I very much enjoyed Gordon Christensens May JADA observations, "Considering Tooth-Colored Inlays and Onlays Versus Crowns" (
JADA 2008;139[5]:617–620[Free Full Text]
).
Ever since my postgraduate education at the University of Oregon Dental School in the late 1960s, I have delivered hundreds of shoulder-bevel gold onlays to my patients. They are the restoration of choice for compromised molars. Most are still in use after 30 to 40 years.
With the advent of pressed ceramics, I have been changing to these materials for pre-molars and some first molars. However, I believe gold onlays should always be used on the most posterior molars to counter the "nutcracker" effect. If the patient is resistant, my usual reply is, "You must be a wealthy person, as there is a much greater risk of fracture!"
Perhaps as pressed ceramics get better and better we can dispense with gold completely. We have not reached that position yet.