DENTAL FILLINGS

 TOOTH FILLINGS/DENTAL FILLINGS:


When a patient has decay, the decayed part of the tooth is removed, and a dental filling is placed in its stead in order to build up the tooth and protect it from getting decay again.

Dental burs, which are used in the dental handpiece (more commonly referred to as the dental drill such as the ones shown below are used to remove tooth structure to access the cavities, and then to polish the fillings after placed. They are also used to prepare teeth for crowns and other prosthetics.


COMPOSITE/TOOTH COLORED DENTAL FILLINGS:

Dental composites are made of varying combinations of glass filler and acrylic resin materials that are either self curing/hardening, or light cured to make them hard. Unlike silver dental fillings that harden over time, composite fillings are as hard as they will get after they are cured properly. Therefore, it is ok to chew on them after you leave the office.

This is generally considered the standard of care, and many offices do not even use dental amalgam fillings anymore.

After the tooth is prepared using dental burs, the dentist uses some type of matrix band, which goes around the tooth and helps to form the filling. This prevents the dentist from bonding the teeth together and helps achieve the desired shape for the dental filling. The tooth is then etched with a type of acid, which helps the filling to bond to the tooth. Because this can contribute to sensitivity, many dentists do this in a combined step when they add the bonding agent, or glue, which helps bond the filling to the tooth.

Tooth colored fillings are the consistency of play doh, which allows the dentist to mold it and help form the filling, until it is light cured, which hardens the filling. This is the bright light that beeps and looks like a mini hair dryer.



CONTAMINATION:

It is very important that the tooth is isolated properly when tooth colored fillings are done. Amalgams can work out even with some salive present, but the composite fillings are very moisture sensitive and do not properly if any salive or undesired fluids contaminate the tooth when the filling is being placed.

The fillings also normally are placed in increments because the curing lights can only cure to a certain depth.

There are products such as Sonicfill which can be placed all at once, but most dentists still place composite fillings in increments.

GLASS IONOMERS are a type of dental composite tooth filling material which also releases fluoride. Fluoride has been shown to help prevent tooth decay , and is sometimes used as a liner underneath a final restoration or as a temporary filling.

Many people prefer to have tooth colored fillings done because of the fear of mercury and other metals in their mouths. Composites also look much more natural, and do bond to the teeth. The older materials were not too good, but the new materials have much better bond strengths and can last a long time.

Tooth colored fillings are currently accepted as the first choice of tooth filling materials.




DENTAL AMALGAM:

Dental amalgam is a mixture of mercury and silver alloy powder that forms a self hardening material. Amalgam used to be the first choice of tooth fillings for dentists, but due to its properties, it has been shown to expand over time, which increases fractures in teeth and is being phased out by dental composite tooth colored fillings. Whether or not your present amalgams need to be removed, is up to you and your dentist.

Yes, there is some mercury in the tooth filling material, but whether it is enough to cause health issues is subject to vast debate (which we will not get into here, since most of you are probably already convinced one way or the other).

MERCURY: There is mercury in those amalgam tooth fillings, but the amounts released are about 20 times below the levels associated with any sort of health issue in the most sensitive person.

On the other hand…

There have been issues with the disposal of the material, and the dental profession is constantly looking for safer ways to dispose of it.



HOW ARE DENTAL COMPOSITES HELD IN? Amalgams/Silver fillings do not bond to the teeth, so they are held in MECHANICALLY, meaning that the way the tooth is prepared is such that the filling gets locked into place.

Composites/Tooth Colored Dental Fillings BOND to the teeth, but the dentist can prepare the tooth in ways to help hold the filling in as well.

CROWNS are cemented into place, but are prepared in ways to help them stay in independent of the cement.

Some of the following dental fillings are also CEMENTED in.

INLAYS: Inlays are an alternative to dental composites, and are similar to dental fillings, except that they are a SOLID unit, done INDIRECTLY in the lab, and are cemented into the tooth,. This is in contrast to a conventional tooth colored filling, which is placed DIRECTLY into the tooth in increments.

There are two main types, (once again)

GOLD and PORCELAIN.

GOLD: Gold inlays are not done very often these days because of the esthetic concern, but if they are done well, may last indefinitely, and do look spectacular. Because the inlay gold if of HIGH QUALITY, it is SOFT, and often times can be burnished to the tooth to be UNDETECTABLE to the touch!!

PORCELAIN: Porcelain inlays look nicer, but just like in CROWNS , they do tend to fracture more, and are harder than natural tooth. On the other hand, porcelain will not adapt to the tooth nearly as well as gold will.

ONLAYS: These are an extension of inlays except that they cover part of the biting surface of the tooth. Sort of between an inlay and a crown, these are also cemented into the mouth.


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