Jaz]
Fine. So I could see the necessity and why you would do that with the better scanning and pressing techniques. I can see how that equation’s completely different and in our favor.

Which is great. So bevels are out. Does that mean that if anyone’s replacing preparing for their first or very few Gold restorations that we get to do that we should be opting for shoulder chamfer? 

[Lane]
Well, for partial coverage where you’re capping a cusp, you could follow what you do for ceramics, just a longer bevel, it could just be a shoulder, it could be a butt joint.

Again, ’cause we, we don’t need to finish. Let me back up a step further. So, so the best closing margin angles when there is cement looting agent present, doesn’t matter what the looting agent is, is an exit angle of a either 35 to 45 degrees, which is just like a light shafer or 90 degrees, which would be a butt joint at the occlusal.

So both of those, if you keep in mind, exit angles or angle that the restoration meets the tooth, if you have one of those two criteria, 35 to 45 degree bevel or just a butt joint, 90 degrees, those are gonna seat very well–

[Jaz]
In terms of angle. Okay. So is the angle of the finished margin, is it, regardless of the material? The ideal 30 to 40 and also the butt joint?

[Lane]
For my preparations actually are pretty similar, both gold and ceramic at this point. So, yeah, I would say that this is gonna be tough. Okay. Without pissing anyone off. Okay I don’t understand a lot of what we see in Biomimetic dentistry. To me, the design of their preparations and their margins are wonderful in the compression dome concept.

This is gonna work. Their designs, their margin exits are perfect for maximum compressive strength to the tooth. The problem is, the off axis loads and understand all indirect restorations fail to buckle lingual off axis loads. So this is where I prefer a little bit of a coming over a cusp tip, a little bit of a shoulder or a shafer versus just that kind of butt joint.

So think of it in terms of resistance to coming off. We know that retention is this way, the path of draw resistance is if you put a groove in the prep or you have shoulders, right? It’s preventing off axis loads and puts your cement slightly under compression, under those off axis loads.

So when it comes to capping a cusp, I think this is what the question is. Do you put prefer a bevel or do I prefer a Shafer around it? It depends. Both will work. One, you may pick, because you don’t want to drop interproximally and get longer axial walls and say a groove or a box, right? Versus, I’m gonna keep this whole thing high water, so maybe I’ll put a little pothole in and a little circumference or shoulder.

Again, up at the occlusal third of the tooth.

[Jaz]
With the slots and grooves that you might place. I found in the past when I was a bit overzealous with them and I was going for, at this stage again non precious metal, but I found that. Sometimes my seating wasn’t good, there was rocking, I’d have to use a clued spray and then figure out where to adjust to get it to fully seed. 

It was a real ball lake. And then now when I keep it simple with just one sort of a groove, things fit more predictably. They still have a good retention resistance form. Is this a scanning PVS error, manufacture error, all compounding when they got too many intricacies?

[Lane]
I think it’s both. We have to find that sweet spot that works in our hands, but more importantly works with the lab that we’re using to work with. So, you know, how many of, how many of us actually ask for the proposal of a single unit crowd? Have you done that? 

[Jaz]
So a proposal, like for example, like an exocad design, would that count as a proposal?

[Lane]
I’ve talked about the internal: The milling proposal. The actual milling. 

[Jaz]
No, not at all. 

[Lane]
You’ll do that and you’ll be kind of surprised at where you need to change your preparations. You know, we think we round over things enough, you know, we think they’re smooth enough. But then you have to remember, a milling machine can only mill to the diameter of the smallest milling bur.

And so if it’s too tight or a little too sharp, the only choice the milling unit can do is over mill, which typically if it’s in the wrong place, can actually lead to a little rocking on your restoration. It’s not an internal high spot, it’s just there’s more slop.

I suggest everyone do that with their laboratories, ask for the milling proposal. And so you can get, see the cutaway of where it is has to over mill. You’ll actually be quite surprised and based on that, you might change your preparation design to be simpler as you evolved to Jaz.

[Jaz]
I mean, I did that for my Zirconias and when I went to Marco’s coast course in Sicily and he showed us all these issues with milling and the bur and how you have to keep in certain dimensions, otherwise you have these cement gaps and yeah, cost as is just point mentioned about Sicily as well, but I didn’t actually draw two and two together for gold and it makes perfect sense.

If we’re going for milling for gold or or non-pressure metal, similar complications can arise. So that’s a very good point. The next question I had was. Again, a stupid one and shows my inexperience in this is inlays, let’s say a gold inlay, right? 

Would the entire restoration be gold or would it be that you’d build up a very generous core and then prep back so you that you are using the least amount of gold possible and therefore saving the lab fee and therefore you don’t have a heavy bit of gold?

[Lane]
Foundation fillings all day every day to, to minimize Gold content. And it’s a very interesting, I heard you mumbling about Richard Tucker. Tucker Gold Foil Study Clubs and Tucker Cast Gold Study Clubs still exist around the world. They’re not as popular as they once were, but they still do.

And I used to like look at Dick and go, either your patients don’t brux, or Yeah, you’re just the luckiest guy on the face of the earth. because he would always, base up an inlay, the pulpal floor. And he put a pothole indirect with more retention into the foundation filling.

And what’s the point of that? Well, he understood buildups much better than a young lane did. And so yeah, you could do that. In fact, it’s so funny back in the days,

I remember when I, when I graduated from well, let’s see, I started dental school. You’ll love this story on the board, professor, first, professor, oral surgery on, on medical history. Writes the number 35 on the board, never mentions it again. 

Whole lecture goes by and at the end of the lecture, typical professor, are there any questions? And I go, yeah, what’s 35? Do we need to know that? Is it something important? He goes,” Oh that’s the spot price of gold per ounce. Right now, if I were you, I would take all your student loans and by every ounce of gold you can buy because I guarantee you it’s not gonna be 35 by the time you graduate.”

Fast forward to the time I graduated. Gold was 900. 

[Jaz]
Wait, it went from 35 to 900?

[Lane]
900 bucks an ounce. So we were still as students then we had to wax and cast, you know, we had to do all our own lab work and the school and ways to try to save money in the wax pattern room.

We would sit there, they would make us like, try to use a round burn and scrape out like the inside of the wax pattern to cast it to save gold. 

[Jaz]
So that we need to build a foundation, build a core to, to save one goal. It makes sense. And so that make, that makes total sense. 

[Lane]
But by the way, a number of older studies, they, they haven’t been replicated in a while, so I don’t really cite them very much. Showed that just in vivo studies, teeth prepared were foundation fillings replaced. They could be amalgam, they could be composite, they could be whatever, tended to leak less than castings fit to a preparation without foundation fillings. So again, I think it goes back to this whole milling internal accuracy.

If you have too many undulations that your poor casting has to fit on, it’s either gonna hang up on a high spot, a tight spot, right? So it, it does make sense. 

[Jaz]
And then what about minimal thickness? We talk about ceramic all the time. Minimal dimension. What about good old gold? Right? We’re, we’re in a tight spot, we’re in a second molar it’s a tight spot. And we’re thinking, are we gonna have enough space? How much is enough? 0.5, 0.71 millimeter. Oh God. How much do we want in the load bearing areas? 

[Lane]
Right. So this is the beauty of Nickel Chrome. Half a millimeter’s more than enough, right.

Obviously if you’re gonna use type two gold, half a millimeter is not enough. If you’re gonna use type three, depending on the parafunctional habits of the patient, you’re probably okay. But they will wear through it. And so you go to type four, which is, you know, the hardest. Yellow metal we, yellow gold we have.

But yeah, with the materials you’re using and Jaz, half a millimeter’s fine, we can expect good. 

[Jaz]
So with the ones with the non precious metal, I’m using half a mil, which is great. But then when, when those who are using gold, you said, just remind us again for the younger colleagues, type one is the highest gold content, the softest not used very much type 1, type 2 is more for inlays. Type 3 for gold and frameworks. Sorry for Onlays and Frameworks, is that right? 

[Lane]
Yes. 

[Jaz]
Talent and frameworks. 

[Lane]
Yeah. That’s a good, that’s a good, kind application and type four is the hardest noble gold. And so, when you don’t have a lot of room, half a millimeter, it would be well indicated.

[Jaz]
Okay. That’s great. And then when we are temporizing, so if it’s half a mil occlusal and then buccal lingual is no 0.3, no 0.5, whatever it might be thin, where if you ever try doing as, I have a bis-acryl, it’s gonna be like onion skin thin and it’s not gonna work. So what techniques do we need to employ to provisionalize for gold?

[Lane]
When typically, and we’re going to the short tooth, limited occlusal distance, I cement it with Duralon and water. That’s just my go-to. I just accept the fact that I’d rather, let me back up. So the beauty of most foundation fillings, it usually involves some immediate dent and ceiling, which usually means that you have less sensitivity at delivery.

So for most gold, if you have a retentive enough prep and you can use something like, reinforced ZOE, like B&T or IRM, you don’t even have to numb a patient to deliver the restoration. When we get to the shorter teeth where we need to use Duralon and water, it’ll retain the provisional quite well.

Oh, and by the way, I also Arab braid quick, lightly a braid, the intaglio of my provisional when I’m worried about it coming off. But then you have to numb the patient to typically ultrasound off. Most patients would rather get numb again. 

I’d rather numb them schedule an extra 15 minutes, even for mandibular block than get that phone call at 10 o’clock in the evening or on the week and say like, provisional came out, and by the way, we’ll bring it in with you. I bid on it, so.

[Jaz]
I’m confused there. So the provisional itself is like Duralon, like actually just molded on, or is it just like it —

[Lane]
Yeah. With Bis-Acryl. 

[Jaz]
Okay. But don’t you find that bis-acryl was like, too thin, too weak to see through with those thin dimensions for gold? I have not had a problem with that.

[Lane]
If you’re really, really that concerned. You know, ’cause I think there’s a, there’s a second question in here is that bisci, krills by nature are very brittle. And so that’s, we worry about breaking them, but they’re only brittle when they move. And so that’s why you need a pretty strong looting agent, temporary looting agent, because what happens, what they lift it just ever so slightly, then they bite down on it and it pops off, or the, it cracks.

So the workaround, I, I don’t fond, I may, I can count the times I had to do this on one. Two, three, maybe four fingers is to use PEMA, you know, like SNAP or, or a PMMA, like Jet. But that’s so much extra work and typically not necessary. So 

[Jaz]
Great. No, that’s reassuring. because that’s physical is what we all have so we can use it and just to use Poly F, Duralon, something like that makes total sense. Couple of questions from the audience. I’m gonna then revert back to some of my questions I had is, any thoughts on gold vertiPreps? Gold Verti preps. 

[Lane]
Well, where do you think  Verti preps came from? The vertical prep is nothing more than the feather margin, which was the go-to standard for gold, again, for a number of reasons.

Cost, right. And, again, we didn’t quite figure out how to work out all the issues of fit and finish. You understand that at the end of the day, you want what we feel clinically is a sealed margin. We wanna look at a radiograph and hope it looks pretty. So the beauty of a VertiPrep crown, be it gold or zirconia, which is radio opaque, is, it always looks like it fits beautifully.

And so, that’s really where the whole VertiPrep is just a rebirth of the feather margin. And by the way, the bat burs are nothing more than gingival rotary curettage diamonds that were created. All we had for impression material was hydrocolloid, which has horrible tear strike.

So we would trough the tissue, the gingival, away from the margins to create enough horizontal space for the hydrocolloid to capture the margin, not tear when we remove the impression material. So VertiPrep, the baters, it’s just one big complete circle. You know, what was– 

[Jaz]
Wow. 

[Lane]
Once is now new.

[Jaz]
Yeah, I love that. I didn’t know. I can visualize now how it creates a space, but some people may just put cord for longer or may use a laser. That’s how you are pretty much using it to create the space. 

[Lane]
Right, and again, we didn’t have lasers in the fact that we, all we had was ElectroSurge good old fashioned ElectroSurge.

And man, let me tell you, patients aren’t happy when they smell a barbecue and they realize it’s coming out of their mouth. 

[Jaz]
I always warn my patients before I use my thermo cut on high speed, no water. And I say it’s gonna smell like a barbecue. And no patients have taken offense just yet.

But Julieta asked, would you still use, I know you have good, good opinions on Nick from what I’ve read before, immediate dentine ceiling for gold restorations. Because I know you talk about delayed dentine ceiling, immediate dentine ceiling. So what do you advise for gold restorations? Does the material choice have a factor to play here?

[Lane]
I don’t think it matters quite honestly. Again, the nice thing about the immediate dead ceiling is no postop sensitivity, right? And probably the need many times you don’t need to anesthetize at delivery. But if you’re gonna hang your hat on biomimetic dentistry, and I’m gonna get in a whole bunch of trouble for this, they really do hang their hat on immediate dent and ceiling being superior to delayed dent and ceiling.

Well, I can assure you now there are two good systematic reviews and one RCT. An RCT Randomized Clinical Trial, right? No difference. After a few months, the immediate dent and ceiling is no better than delayed dentine ceiling. So I don’t think there’s anything wrong with it. I would do it because for patient comfort and predictability. Yeah. So absolutely go for it. 

[Jaz]
Great. Thank you so much. Harmit. Hello Harmit. You say the biggest headache she’s had recently is physical temp bonding to my immediate dentine ceiling. What would you place to prevent this glycerin? So, yeah, that’s something, once you’ve set it all up to place a glycerin and cure through it, you lose the oil, the oxide inhibited layer and, and that’s all fine personally. 

I don’t know about you Lane, but I don’t have this issue. I just allow the patient’s saliva to do that separating medium for me. I don’t tend to have that issue for many years now. But anything further you can advise on that. 

[Lane]
No, I’m the same. I just use saliva. May, may I ask though? You know, I think it’s also bis-acryl specific. I know I get sent things to evaluate constantly and I noticed a couple products. I can’t mention their names because I don’t remember their names. I had trouble with saliva. It would adhere to my immediate dent and ceiling, but I have no trouble using luxatemp so I don’t know what you’re using Jaz but yes, 

[Jaz]
We’re using pro temp. It’s been fine. I haven’t had that issue. I’ve had it, I’ve had it before, years and years ago. I just make sure I don’t dry the tooth. I let the saliva be there and I’m able to remove my provisional and that’s not been an issue. So maybe try that Hermit, if you, maybe if you’re drying before you placing your physical, that could be then encouraging that to happen.

But of course you can glycerin cure like many of us do. April, I’m gonna come to your question again higher, but April ask when he talks about Duralon plus water and not Duralon plus the sticky mixing liquid, it comes with, is that what you meant? 

[Lane]
No, good question. So basically like one to one to one, like one scoop of powder, one drop of Duralon, the poly acrylic acid and one drop of water.

So you’re just adding some water to the polyacrylic acid to dilute it, which also thins it. You’re not going, oh, yeah, it’s perfectly adjusted cement, you know, you push it down. What, how’s that feel? I can’t feel my teeth touching because it was too thick. And then you go through and adjust, and if you’re point half, if you’re half a millimeter thick, you’re gonna cut through it and piss yourself off.

So, , it does help to add the, a drop of water to the polyacrylic acid so that it thins it. And so your rest, your provisional seats better. Yeah. Great. Great question. I’m sorry, I was not. 

[Jaz]
Good question. April. Well done. Excellent. Do you still use a silicon putty index for your temporary stents?

[Lane]
Well, yeah. I, I use the, I basically use the non hydrophilic modified PVS I use Silginat by Kattenbach. For provisionals, I just use the cheapest PVS fastest I can find, I use a plastic triple tray because I don’t care if it destroys a little bit. So, you know, keep your costs down on that part, you know?

You could really keep out and just use alginate, but God forbid your patient breaks or loses a provisional, then all the money you saved, you lose in time having to freeform one. So , just the DVS. 

[Jaz]
The same. And I’m glad you mentioned about the plastic triple tray because that’s exactly what I do for temps. I know Richard Coates messaged me earlier today. He said he watched my crack tooth walkthrough video, and he was like, oh, that’s a good idea. So I probably learned it from you. So we talk about indications for gold. When you are stuck for space, that’s small clinical crown, there’s still a, a place for gold, fantastic self-healing material.

More 0.5 millimeters. All you need really anymore is a bonus, but don’t give too much, build a foundation so that you’re not having too much of it. You explain what burnishing is and why it was historically needed, but nowadays, if we do a good job, good capture of the margin, but we may not need that skill anymore.

But it’s a fantastic ability for gold that we had. You talked about cement choice. You know, we talked about bonding panavia, we didn’t talk about it, but I guess any GIC based cement. Any of these modern cements will do. Considering in your mouth there’s 45-year-old gold crowns that were, were cemented with not the best stuff.

The oxy, as you said. Any anything lab consideration? You talked fantastically about milling actually, and how we need to be mindful of that and the parameters. Any other, the lab considerations nowadays for the labs who are, so they’ve invested so much in going into zirconias and, the whole, even the modelless future that we’re, we’re facing, if you like.

Anything to bear in mind either picking the right technician or anything to advise the lab? I just check that they’re doing this. 

[Lane]
Yeah, I think it is just opening, having a conversation with them. You know, it’s what the parameters that we’re now looking at labs is internal milk, internal spacing. Don’t give me too much. I do need enough for looting. And, this dialogue goes across the board, not only short teeth, right? Shorter teeth. We don’t want as much. For what I would call film thickness for cement. because that’s an analog. But we don’t want as much spacing as we would for a longer prep, right.

Where the cement has to be pushed out through. And again, when we talk about full coverage now on a normal tooth, this is where I love some of the things that are coming out from the VertiPrep crowd is where do they excessively dye space, they dye space on the axial walls closer to the margins, right?

Because again, as the cement goes down, right, if it can’t escape, it’s just gonna put lateral pressure at this. Lateral pressure may set up what we call missed fractures in zirconia. So the work around that is just give, make sure you have more room there because it doesn’t affect the marginal fit at all. It just allows the looting agent to get out of the way. You know, the labs don’t understand our our parameters and honestly, we do a horrible job of collaborating with our labs. We just assume they know everything and they don’t, and they don’t see delivery of things.

So this is where, we need to educate them about everything from the occlusion we want, that we desire. The internal spacing of our restorations and you know, how fine, areas that we want mill. And I would tell you that it’s hard to find labs at mill metal. And so, you may not want to use your regular lab for that.

You may wanna go to a milling, specific laboratory because it is different. I would emphasize we could get away, with zirconia because it’s so soft with maybe a three axis milling machine. But when it comes to metal, man, you better have a five axis machine, go on.

[Jaz]
I’m pretty sure the labs I use, I mean I use for the recent cobalt chrome stuff, I’ve been using a Precision Dental studio for those in the UK in Reading, as I do for so many so much of my work. And I think they all outsource it to like a spec specialized milling facility in Germany or something. Most likely.

So that’s how it usually works. Peter asked about the cost and we, we said earlier that, you know, the cost is a major factor. It’s so expensive. But a great point that Lane made earlier is that, look, if your patient is really bought in and then they’re happy to pay for your time, plus the goal, then why not?

Right? Yeah, for my patients, I’m like convincing them that, look, can I please choose a material that’s not as pretty, but because this is the best, because of the space considerations and they don’t wanna pay so much, and therefore the cobalt chrome works brilliantly for them. But if someone specifically is like, oh, you know what?

I’ve had great success with gold. I understand. I’ve been educated by my previous dentist, that gold is the best. Then just make sure you don’t price it so low that you are, you’re not actually making your hourly rate. You gotta make it hourly rate plus the material. And sometimes you gotta find out, okay, what is the price of gold at the moment?

Speak to your technician and quote your patient. Would you agree? 

[Lane]
It’s like a vacationing at a five star resort, there’s gonna be plus, plus plus costs, right? It’s, and they’re built in, but they’re there. Or if you prefer it, it’s just all a card pricing.

I actually show them the lab bill here, here’s the invoice, here’s the goal. And they know beforehand they’re gonna pay my fee plus the gold, so they know they’re shown exactly what the gold price is. Now, I do hide the total fee, by the way, because some, some, sometimes there’s this disconnect between, how much profit we should be making patients.

I remember when I graduated from school, what was it, a multiple of five. You should be, making five to, like, whoa, today that, that gets a little more difficult. You know, they just, again, patients appreciate the option, they appreciate the honesty that you’re showing them, but don’t. Don’t take off all your clothes. 

[Jaz]
Don’t chip out. I just remember this question I had earlier that I blanked out on, but I, it’s such a relevant question for me. because I often wonder, Hmm, should I intervene or not? Is I’m sure guys, we all have patients who have that lower molar gold crown, which is just now got like a two to three millimeter perforation and we can see the, the core material, but everything looks so nicely sealed. Should we—

[Lane]
Open it? Continue to monitor it, 

[Jaz]
Open it, right? So open it. So perforation means, okay, we need to now intervene, right? 

[Lane]
Yeah. You know, patients that love exploratory surgery, look, you know, the integrity of the restoration has been compromised by design. It your teeth wear out by the gold wore out, you know, this restoration may be perfectly fine, but it could be like mold, you know, in, in the walls of your house. It could be growing underneath it. 

[Jaz]
I love analogy. 

[Lane]
Right. Every ’cause everyone hates you understand, if you’ve got mold in your house and remediation is a big deal, then we could do a little exploratory procedure. I can make a a little bit bigger hole in there and look around and if it looks fine, I’ll cut back to some thicker gold and we’ll put a nice filling in it.

Yeah we can go ahead and continue monitoring it. If we find that the decay is working its way underneath this, then I’ll stop and we’ll talk about what to do next. And so–

[Jaz]
Okay, that’s perfect. So the intervention is basically an investigation. And if you go in and it looks clean, just rebuild it at composite back to the same level again. And if not, then now and then you can plan the new extra criminal restoration.

[Lane]
You know what, who doesn’t appreciate attempts, right? It’s just human nature. Like, I trust doctor because he just doesn’t say I need it redone. He’s gonna verify, right? It’s the old trust but verify routine.

And these little things are huge practice builders because the next time, even if you repaired it right, and some of you will, in the same breath, tell people, you know what? You should probably get another three, maybe five years out of this before we have to replace it. It goes by like that three to five years comes around and they wear another hole. And now you can say, well, now it’s time. And they go, yep. Okay. Let’s do it. 

[Jaz]
It’s a great step. And also then you gain that extra data about what the situation is, is the mold situation or not. Again, I love that analogy. I hope everyone enjoyed that as much as I did. Okay. Some questions now as we are wrapping up.

Final couple of minutes. Okay. Hello, Vassi-Anna Bent. She ask, my clinic uses temp on that. I always think it’s too thick. Do you think I can do the same technique of adding a drop of water prior to mixing previously lane? We’ve used Vaseline? Is that acceptable? 

[Lane]
Yeah. Temp-Bond, if you add water to Temp-Bond, that’s what causes it descent. So don’t do that. Vaseline, yes, it’ll thin it, but remember Vaseline is a plasticizer, so it keeps the temp on from getting hard. So if the prep isn’t very retentive, you don’t wanna thin it with Vaseline because it will come off. But if it’s fairly retentive, then straight temp bond is fine. You know, the trick is to get to, dry the tooth, get it on quickly, and press firmly, and then have them bite on it.

And I tell people to bite. It’s like, so. So many things, right? Taking a double bite PVS impression, the workhorse of of indirect restorations. You know, I need you to find your bite on the not numb side, or I’ll do a savior behind bite. And you know, you’re gonna need to keep your teeth together for five minutes.

And when I say together, on a scale of one to 10, if one is completely open and 10 is as hard as you can clench, I want about a five. I just want moderate pressure. So when they’re biting on their provisional, I tell them I want a 6 or 7 And they go, oh. And you can see them bite a little firmer. So–

[Jaz]
I like that visual scale, if you like. It’s very, very, very good. Yeah. One technique I use for sometimes if your biral is a bit thin. This was taught to me by Sophie Lane who was taught by Attiq Rahman, who I’m sure you use this technique as well, is when you have a thin bis-acryl and you are worried about a cracking on the pressure of the cement is to just poke a little hole in it, an escape hole.

So I think that’s what I was thinking, like, if you’re having a feeling, like a stick put a little escape hole, maybe politely lingually and then that’ll give it a nice escape and hopefully less likely to fracture. Yeah. Anything you wanna add to that lane? 

[Lane]
No venting is perfect, right? And again a little, just a little drop of flowable composite, zip hit it with the light and you’re fine and dandy. You don’t even really even need to smooth it most of the time, in fact. you know, when it comes to really short, short teeth, if there, if it’s an onlay you know, I’ll not only tack, a little bit a drop of a flowable on the margin of the buckle and lingual, I’ll lock it in underneath in approximately two, .

[Jaz]
Okay, great. Last questions. I saw research from Henry Kaye. I saw research suggesting that gold lasts 40 to 46 years. Would that reflect the body of the research? Hence, it would be okay to suggest that gold may be better value for money than a ceramic. I like this. 

[Lane]
Well, okay, so here’s the problem. When you’re looking at articles, the literature, you’re talking about all cohort, articles, right? So, Terry Donovan, the classic one is Terry Donovan looked at Dick Tucker’s nations, thousands of gold restorations, 40, 45 years and of course. Well, Dick Tucker did them. So attention to detail. A crappy fitting, indirect restoration is gonna have crappy longevity, period.

It doesn’t matter if it’s submitted with panavia or zinc, oxyphosphate. So the truth of the matter is a well executed. A partial veneer, gold crown or even a gold crown will have a much longer run clinically in the mouth than anything else that we have today, meaning all ceramics because we just don’t have the longevity studies behind them.

Again, lithium disilicate in its current form is pretty damn nice, but it took decor Empress two. Aris, which lasted a year before we got to emax. Same material, same company. It took four evolutions before we got there. And so again, we’re still talking 15 years, right? We’re not talking multiple generations.

So there are people that are gonna go for longevity versus pretty. And I don’t wanna call it a marketing pitch to utilize metal in people’s mouths. It’s just a reality. Well, Mrs. Smith, what is your desire? Longevity, or pretty, you know, you’re say 45 years old possibly. If we make it pretty, you’re gonna have to have it redone once or twice in your lifetime.

That’s just the odds. You’re 45 years old. You know, if we use metal and we’re conservative, you know, this restoration can last you the rest of your life. Okay. And just patients then pull their values into it. Right. It’s the patient’s why it’s not our why, you know? We’re, we’re just the providers of the how we do it.

You know? We know what we do. Mm-hmm. We fix teeth, you know, it’s, how we do it is based on. The patients why? And this is why as you talk about Jaz understanding patients gaining their trust, don’t be in a rush to do a bunch of c when you first meet them. This is where trust and value are established.

And so your words and your dialogues are actually being listened to versus just going in one ear and out the other. And that’s critical for all of us, no matter where you are in your career, because you always want to have the patient who is part of the decision process. You’ve heard my dear friend and my brother from another mother, Michael Melkers.

I mean, he loves to quote Albert Schweitzer. Every patient carries within them their own best doctor. It’s our job to help them find that doctor. 

[Jaz]
Lovely. And Henry, just to add you, you mentioned, you know, better value for money. It was a paper I saw on the BDJ. It was maybe, gosh 10 years ago now.

I saw it come through in the post and it was like, it had exactly that parameter, like, you know, gold this many years, therefore divided by the actual cost, whatever. And then, yeah, it came out the best in that regard compared to the data that we have for ceramics. And that’s exactly what Lane echoed and Julieta says, thank you.

She always loved gold and now she knows why. Amazing. I love that. I guess last two questions guys. And then we will say a good thank you to Lane A higher asked, in what clinical scenarios might a THREEQUARTER or Seven Eighth Gold Crown offer a superior solution to full coverage? And what are the technical risks of these designs?

I like this question. 

[Lane]
Well, again, at the whole concept of partial veneer is to save as much tooth structure as possible while, while protecting the cusps that are undermined, that you need to restore. So, properly done. There’s no need to do full coverage, right? Why? Why do you wanna do full coverage?

You wanna cover from, let’s go from the top down. Alright, let’s do, why would we pick an onlay over a, a direct composite restoration Well, the cusps are unsupported. They’re gonna fracture. Then if there’s more of the tooth broken down, say the palatal cusp of an upper molar. Well, you know, now you’re going to circumscribe that, and that can be done with a three quarter crown, seven eighths crown may be necessary because, okay, now the buccal cusp of the tooth is broken. So we come around that we still have to cover the cusp. It’s just how much coverage do we need to integrate everything?

There is a philosophy, this is my philosophy, so again, quote me versus date me. I would rather not for the reasons that Biomimetic talks about drop margins, past the gingival third of the tooth, not because of the more fringes and and strength, it’s just I don’t like margins, in non cleansable areas you know, it’s always still, I mean, how many patients do we see that still get, you know, caries on the roots, the buccal roots of their molars?

So, that’s just me. But there’s really, in terms of longevity, a well-designed three quarter, seven eighths partial veneer crown is going to last every bit as long as a full coverage. And the reason we’ve gone back to partial veneer coverage and why I do like bio medic is that the more tooth we preserve means, the more we have to work with down the line.

You know, there’s a point where a tooth can’t have any more work and we never wanna get there. 

[Jaz]
Well, whilst we argue about the, the merging data and how some of the data may be in vitro, and we need more in vivo to be able to substantiate some of the biometric claims. One thing Pascal Magne said in a recent podcast coming out tomorrow actually, guys on Protrusive, is he said, the meaning the real crux of biometric dentistry is if something fails, the tooth is still there to work with.

And that’s gotta be loved, right? So, so that’s great. Thanks for your wonderful questions. Absolutely brilliant. Last ones a crazy one. What about a gold crowns on implants? I know of a madman who wants gold on implants? Are the, are there any strong contraindications? None whatsoever. 

[Lane] Again, we started this whole conversation as gold’s weakness is its strength, right? Implants don’t have PDLs. Right? Think, about this. Can you, some of my biggest zirconia failures were all on Xs opposing all on X zirconia. They just broke and we’re talking well designed connectors. I mean, these, these things were thick, but yet they still broke. We sent them in for fractographic analysis.

And the failure mode was, was again, one, was a tool grinding mark that just never healed it. But the sheer fact is that we, you know, having a softer, forgiving, adaptable material on top of an ankylos tooth, which an implant is, I think is a great idea. It’s just getting patients to accept it. So do it. 

[Jaz]
If Eliana, if you’ve got a madman go with it. Use it as an experience to, to deliver something that’s gonna probably stand the test of time. And you know, as we know, implants are ankles, as Lane said, so it makes a lot of sense, so amazing. We actually managed to r through all the questions.

Lane wise, I love I just wanna show some appreciation. I love your just no BS way of just educating. Honestly, I just feel when you ask someone who’s a podcaster, and I don’t know maybe I’ve shown this publicly or not, but of any guest I’ve ever had. The history of Protrusive or maybe I ever will, you have been my favorite in the sense of easy to podcast because I ask something and you give a wonderful, coherent answer and then you stop and it’s like, wow, okay.

That was like, you just put it on a plate for us and like you are like, okay, next. And honestly, it’s just brilliance. Thank you for your education style. Thank you for your wisdom. Thank you for all your contributions to our little community over this one year so far as we’re a baby community growing and thanks for everything you do.

Everyone’s just pouring in with thank yous and it is just so nice to see. So Peter agrees with my sentiments there. And Miles, thanks so much for joining us to make things practical. Understandable. Amazing. Thank you so much, lane. Anything to add? Are you coming to, I know you hate flying. I doubt you’re coming to Europe anytime soon. 

[Lane]
No, but there, there’s these two guys that are speaking in Chicago, Midwinter at the AES next year that I think I will fly to see So. 

[Jaz]
Oh my God, that’d be amazing. 

[Lane]
For those of you who don’t know, for those of you don’t know, the American Equilibration Society is one of the premier restorative academies in America.

It is a huge honor to be asked to present in front of this group. Mahmoud is online to speak at our 2006 meeting. So, you know, my hat’s off to you, from mentee to mentor. This journey is wonderful. Thank you for everything you do. The torch, honestly, my friend as, as a mentor, is a and an educator is being passed to you and I cannot think of a better person. So, keep doing what you’re doing, man. 

[Jaz]
I love it. So thank you so much. I mean, me and Mahmoud we talk about this the next year, February, and we get this major imposter syndrome because it’s such a amazing crowd and all these educators. And thankfully they gave us the paracetamol slot on the second day, first thing in the morning.

But, it’s great. We’re hung over grumpy then. Perfect. Honestly, it’s so, I mean, what a what a what a lineup, right? We’ve got Jeff Rouse, Dania Tamimi, Łukasz Lassmann. So guys, I would love for as many people as possible in this chat here to come and join us in Chicago next year.

You know, hot dogs on Michael. Michael’s gonna buy us all hot dogs. It’d be great. Oh, hot’s coming to a lovely, amazing place, so already what I love here is Vassi says, I can’t wait to re-watch this amazing presentation. And of course, for those in the future listening to Spotify and stuff, I hope you enjoy it as well. Lane, thank you so much from all of us. 

[Lane]
Thank you. It’s been a pleasure and an honor as usual. And hey, feel free to reach out anytime. If you know, I’ll leave one of my father’s favorite quotes about me. You know, most of you got to hear the real, heart Puller commentary in London.

But my dad was always fond of describing me as well. He may not be able to dazzle you with his brilliance, but he’ll baffle you with his 

Jaz’s Outro:
Well, I like that. I like that very much. And it just wraps things beautifully with the, none of what you say is ever my friend. I love it. It is amazing.

Guys, thank you so much for this rare live podcast lane. Thanks again for making time for it, and I’ll see you in the group and see you next year in Chicago. That was good. Bravo. Thank you. Alright. Thank you so much. Well, there we have it guys. Thank you so much for listening all the way to the end.

If you’re watching on the iOS Android app or the web app, scroll down 80% in the quiz, if you dare, and you’ll get your certificate sent over to you. We are a PACE approved education provider. If you’re not yet a member, head over to protrusive.co.uk/ultimate. We’ve recently added splint course on there as well.

So if you’re looking to learn occlusal appliances, you can check that all there. So if you’re looking to learn occlusal appliances and management of bruto and protecting that delicate restorative dentistry that you do, that’s now part. Of the Ultimate Education Plan. 

I also wanna take another moment to thank my team, especially some new members that we have got Dr. Xyra who joined us about three or four months ago, and she’s responsible for really improving our premium notes. 

Also, some of our infographics that we make, she’s spearheading that and honestly, we’re able to add so much more value thanks to Xyra Also, a shout out to Angel, who’s the newest member. She’s really helping a lot with getting these initial edits of the podcast before they enter an even media sequence, as well as a lot of the video work behind the scenes, including editing the 21 day photography challenge coming next month.

And lastly, our new manager, Alex. Alex, has been messaging some of you on cursive guidance. Alex, you’ve been an absolute breath of fresh air. We are so lucky at Protrusive to have you. Thank you for looking after the protrusive so well, and being part of the team. I’m just so excited about how we’re going to grow our mission.

To make dentistry tangible, prorate, watch this space. Honestly, it’s a very exciting time here at Protrusive and I wanna thank you all for being part of it. Thanks for listening. Again, I’ll catch you same time. Same place next week. Bye for now.