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, Dr. Hanselman’s 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.
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 you in consultation with Dr. Hanselman. Before your treatment begins, Dr. Hanselman will discuss the options with you to make sure you understand the benefits of each option.
There are two types of dental restorations or fillings:
Direct fillings are fillings placed immediately into a prepared cavity in a single visit. They include dental amalgam and some resin composite fillings. Dr. Hanselman 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, Dr. Hanselman 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, we’ll cement the restoration into the prepared cavity and adjust it as needed.
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.
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 we prepare 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 Dr. Hanselman 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 to place it in the prepared tooth. It generally takes longer to place a composite filling than the time 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.
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.
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.
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.
Gold alloys contain gold, copper and other metals that result in a strong, effective filling, crown or 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 us 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.
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.
Constant pressure from chewing, grinding or clenching can cause dental fillings, or restorations, to wear away, chip or crack. Although you may not be able to tell that your filling is wearing down, we can identify weaknesses in your restorations during a regular check-up.
If the seal between the tooth enamel and the restoration breaks down, food particles and decay-causing bacteria can work their way under the restoration. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp and may cause an abscess.
If the restoration is large or the recurrent decay is extensive, there may not be enough tooth structure remaining to support a replacement filling. In these cases, Dr. Hanselman may need to replace the filling with a crown.
Yes. Dental amalgam has been used in tooth restorations worldwide for more than 100 years. Studies have failed to find any link between amalgam restorations and any medical disorder. Amalgam continues to be a safe restorative material for dental patients.
Only a very small number of people are allergic to one or more of the metals used in amalgam fillings. In these rare instances, the filling may trigger a localized reaction that produces symptoms similar to a skin allergy. Often patients who have this reaction to amalgam have a medical or family history of allergy to metals. Another dental filling material will be used instead of amalgam in these situations.
Yes! Composite resins are tooth-colored, plastic materials (made of glass and resin) that are used both as fillings and to repair defects in the teeth. Because they are tooth-colored, it is difficult to distinguish them from natural teeth. Composites are often used on the front teeth where a natural appearance is important. They can be used on the back teeth as well depending on the location and extent of the tooth decay.
© 2020 Mark R. Hanselman, D.D.S.