Even with the very best of care it is often necessary to restore teeth. Teeth can be damaged through trauma or decay, or sometimes by what we call non carious tooth surface loss – basically the teeth are worn away by grinding, acid attack or due to habits such as holding sewing needles or screws between your teeth.
Fillings have been used to repair and restore teeth for over a hundred years. There are different materials available to use, each of which have their own advantages and disadvantages.
Dental amalgam is a metal alloy comprised of tin, copper, silver and mercury. It is a long established material which is cheap, convenient and easy to use. In NHS service dental amalgam is still the first choice material in many cases despite there often being better alternatives.
Dental amalgam fillings are grey/black in colour and due to the way they are retained in the teeth the procedure can also cause damage to the tooth which wouldn’t be required with other materials. Their advantages include cost, durability and strength.
Advances in dental material science have allowed the use of dental composite resin based materials to restore teeth. Composite fillings are tooth coloured and rather than ‘lock’ in to teeth like amalgam they bond to the tooth structure using bonding techniques.
Modern dental composite resins have excellent physical and aesthetic properties. They are almost as strong as amalgam, are less damaging to teeth (and can in fact increase the strength off a broken tooth), and can be made almost indistinguishable from the natural tooth. Despite these advantages composite resins are not used commonly in NHS practice, due to NHS regulations, however are available for all our patients.
This type of filling is more technique sensitive and takes a lot longer than placing dental amalgam fillings, hence the increased cost. They are used commonly in every other country worldwide and are taught as the first choice restorative material in all UK dental schools.
This material is used more commonly for children’s fillings and simple fillings on the sides of adult teeth. They stick to natural tooth substance by way of a chemical bond so need very little tooth preparation. Another advantage of glass ionomer type materials is their ability to absorb and then gradually release fluoride, providing long term protection which is important in root cavities. They are almost tooth coloured but do not have the aesthetic quality of composite resins. They are also not as strong as other commonly used dental materials.
Dental gold is the absolute best material for restoring damaged teeth however the price of gold and the undesirable appearance means they it is not commonly used in dentistry today. Gold is biocompatible and due to its special physical properties actually adapts to the tooth during function.
Most gold restoratives are in the form of crowns or inlays rather than directly placed fillings.
New advances in porcelain technology and bonding techniques mean porcelain inlays are a popular means of restoring teeth. The porcelain is incredibly strong and the restoration is bonded to the damaged tooth using special bonding techniques. Porcelain inlays are made by highly skilled technicians and require sensitive techniques when being placed so can be an expensive option.