Fillings

Fillings: More Choices than Ever Before

Space age materials – New Composites & Reinforced Silver Amalgams – cover all of your needs.

Different Types of Tooth Colored Fillings

Tooth Colored Fillings are of several different types, each especially designed for the different applications needed, e.g., Children’s fillings, Adult Fillings, Front teeth, Back teeth, Rampant Decay, Posts, Cores, Implants, Orthodontics, etc..

Regular Adult Composite Fillings do not bond as well to children’s teeth due to the “Brillo pad” pattern of childhood enamel rods. Special bonding layers that release Fluoride to the tooth to prevent further decay are often used in Children’s fillings.

Composite Bonded Fillings take more time to place than Silver Amalgam Fillings due to the multiple layers that are applied. Composite Bonded Fillings require better patient cooperation since any moisture can contaminate the bond and the area must be kept dry for an extended period of time – much longer than the time and dryness needed for Silver Amalgam Filling placement.

Best Practices for Dental Fillings

For an Adult with lots of Gumline Decay, we would use something similar to the children’s tooth colored, Fluoride releasing base to reduce the chances of recurrent decay in those areas.

For most Adult Tooth Colored Fillings, we use 3-5 layers of various Composites with a Fluoride releasing base on the inside. These are the strongest combinations for long term reliability while maintaining the natural color and translucency of your teeth. Amazingly beautiful results can be achieved in one visit with the new Composite Materials.

While amazing results are possible visually, Composite Fillings that replace supporting tooth structure, or significant tooth structure, are not as strong as Full Coverage Crowns. Crowns are the best solution when significant tooth structure has been lost, such as in deep decay or Root Canal Treated teeth.

In some cases, when a strong enamel bond is possible to the Composite Filling, there is some resistance to fracture of the remaining tooth structure in a heavily damaged tooth. However, in the long term one cannot depend upon bonding alone as the sole means of strength and retention. You must have a reasonable amount of sturdy tooth structure to support the filling. Composite cannot bond to thin air and is no stronger than the part of the tooth to which it is bonded.

Silver Amalgam Fillings

No other filling material has the decades long, proven safety, reliability and predictability of Silver Amalgam Fillings. New alloys develop an early high strength to reduce chances for breaking, and they can be later polished to a chrome-like finish.

Silver Amalgam Fillings are:

  • Fast to place. For this reason, they are helpful in restoring skittish children’s back teeth. They do not require the many layers like Composite and are more forgiving should moisture or saliva contaminate the prepared decay area.
  • Generally much less expensive than Bonded Composite Fillings.
  • More likely to be cold sensitive after placement due to the large amount of metal.

Fillings vs. Crowns

When large decay results in a tooth with a filling over 1/3 the width, or undercutting the supporting enamel, a Full Coverage Crown is the best long term treatment. The same is true for teeth with cracks or fracture lines. For certain, when a tooth cusp is broken or missing, a Full Coverage Crown is indicated as the most reliable, long term restoration.

While we can certainly put oversize fillings into or “onto” a cratered out or cracked tooth, the resulting weak enamel edges are fragile and likely to fracture in a short time. Enamel is crystalline with a grain to it. Much like a diamond, if you hit it at the right angle, pieces just fall off, unless it is backed up by strong, underlying tooth structure (Dentin).

A “Filling” generally refers to one substance inserted INSIDE another substance, i.e., the “Filling” is surrounded by the thing it fills. For example “Cream Filled” Cupcakes have the white cream filling completely surrounded by the chocolate cake. Just as it is unstable to just put the cream on top of a flat spot, it is unstable to just set a filling material on top of a shelled out tooth. We can put it there, but it just won’t stay.

If half of your tooth is gone, putting a filling “in” it is more like putting a filling “on” it.  It is like putting something on a stair step – there is nothing to hold it in place on 3 or so sides. When you go to load it, or step on it, it can just fall off the step.

Silver Amalgam Fillings do not attach to your tooth. The only significant thing holding them in place is having strong, thick Dentin and Enamel surrounding the Filling with undercuts placed to keep the Silver Filling from falling out.

Composite Fillings, Tooth-Colored Fillings, do bond to Dentin weakly and Enamel strongly. However, the bonds can weaken over time, and are not strong enough, even in the beginning, to support biting pressures from the bond strength alone. You must have some reasonably thick, sturdy Dentin and Enamel to support even the Composite Fillings.

Full Crowns completely surround your remaining tooth structure, giving you the greatest amount of support and protection over time of any restoration. If your tooth has a Fracture Line, or Partial Crack, or Green Stick Fracture, a Full Crown can help to stop or reduce movement in the fault line.

IT IS MUCH BETTER TO RESTORE A TOOTH WITH A BIG FILLING THAN TO REMOVE IT

We have all experienced periods when time, family and other obligations make it impossible for us to have a crown done right away. Just understand the temporary nature of the large filling and start saving up for a Full Crown.

Build Ups, Pulp Caps, and Posts

Build Ups or Core Build Ups refer to a filling placed in the prepared tooth stub before the Crown is seated. This is usually done to protect the nerve, bolster remaining dentin, and/or to fill in undercuts which would require too much trimming for the crown to slide on and off clearly.

If your decay is into or near the nerve chamber, a Pulp Cap may be placed. A Direct Pulp Cap is a medicated covering over a hole directly into the nerve chamber. An Indirect Pulp Cap is a medicated covering over a hole very near the nerve chamber, but not all the way into it.

Teeth that have had deep decay or cracks near the nerve may eventually need Root Canal Treatment (Endodontic Treatment). Once a tooth has had a Pulp Cap, it has about a 50:50 chance of needing a root canal sometime in the future. In many cases, teeth with deep decay do not hurt you until they are sealed with a filling or crown. This can lead a patient to erroneously believe that the recent filling or crown caused the tooth to die.

A Post is like a build up for a Root Canal Treated tooth. A Post of metal, woven glass, ceramic or composite material is cemented down into the now empty Root Canal to strengthen the tooth stub where it has been hollowed out to clean the Root Canals and Pulp Chamber.

A Post may have a Full Crown placed over it, or, in some instances, a Post may need a Filling over it.  “Post” refers to reinforcing the inside of the Root Canal and Nerve Chamber, a “Filling” refers to restoring the outside surfaces and biting part of the tooth.

Call us at 316-943-2266 for a Free Consultation Visit about Your Unique Needs