Chinese pair Sui Wenjing and Han Cong needed a personal-best score by nearly five points to avoid a silver medal for a third straight year.
Sui and Han beat Germans Aliona Savchenko and Bruno Massot by 1.76 points at the world championships in Helsinki on Thursday.
They tallied the highest short-program and free-skate scores, including 150.83 in the free Thursday, despite Sui falling on a triple Salchow. Their previous best free skate was 144.28 points.
Russians Yevgenia Tarasova and Vladimir Morozov earned bronze as the top three after the short program stayed that way after the free skate.
Canadians Meagan Duhamel and Eric Radford, who had been seeking the first pairs three-peat in 39 years, finished seventh.
Americans Alexa Scimeca Knierim and Christopher Knierim finished 10th in their second competition this season after she came back from three abdominal surgeries last summer and fall.
“I am not as confident as I was before I got sick, but I think that’s 100 percent normal when you’re off the ice for so long and you have to re-learn things and start from the bottom,” Scimeca Knierim said. “I’ve only been back at my elite level for a month or two, so I think it’s OK that my confidence is a little shaken. I’m confident that my confidence will grow.”
U.S. champions Haven Denney and Brandon Frazier were 20th in the short program, failing to qualify for the free skate.
Based on those results, the U.S. earned one entry for pairs at the PyeongChang Winter Games, according to NBC Sports research in Helsinki. The only time that fewer than two U.S. pairs competed at the Winter Olympics was at the first Winter Games in Chamonix, France, in 1924.
Just about every star pairs team dealt with serious injury problems this season.
Sui and Han missed the autumn season due to Sui’s right ankle and left foot surgeries last spring, after they squandered the 2016 World Championships short program lead.
They returned at the Four Continents Championships in February and posted then-personal-best free skate and total scores, ranking only behind Tarasova and Morozov for the season.
Savchenko, who earned her 10th career worlds medal, and Massot won both of their fall Grand Prix events but missed the Grand Prix Final after she tore an ankle ligament.
Tarasova needed 10 stitches in her left leg after slicing it on Morozov’s skate in a Wednesday practice accident, hours before the short program. Their bronze medal meant Russia avoided a three-year world pairs medal drought. Soviet and Russian pairs have never missed the worlds podium three straight years since their run of dominance started in the 1960s.
Russians Ksenia Stolbova and Fedor Klimov, the only Sochi medalists competing together at worlds, missed the fall season due to Stolbova’s left leg injury. They finished fifth on Thursday.
Duhamel and Radford suffered more recent injuries. Duhamel said after the free skate she may have a stress fracture in her left foot, according to the Associated Press. Radford suffered a hip injury in the week before worlds that led to thoughts of withdrawing.
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Gold: Sui Wenjing/Han Cong (CHN) — 232.06
Silver: Aliona Savchenko/Bruno Massot (GER) — 230.30
Bronze: Yevgenia Tarasova/Vladimir Morozov (RUS) — 219.03
10. Alexa Scimeca Knierim/Christopher Knierim (USA) — 202.37
20. Haven Denney/Brandon Frazier (USA) — 56.23