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.
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
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.
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.
You may wish to read a good article called
"Fillings Get Smaller…and Smaller" you can find it at:
http://www.san-diego-dentist.us/san-diego-fllings-getting-smaller.htm
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