Dental Filling
What Exactly is
Dental Filling
To treat a cavity your dentist will remove the decayed portion of the tooth and then “fill” the area on the tooth where the decay was removed.
What Steps Are Involved in Filling a Tooth?
First, the dentist will use a local anesthetic to numb the area around the tooth to be filled. Next, a drill, air abrasion instrument, or laser will be used to remove the decayed area. The choice of instrument depends on the individual dentist’s comfort level, training, and investment in the particular piece of equipment as well as location and extent of the decay.
Next, your dentist will probe or test the area to determine if all the decay has been removed. Once the decay has been removed, the dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it.
Several additional steps are required for tooth-coloured fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-coloured material is applied in layers. Next, a special light that “cures” or hardens each layer is applied. When the multilayering process is completed, the dentist will shape the composite material to the desired result, trim off any excess material, and polish the final restoration.
What Types of Filling Materials Are Available?
Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, and materials called composite resin fillings. There is also a material that contains glass particles and is known as glass ionomer. This material is used in ways similar to the use of composite resin fillings.
Tooth-coloured Composites
Advantages of composites:
- Aesthetics — the shade/colour of the composite fillings can be closely matched to the colour of existing teeth. Composites are particularly well suited for use in front teeth or visible parts of teeth.
- Bonding to tooth structure — composite fillings micro-mechanically bond to tooth structure, providing further support.
- Versatility — in addition to using as a filling material for decay, composite fillings can also be used to repair chipped, broken, or worn teeth.
- Tooth-sparing preparation — sometimes less tooth structure needs to be removed compared with amalgam fillings when removing decay and preparing for the filling.
Disadvantages of composites:
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- Additional visits — if composites are used for inlays or onlays, more than one office visit may be required.
- Chipping — composite materials can chip off the tooth depending on location.
In addition to composite resin fillings, two other tooth-coloured fillings exist — ceramics and glass ionomer.
Other filling types:
- Ceramics. These filings are made most often of porcelain and are more resistant to staining than composite resin material. This material generally lasts more than 15 years and can cost as much as gold.
- Glass ionomer is made of acrylic and a specific type of glass material. This material is most commonly used for fillings below the gum line and for fillings in young children (drilling is still required). Glass ionomers release fluoride, which can help protect the tooth from further decay. However, this material is weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts five years or less with costs comparable to composite resin. The newest ones have an even better lifespan and, when placed in appropriate areas are equal to composites.
Temporary fillings:
Temporary fillings are used under the following circumstances:
- For fillings that require more than one appointment — for example, before placement of gold fillings and for certain filling procedures (called indirect fillings) that use composite materials
- Following a root canal
- To allow a tooth’s nerve to “settle down” if the pulp became irritated
- If emergency dental treatment is needed (such as to address a toothache)
Temporary fillings are just that; they are not meant to last. They usually fall out, fracture, or wear out within a month. Be sure to contact your dentist to have a temporary filling replaced with a permanent one. If you don’t, the tooth could become infected or you could have other complications.
Silver amalgams:
Advantages of silver fillings:
- Durability — silver fillings last at least 10 to 15 years and usually outlasts composite (tooth-colored) fillings.
- Strength — can withstand chewing forces
Disadvantages of silver fillings:
- Poor aesthetics — silver fillings don’t match the color of natural teeth.
- Destruction of more tooth structure — healthy parts of the tooth must often be removed to make a space large enough to hold the amalgam filling.
- Discoloration — amalgam fillings can create a grayish hue to the surrounding tooth structure.
- Cracks and fractures– although all teeth expand and contract in the presence of hot and cold liquids, which ultimately can cause the tooth to crack or fracture, amalgam material — in comparison with other filling materials — may experience a wider degree of expansion and contraction and lead to a higher incidence of cracks and fractures.
- Allergic reactions — a small percentage of people, approximately 1%, are allergic to the mercury present in amalgam restorations.
What Are Indirect Fillings?
Indirect fillings are similar to composite or tooth-colored fillings except they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.
During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental lab that will make the indirect filling. A temporary filling is placed to protect the tooth while the restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place.
There are two types of indirect fillings — inlays and onlays.
- Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
- Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.
Inlays and Onlays are more durable and last much longer than traditional fillings. They can be made of tooth-colored composite resin, porcelain, or gold. An onlay can be used to protect a weakened tooth because it can cover the top chewing surface and distribute the forces around the tooth like a crown.
Another type of inlay and onlay — direct inlays and onlays — follow similar processes and procedures as the indirect, but the direct is made in the mouth and can be placed in one visit. The type of inlay or onlay used depends on how much sound tooth structure remains and consideration of any cosmetic concerns.
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