Gold fillings

09-12 - GOLD FILLINGS - CAVITY PREP

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NOTE - 09-01-13 - Filling in cavity on lower right second molar #31 Distal - ON HOLD - Reason is the tooth is abscessed all around and very very wobbly and wants to pop out of my mouth. The nerve is still alive. Cleaning out furcation. Main issue is dead cementum. Hope Hirschfield files work. But not optimistic. Once tooth is perfectly clean then bone should grow back and tooth will become less wobbly. Then can fill in cavity. In meantime am keeping hole clean, periodically mineralizing it and disinfecting with iodine.

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NOTE - 10-12-13 - RE Use of silver foil to maintain an anti-bacterial environment around area of root caries or resorption near apex of questionable or hopeless tooth

#31 Mesial also has a very very sensitive area in the front of the tooth. Right around where the remnants of the periodontal membrane would meet the nerve. What I think may be going on is root caries or resorption. So a hole is eating through the tooth to get to the nerve. This would spell the destruction of the tooth. So I cleaned it out as best as I could with a toothpick and some brushes. Also squirted in some DuoDerm. Idea is if the are can be properly debrided and the bacterial infection can be stopped then the root caries or resorption will end. Also is the issue of whether the dead leftover periodontal membrane is the only thing protecting the nerve from the infection.

Reading up... it looks like surviving teeth with this particular problem often have dead periodontal membrane acting as a protective layer over the nerve. In essence the periodontal membrane fossilizes in place to protect the nerve. And somehow the rest of the area is rid of the ongoing bacterial infection. Have a few ideas. One is gold leaf. But the stuff I have, in ribbon form, is probably too fragile and will disintegrate. The other possibility is silver foil. Which also has issues. Plan is going to be to insert a small piece of silver into the area.

In addition are flouride, plus remineralization. Which I am doing right now. Became highly aware of the issue only a few days ago, so I cleaned it out fairly aggressively and waiting for it to calm down. Additionally I also want to approach the area from the buccal side, but I may have done a good job there already. Also want to clean it out with some EDTA and then mineralize it. Basically doing a whole bunch of stuff.

Also part of the issue of the silver is it could discolor the area or cause other problems, largely with colorization. Likewise could treat area with colloidial silver, which have.

Bottom line is believe that if the area can be largely debrided and made anti-bacterial and get cleaned of protein then remineralized then there is a good chance that whatever is there protecting the nerve will fossilize and turn into a semi-permanent repair.

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SUMMARY - This stuff is largely just speculation on how to fill the cavity with gold. Pretty much already figured it out. Bought a gold annealer from eBay. Plan is to use Jensen Dental Gold. Plus use a professional tooth dam. Still issue of whether to use dental dam frame. Also to use wooden splints as backstops for the gold. Then to cut the gold foil into pieces. Anneal them. Then place them in position. Then pound them in. Still have to figure out the hammer.

The basic principles of using the gold are fairly simple. Gold will cold weld if it is perfectly pure and without impurities. Which you rid with the gold annealer. Meanwhile the cavity has to be properly prepared. Typically with chisels. Which I have. Then pound in the gold. Then finish it off.

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DESCRIPTION - Cavity is on distal side of tooth #31. There is a filling over almost all of the center biting surface of the tooth. Was not overly exited about opening up cavity. Had even imagined minimalist debridement. This would have been a big mistake. Opening up cavity to its proximal edge to the wisdom tooth. Gave up dumb idea of filling in the bottom with bone-minerals and decided to go for pure gold. Now main issue is how to get the gold into the hole.

WHY??? - I have a valid reason. A very valid reason. Indeed - AND WHAT PRAY TELL IS YOUR "VALID REASON"? - My valid reason is that standard dental therapy would include drilling out my prior filling - YES INDEED - I CHECKED - So what that means is that to just fill up the hole with gold is - UNCONVENTIONAL so YOU ARE SOL - Meaning that to get what I want I have no choice but to DIY - OK?

CONTINUED DEBRIDEMENT - GET RID OF THE STALKS! NOTHING STALKY! NOTHING STINKY! NO CRUD - ZERO CRUD - CLEAN & POLISHED WITH TOOTHPICK - I MEAN CLEAN - LIKE FOR REAL - NOT PRETEND

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PLAN - FILL UP THAT THAR HOLE WITH GOLD - THAT IS THE PLAN

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Explorer - Did initial debridement with explorer. It's like scraping a nail against the inside of a shot glass with a closed top. Meaning it works. But the progress is slow.

20 guage irrigation needle - Use 5ml vet syringe to flood with water. Have largely not troubled myself with strange concoctions as not worth the trouble. Because I am too lazy.
Sugarman 14-15 dental file. Round. Per

CORRECT CHOICE - Jensen Gold Foil - 10 cm x 10 cm - seems large - have to fold over.

WRONG CHOICES - Why so stupid? - Because gold leaf will disintegrate just by looking at it wrong or thinking bad thought. Gold foil is the only choice. And dental gold is the only logical gold foil to use. Spend the $300 to get the quantity. Sell it back to the jeweler or keep it for later.

1/4" strip of gold foil. 75' long - WRONG! - Why? Main reason was figured there would be less worry about air bubbles trapped in the gold. But want to make a layer of barrier gold. Almost like a plastic bag of gold inside the cavity. So considering purchasing a 1/2" as additional. Or even fatter. Plan is to roll gold onto shirt pins. Then insert using the pin. Then to tamp down with the same pin to fill the gold with holes so the air can leak out.

1/2" strip of gold? - WRONG! - Thinking YES - I committed to my strategy. Now I should just - LIVE MY STRATEGY - Consider 3/4" - Just in case your original 1/4" decision was dumb? Do not know. My choices are either 1/2" or 3/4" - I am more inclined to go for 1/2" - since no matter what my decision will still work. Plus the 3/4" strategy seems more inclined to somebody who wants to hurry up. I am just the opposite. My preference is to go as slowly and as slowly as possible. And to focus my strategy on slowness as one of my primary objectives to achieve. Even higher than execution. Hence, thinner strips should make the job go slower. So I should want to do that.

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Wood blocks. Figure to make from balsa. Why? the balsa will compress. So will tend to slip into the teeth easier with less trauma. Also it will tend to mold to the groove in the teeth. Also any amount of compression is more than enough to condense the gold.

Dental dam. No great ideas. But figure can likely make a skirt from plastic and dental floss. Can imagine pinning the tooth inside so can take a break without too much trouble. Since may want to do everything in several sessions. Plan to being to have all day to do the project.

DENTAL DAM - WORKABLE IDEA - Use one of the Harp Dental Floss Contraptions - pull a piece of plastic in between the teeth. Make it big. THERE - THERE IS YOUR DENTAL DAM - OKAY?

BUTTERFLY DAM - LOOKS OBVIOUS - CONTOUR PLASTIC TO PURPOSE - Idea here is the dam between the teeth, including the WOOD JAM - is just large enough for the job. Meanwhile... the dam outside the tooth is also large enough for its job. But not unnecessarily large. HENCE CAN TAKE BREAKS - BE LAZY - TAKE ALL DAY TO FILL UP THE TOOTH WITH GOLD

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Issue of pellets vs cylinders. My general preference would be for cylinders.

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IMAGINATION EXERCISE - ERROR - FALSE VISION - THAT A HOLE ALMOST TO THE OUTSIDE OF THE TOOTH IS STILL WITHIN THE TOOTH - ANSWER IS NO - AREA HAS TO BE OPENED UP COMPLETELY OR REPAIR WILL BE FAULTY - Imagine not just forgetting about the cavity supposedly being within the limits of the tooth. Thought could clean out and stuff with gold. WRONG. Figure what will happen at the bottom or along the back wall is there will be incomplete filling in and a second cavity will form around the gold. Result is dead tooth.

BLAH BLAH BLAH - NONSENSE AND SPECULATION ABOUT HOW TO MAKE A GOLD HAMMER

- HAMMERS FOR POUNDING GOLD INTO TEETH - OOPS - I MEANT MALLET - ANY EASY SOURCES OF HAMMERS LESS THAT $20? THAT DON'T HAVE TOO MUCH VERTICAL? ANSWER = NO - TOUGH NOOGIES - Will likely make my own hammer with a rubber stopper and a doorknob spindle to add weight.

YES INDEED EXPENSIVE HAMMERS DO INDEED EXIST. - Here is a $130 hammer. Termed as a mallet to get more money.

Realistically figure a genuine mallet is necessary and forget-about trying to find the right one. The mallet should be concave. Imagine a bolt stuck on the end of a scrap dental tool. This is close to the reality. Just need to find something that has some mass that has a concave face. Bolts are convex. WRONG. What is convex? Without so much trouble? A recessed bolt? Perhaps. That might be reasonable?? NOT!! Turns out this is a toughie. With no easy post 19th C solutions. But the net is simple enough. To be able to hammer on something and miss the center and have the force transmit inward rather than outward.

SOLUTION TO CONCAVE HAMMER DILEMMA - WRONG!! - One solution would be to take a flat head hammer and roughen it up. Indeed could even imagine a fat nail head used as a hammer.

SOLUTION? TOUGH NUTS!! I can't think of any solutions that do not involve wood.

WHAT DO YOU FIGURE? I figure there is some common spare piece with an inside that looks like a slight bowl, that is almost flat. That is also amenable to having some weight. If lack this imagine a simple flat-head flat-heat screw where you can hollow out the inside and give it some mass without much perpendicular distance. Purpose is to hammer the gold into the teeth. And to have as much available force as you need. It's a little late to ask for more force once you get started.

WRONG VISION!! - IN SIMPLE FORM GO TO A FISHING STORE AND TRY TO FIND A LEAD WEIGHT THAT IS JUST THE RIGHT SHAPE AND THEN STICK IT ON THE END OF A CHOPSTICK. IF IT IS NOT PERFECT THEN MAN-HANDLE IT UNTIL IT IS PERFECT. AND DON'T POISON YOURSELF! OR ANYBODY ELSE!

ALTERNATE WRONG VISION!! - The hammer or mallet is really just a knob for a drawer that just happens to have the ideal flat or concave head shape. Yes, Yes I am very bullish. But just remember... you are trying to make a hammer that does not need much vertical passage and where it would be very bad if you slipped. You could even break the tooth! So... the hammer should be just right. And stop calling it a hammer will you? The proper term is MALLET !

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MALLETS - WE GOT THE MALLETS - WHAT IS THE PROBLEM? - SIR YOUR MALLETS ARE ALL TOO BIG - DO YOU HAVE ANYTHING THAT IS TRULY MINIATURE OR DIMINUTIVE? - NO -

- tough noogies - make your own hammer-mallet - okay? - Do whatever you have to do. Okay? But make it real. Flat or concave. Why mess with your gold? YOU ONLY GET ONE CHANCE TO GET IT RIGHT - ONLY ONE - WHY SCREW IT UP JUST TO BE CHEESY? CHEESY IS NOT GOOD. ESPECIALLY WHEN IT COMES TO GOLD - CHEESY IS BAD - DO THE RIGHT THING - PAY PAY PAY!

SUMMARY - Thoroughly think through all the truly stupid things you could do and don't do them. But do think about them and then figure out exactly why they are so wrong. What you will be left with is the singular vision of what is actually the right thing to do. But you never would have figured it out without working through all the dumb stuff first.

SUMMARY ON GOLD - Debride the debris - Apply the liquid calcium over months and months to get the fibroblasts to grow back right - Shape hole properly according to principles of gold - Get a gold annealer cooker (KustomKraft) - Figure out the lid (glass??) - Buy the gold - Cut the gold to shape - anneal the gold -WHAT ABOUT MY HAMMER? -OOPS! FORGOT SOMETHING - What about my dental dam? - What about my splints? - What about my bottled air? - What is this like cooking meth on Breaking Bad or something? YES IT IS! - Study the masters for a long time. Practice each step. Then maybe you can do it okay.