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Dental Fillings Overview:
Although Ifind myself placing composite fillings 99% of the time, but alwaysreview all of the options with patients before deciding on what typeof filling material will be placed in their tooth. As a dentist I do notendorse products of one company versus the other, but I find peace of mindusing products of reputable manufacturers. Dental fillings must survivein the extreme conditions of the mouth. The human mouth is a perfectenvironment to test any material to its limits. It is mostly neutralin pH (due to neutralizing effect of saliva), but depending on the foodcontent it can have rapid upward or downward spike in pH. The samething can happen with temperature swings of up 60 degrees Celsius (from icecold to coffee hot). Any type of filling material has toendure normal chewing forces and also abnormal para-functional grindingwhich can put up to 20 times more pressure on the teeth compared to normalchewing forces. This article aims to inform the prospective dentalpatient of their different options, because not all dental fillings are createdequal.
1.Amalgam Fillings: Composed mainly of Mercury, Silver, Tin, Copper andsometimes Aluminum alloys.
Advantages:Very durable; works in wet or dry environment when placed; releasesantibacterial silver ions that fight future cavities that may form around thefilling.
Disadvantages:Has mercury; does not match tooth color; most amalgams are not bonded to thetooth which may render back teeth in people who grind their teeth moresusceptible to tooth fracture; in general teeth with metal filling may becomemore sensitive to cold drinks.
2.Composite Fillings: Composed of inorganic fillers such as Silicon Dioxide,organic resins and photo initiators.
Advantages:Color match with the tooth; can be polished to a very high luster; is bonded tothe tooth vs. just sitting in it; the only type of filling that can be placedin very shallow cavities (does not require thickness for strength.
Disadvantages:Require dry field during placement; can absorb stains over time; more sensitivethan other types of filling to left over decay in the tooth.
3.Porcelain or Ceramic Fillings (Onlay): Composed mainly of inorganicminerals.
Advantages:Excellent color match to the tooth; lasting luster and does not staineasily; very durable but prone to fracture in people who grind or clenchtheir teeth; is bonded to the tooth; can be used on severely broken down teeth;excellent replication of the tooth anatomy since is made by a lab technician.
Disadvantages:Cost (more expensive that amalgam or composite fillings); requires twoappointments.
4.Gold Fillings (Onlay): Composed of gold alloys in different quantities of goldfrom 30% up to 90%.
Advantages:The most durable type of dental filling.
Disadvantages:Cost; no color match; takes two appointments.
5.Glass Ionomer Fillings: Composed mostly of inorganic fluoride releasingsalts, and organic matrix, may also contain photo initiators ans oxygeninhibitors.
Advantages:Can be placed on wet or dry environment; is white in color (butdoes not exactly match tooth shade); bonds to the teeth; releases fluoridehence has decay fighting properties.
Disadvantages: Not very durable; used mostly on baby teeth, not the best choice foradult teeth specially on the load bearing surfaces.
Inearly 2008 several European countries made the move to ban use of dentalamalgam in concern about safety of mercury vapors released during placement onthe filling. So far there has not been a strong evidence showing healthrisks associated with dental amalgam. US Food & Drug administration(FDA) and American Dental Association (ADA) endorse safety of the dentalamalgam.
Author:Syamack Ganjavian, DDS
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