Gold Tooth Restorations: Pros, Cons, and Costs

Choosing a gold restoration is often a decision based on long-term value and oral health rather than visual appeal.

1. Unmatched Longevity

Gold is arguably the most durable material in restorative dentistry. Research published in Clinical Oral Investigations indicates that gold restorations have significantly higher survival rates over a 10-year period compared to indirect resin composites [2]. While a typical porcelain crown might last 5 to 15 years, a well-placed gold crown can last 20 to 40 years, and in many cases, a lifetime [3].

2. Conservation of Tooth Structure

Unlike porcelain or zirconia, which require significant “reduction” (shaving down) of the natural tooth to ensure the material doesn’t crack, gold is extremely strong even in thin layers. This allows your dentist to preserve more of your natural tooth structure during the preparation phase [3].

3. Wear-Friendliness (Bruxism)

For patients who suffer from bruxism (teeth grinding), gold is the ideal material. Materials like zirconia are so hard they can wear down the opposing natural teeth like sandpaper. Gold, however, has a wear rate similar to natural tooth enamel, meaning it won’t damage the teeth it bites against [3].

Despite its clinical superiority, gold is not the right choice for every patient or every tooth.

• Aesthetics: The most obvious disadvantage is the color. Most patients prefer tooth-colored options for any teeth visible when speaking or smiling.
• Conductivity: Because gold is a metal, it conducts heat and cold more efficiently than composite or ceramic. Some patients report temporary sensitivity to hot and cold foods immediately after placement [1].
• Procedure Time: High-quality gold inlays and onlays usually require two appointments. The first involves taking an impression, and the second involves cementing the lab-fabricated piece [4].

Gold is consistently among the most expensive restorative options due to the fluctuating market price of precious metals. Unlike silver amalgam or composite fillings, which are “direct” restorations placed in one visit, gold is an “indirect” restoration made in a lab.

Data sourced from Dental Treatment Guide and The American Dental Association.

While the upfront cost is higher, the “cost per year” is often lower. For example, a $1,500 gold crown that lasts 30 years costs $50/year, whereas a $1,000 porcelain crown that needs replacement after 10 years ends up costing $100/year over the same period.

For those looking for a balance, Porcelain-Fused-to-Gold (PFG) crowns offer a gold base for a perfect fit and strength, with a porcelain layer on top for aesthetics [3]. This is often a preferred middle ground for premolars. If you are also considering other major procedures, such as orthodontic treatment, it is vital to discuss the timing of your gold restorations with your dentist, as crowns cannot be easily moved after placement.

• Longevity: Gold is the longest-lasting dental material, often performing well for 20+ years.
• Tooth Health: It requires the least amount of natural tooth removal and is the kindest material to your opposing teeth.
• Ideal Use: Best suited for back molars, especially for patients who grind their teeth.
• Cost Factor: Expect to pay between $1,000 and $1,500 per crown, though the long-term ROI is high compared to cheaper materials.

Action Plan

1. Check Your Bite: If you have signs of heavy wear or frequent crown fractures, ask your dentist specifically about a gold onlay or crown.
2. Evaluate Insurance: Confirm if your plan covers “High Noble Metal.” Some plans only cover base metal alloys, which can cause allergic reactions in some patients.
3. Prioritize Function Over Fashion: Use gold for the “second molars” (the very back teeth) where visibility is zero, but chewing forces are at their peak.

While the dental industry moves toward all-digital, ceramic-heavy workflows, the physical properties of gold alloys remain unsurpassed for heavy-duty tooth restoration.