Fillings
Fillings are so commonplace in the dental office that people tend to take them for granted. While it is true that there are seldom complications from this dental procedure, it is important to understand the different materials available for restorations and their benefits.
Air Abrasion Fillings
Sometimes the decay is totally within the enamel. Since bacteria are present these areas of decay must be removed. We use either LASER or Air Abrasion to remove just the decayed part of the tooth.
Types of Fillings
Composites
These are tooth colored fillings that are bonded in place. The filling material is composed of quartz ceramic particles in a matrix of liquid resin; the material is hardened, or cured by a special light. These fillings harden quickly (silver fillings take twenty-four hours to harden) and a patient can chew on them immediately after placement. We use composite materials for most fillings we place.
A tooth is prepared for a composite filling with either a drill or air abrasion technology. The tooth is then etched with a gentle acid (about the strength of lemon juice) to make it rough to accept a bond, and a bonding agent is placed on the tooth. The filling material is then placed in layers, with light curing occurring between each layer. After the filling material is placed and sculpted, occlusal (bite) adjustment is performed.
Advantages: Tooth colored fillings look good, and since the filling material is chemically bonded to the tooth, this type of filling material resists fracture. Composite fillings can also be kept smaller than silver fillings because no undercuts are necessary for retention of the material, and air abrasion technology can be used in tooth preparation when composites are used.
Disadvantages: This type of filling is very technique sensitive. If a drop of saliva leaks into the prepped filling area, the bond may not take and the filling may have to be replaced. This occurs in about 0.5% of composite fillings placed. Since the filling is hardened before anesthesia wear off, there may be a higher incidence of needing a filling adjustment with this type of filling. Adjustment is required about 1% of the time.
Silver Amalgam Fillings
Amalgam is the traditional filling material that has been the basic restoration material in dentistry. To place a silver filling, decay is removed with a drill, and undercuts are made into the tooth to lock the metal in place. Amalgam is placed in the tooth, packed, and carved. The filling remains soft for twenty-four hours, so care must be taken with chewing for a while.
Silver amalgam is composed of silver mixed with other metals such as copper, with mercury added to keep the material soft while working it.
Advantages: This material is easy to work, inexpensive, and durable. Silver amalgam can be placed in a wet environment; saliva does not affect a silver filling’s success to the same degree.
Disadvantages: Amalgam does not look natural and cannot be used where a filling is visible while smiling. The need to make undercuts destroys sound tooth structure, although it is possible to use a special bonding agent with amalgam that minimizes the need for undercuts. Silver amalgam fillings do not provide support for the rest of the tooth and are more subject to fracture of the natural tooth structure than a bonded composite resin filling.
Current research contends the mercury in silver amalgam has not been proven to cause any side effects except in persons with specific metal allergies. However, it is known that after placement of a silver filling, there is a rise in mercury level in that person for a period of time. There has been no proven correlation between this and any adverse health effects to the date of publication of this article.
Gold, Porcelain, or Composite Inlays
While most fillings are direct placement procedures (drilling out decay and immediately filling with restorative material), indirect restoration may be an option for restoration.
With an inlay, the preparation is made to clean out the decay, and an impression is taken of the tooth. This impression is sent to a lab and a restoration is cast or fabricated in the material of choice. The patient returns after the lab work is completed and the inlay is fitted into the prepared tooth and cemented.
Complications of Fillings
"High" Feeling
Occasionally a filling needs to be adjusted because the occlusion is off. This usually happens because it can be difficult for a patient to feel a proper adjustment when he or she is numb from anesthesia. A quick visit to the office is usually all that is necessary to adjust a filling. This complication occurs in about 1% of fillings.
Sensitivity
A filling may be sensitive because it is "high" and needs adjustment, because it was a deep restoration, or because a bond may not have been successful. Call the office if sensitivity persists beyond two days.
Abscess
If a filling was very deep and near the pulp, there is a chance that the tooth could abscess and need a root canal. This is because bacteria can damage the pulp without showing up as actual decay. If you do have a filling that is close to the nerve, we will inform you that there may be a future need for a root canal. Occasionally because of unusual tooth anatomy, a filling that is not that deep can nick pulpal projections called pulp horns, and there may be no way of predicting the need for a root canal in the future.
Allergies
Rarely a person may have an allergy to a dental material used in filling placement, including metals, latex, bonding agents, or adhesives. If you have any known allergies, be sure to inform us.
