Fillings
A dental filling, also known as a dental restoration, is a treatment aimed at restoring the function and shape of missing tooth structure resulting from decay or trauma. It is utilized to prevent the spread of tooth decay or correct any cosmetic damage, representing just one of the ways our dentists preserve your oral health. Before placement, any infected part of the tooth must be drilled out. There are two main types of fillings: amalgam (commonly known as silver fillings) and composite resin, which can be customized in color to match your natural teeth.
Restoring a tooth to the normal form and function involves usually done in two steps:
Preparing the tooth for placement of restorative material.
Placement of these materials.
The preparation process typically involves using a rotary dental headpiece and dental burs to cut the tooth, creating space for the planned restorative materials and removing any dental decay or structurally unsound portions of the tooth. If a permanent restoration cannot be immediately placed after tooth preparation, a temporary restoration may be performed.
Once the tooth is prepared, it is ready for the placement of restorative materials, which may include dental composite or glass ionomer cement.
Several factors determine the type and extent of tooth preparation for restoration, with decay being the most crucial consideration. The extent of decay largely defines the extent of the preparation and, consequently, guides the choice of method and appropriate materials for restoration.
Amalgam
Composed of silver, copper, mercury, and tin, amalgam fillings are the most durable and cost-effective option for our patients. They can last up to ten years and are less prone to falling out or breaking. Often utilized for filling molar cavities, amalgam fillings can withstand biting pressure and can be completed in a single visit. Despite containing mercury, these silver fillings are considered safe for individuals aged six and older.
Composite Resin
Due to its customizable color, composite resin filling is the most aesthetically pleasing option available. It's ideal for repairing chipped or cracked teeth, filling tooth gaps, correcting dental discoloration, protecting exposed tooth roots from gum recession, and altering tooth shape. Patients often select composite resin for cavity fillings because they are bonded to the teeth in layers, requiring less removal of natural tooth during the process.
Comparison Pros/Cons and Cost:
Composites and amalgam are primarily utilized for direct restoration purposes. Composites can be color-matched to the tooth and the surface can be polished once the filling procedure is completed.
Amalgam fillings can expand with age, potentially leading to tooth cracking and necessitating repair and replacement of the filling. However, the likelihood of filling leakage is reduced.
Composite fillings may shrink with age, potentially causing them to pull away from the tooth and allowing for leakage. If this leakage goes unnoticed, it can lead to recurrent decay.
A 2003 study revealed that fillings have a finite lifespan, averaging 12.8 years for amalgam and 7.8 years for composite resins. Fillings may fail due to changes in the filling material, the tooth, or the bond between them. Additionally, the formation of secondary cavities can compromise the structural integrity of the original filling. Fillings are typically recommended for small to medium-sized restorations.
Inlays and onlays serve as more costly indirect restoration alternatives to direct fillings. While they are intended to be more durable, long-term studies have not consistently shown a significantly lower failure rate for ceramic or composite inlays compared to direct composite fillings.
Porcelain, cobalt-chrome, and gold are commonly used materials for indirect restorations such as crowns and partial coverage crowns (onlays). However, traditional porcelains can be brittle and may not always be recommended for restorations. Additionally, some hard porcelains can cause excessive wear on opposing teeth.