Procedures |
Dental Filling Options
Overview
Thanks
to advances in modern dental materials and techniques,
dentists have more ways to create pleasing, natural-looking
smiles. Dental researchers are continuing their often
decades-long work developing materials, such as ceramics and
polymer compounds that look more like natural teeth. As a
result, dentists and patients today have several choices
when it comes to selecting materials to repair missing,
worn, damaged or decayed teeth.
These new
materials have not eliminated the usefulness of more
traditional dental materials, such as gold, base metal
alloys and dental amalgam. That’s because the strength and
durability of traditional dental materials continue to make
them useful for situations, such as fillings in the back
teeth where chewing forces are greatest.
Restoring Your Smile: Dental Filling Choices
- What's
Right for Me?
-
Types of Dental Restorations
- Amalgam
Fillings
-
Composite Fillings
- Ionomers
- Indirect
Restorative Den tal Materials
(Two or more visits)
-
All-Porcelain (Ceramic) Dental Materials
-
Porcelain-fused-to-Metal
- Gold
Alloys
- Base
Metal Alloys
- Indirect
Composites
What's
Right for Me?
Several factors influence the performance, durability,
longevity and cost of dental restorations. These factors
include: the patient's oral and general health, the
components used in the filling material; where and how the
filling is placed; the chewing load that the tooth will have
to bear; and the length and number of visits needed to
prepare and adjust the restored tooth.
With so many choices, how do you know what's right for you?
To help you better understand what's available, here are the
advantages and disadvantages of commonly used dental
restorations.
The ultimate decision about what to use is best determined
by the patient in consultation with the dentist. Before your
treatment begins, discuss the options with your dentist.
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Types of Dental Restorations
There are two types of dental restorations: direct and
indirect.
Direct restorations are fillings placed immediately into a
prepared cavity in a single visit. They include dental
amalgam, glass ionomers, resin ionomers and some resin
composite fillings. The dentist prepares the tooth, places
the filling and adjusts it during one appointment.
Indirect restorations
generally require two or more visits. They include inlays,
onlays, veneers, crowns and bridges fabricated with gold,
base metal alloys, ceramics or composites. During the first
visit, the dentist prepares the tooth and makes an
impression of the area to be restored. The impression is
sent to a dental laboratory, which creates the dental
restoration. At the next appointment, the dentist cements
the restoration into the prepared cavity and adjusts it as
needed.
Amalgam Fillings
Used by dentists for more than a century, dental amalgam is
the most thoroughly researched and tested restorative
material among all those in use. It is durable, easy to use,
highly resistant to wear and relatively inexpensive in
comparison to other materials. For those reasons, it remains
a valued treatment option for dentists and their patients.
Dental amalgam is a stable alloy made by combining elemental
mercury, silver, tin, copper and possibly other metallic
elements. Although dental amalgam continues to be a safe,
commonly used restorative material, some concern has been
raised because of its mercury content. However, the mercury
in amalgam combines with other metals to render it stable
and safe for use in filling teeth.
While questions have arisen about the safety of dental
amalgam relating to its mercury content, the major U.S. and
international scientific and health bodies, including the
National Institutes of Health, the U.S. Public Health
Service, the Centers for Disease Control and Prevention, the
Food and Drug Administration and the World Health
Organization, among others have been satisfied that dental
amalgam is a safe, reliable and effective restorative
material.
Because amalgam fillings can withstand very high chewing
loads, they are particularly useful for restoring molars in
the back of the mouth where chewing load is greatest. They
are also useful in areas where a cavity preparation is
difficult to keep dry during the filling replacement, such
as in deep fillings below the gum line. Amalgam fillings,
like other filling materials, are considered
biocompatible—they are well tolerated by patients with only
rare occurrences of allergic response.
Disadvantages of amalgam include possible short-term
sensitivity to hot or cold after the filling is placed. The
silver-
colored filling is not as natural looking as one that is
tooth-colored, especially when the restoration is near the
front of the mouth, and shows when the patient laughs or
speaks. And to prepare the tooth, the dentist may need to
remove more tooth structure to accommodate an amalgam
filling than for other types of fillings.
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Composite Fillings
Composite
fillings are a mixture of glass or quartz filler in a resin
medium that produces a tooth-colored filling. They are
sometimes referred to as composites or filled resins.
Composite fillings provide good durability and resistance to
fracture in small-to-mid size restorations that need to
withstand moderate chewing pressure. Less tooth structure is
removed when the dentist prepares the tooth, and this may
result in a smaller filling than that of an amalgam.
Composites can also be "bonded" or adhesively held in a
cavity, often allowing the dentist to make a more
conservative repair to the tooth.
The cost is moderate and depends on the size of the filling
and the technique used by the dentist to place it in the
prepared tooth. It generally takes longer to place a
composite filling than what is required for an amalgam
filling. Composite fillings require a cavity that can be
kept clean and dry during filling and they are subject to
stain and discoloration over time.
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Ionomers
Glass
ionomers are translucent, tooth-colored materials made of a
mixture of acrylic acids and fine glass powders that are
used to fill cavities, particularly those on the root
surfaces of teeth. Glass ionomers can release a small amount
of fluoride that may be beneficial for patients who are at
high risk for decay. When the dentist prepares the tooth for
a glass ionomer, less tooth structure can be removed; this
may result in a smaller filling than that of an amalgam.
Glass ionomers are primarily used in areas not subject to
heavy chewing pressure. Because they have a low resistance
to fracture, glass ionomers are mostly used in small
non-load bearing fillings (those between the teeth) or on
the roots of teeth.
Resin ionomers also are made from glass filler with acrylic
acids and acrylic resin. They also are used for very small,
non-load bearing fillings (between the teeth), on the root
surfaces of teeth, and they have low to moderate resistance
to fracture.
Ionomers experience high wear when placed on chewing
surfaces. Both glass and resin ionomers mimic natural tooth
color but lack the natural translucency of enamel. Both
types are well tolerated by patients with only rare
occurrences of allergic response.
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Indirect Restorative Dental
Materials (Two or more visits)
Sometimes the best dental treatment for a tooth is to use a
restoration that is made in a laboratory from a mold. These
custom-made restorations, which require two or more visits,
can be a crown, an inlay or an onlay. A crown covers the
entire chewing surface and sides of the tooth. An inlay is
smaller and fits within the contours of the tooth.
An onlay is similar to an inlay, but it is larger and covers
some or all chewing surfaces of the tooth. The cost of
indirect restorations is generally higher due to the number
and length of visits required, and the additional cost of
having the restoration made in a dental laboratory.
Materials used to fabricate these restorations are porcelain
(ceramic), porcelain fused to a metal-supporting structure,
gold alloys and base metal alloys.
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All-Porcelain (Ceramic) Dental
Materials
All-porcelain
(ceramic) dental materials include porcelain, ceramic or
glasslike fillings and crowns. They are used as inlays,
onlays, crowns and aesthetic veneers. A veneer is a very
thin shell of porcelain that can replace or cover part of
the enamel of the tooth. All-porcelain (ceramic)
restorations are particularly desirable because their color
and translucency mimic natural tooth enamel.
All-porcelain restorations require a minimum of two visits
and possibly more. The restorations are prone to fracture
when placed under tension or on impact. The strength of this
type of restoration depends on an adequate thickness of
porcelain and the ability to be bonded to the underlying
tooth. They are highly resistant to wear but the porcelain
can quickly wear opposing teeth if the porcelain surface
becomes rough.
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Porcelain-fused-to-Metal
Another type of restoration is porcelain-fused-to-metal,
which provides strength to a crown or bridge. These
restorations are very strong and durable.
The combination of porcelain bonded to a supporting
structure of metal creates a stronger restoration than
porcelain used alone. More of the existing tooth must be
removed to accommodate the restoration. Although they are
highly resistant to wear, porcelain restorations can wear
opposing natural teeth if the porcelain becomes rough. There
may be some initial discomfort to hot and cold. While
porcelain-fused-to-metal restorations are highly
biocompatible, some patients may show an allergic
sensitivity to some types of metals used in the restoration.
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Gold Alloys
Gold alloys contain gold, copper and other metals that
result in a strong, effective filling, crown or a bridge.
They are primarily used for inlays, onlays, crowns and fixed
bridges. They are highly resistant to corrosion and
tarnishing.
Gold alloys exhibit high strength and toughness that resists
fracture and wear. This allows the dentist to remove the
least amount of healthy tooth structure when preparing the
tooth for the restoration. Gold alloys are also gentle to
opposing teeth and are well tolerated by patients. However,
their metal colors do not look like natural teeth.
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Base Metal Alloys
Base metal alloys are non-noble metals with a silver
appearance. They are used in crowns, fixed bridges and
partial dentures. They can be resistant to corrosion and
tarnishing. They also have high strength and toughness and
are very resistant to fracture and wear.
Some patients may show allergic sensitivity to base metals
and there may be some initial discomfort from hot and cold.
However, due to their metal color, gold alloys do not look
like natural teeth.
Return to Restoring Your Smile
Indirect Composites
Crowns, inlays and onlays can be made in the laboratory from
dental composites. These materials are similar to those used
in direct fillings and are tooth colored. One advantage to
indirect composites is that they do not excessively wear
opposing teeth. Their strength and durability is not as high
as porcelain or metal restorations and they are more prone
to wear and discoloration.
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Information provided by the ADA, American
Dental Association,
www.ada.org
