A dental filling
is also called dental restoration. As it is called, it is a restorative
material that artificially restores the function, shape and morphology
of any part of the tooth that is missing. Tooth structure is
often eroded due to caries that will lead to tooth decay. There
are also times that the teeth will break or chip due to external
factors like accidents, trauma, and so on.
With our society today, aesthetic qualities play a vital role
to every individual. Many surveys showed that the smile and the
appearance of the teeth are but two things that people would
change in their appearance if they were given the opportunity.
There are a variety of materials being used on dental fillings
for teeth restorations. Dental amalgam, composite resins or glass
ionomer cement are commonly used materials for direct restorations.
These restorative materials can be used indirectly. For example,
the porcelain, gold, zirconia or other metals are prepared outside
and then attached to the tooth.
Our anterior teeth are the ones immediately visible when we
smile. Therefore the choice of a dental filling is largely dependent
on its aesthetic value alone. The posterior teeth or the teeth
lying at the back of the mouth on the other hand are not immediately
visible which lend themselves to a wider choice of dental fillings.
The posterior teeth have several methods of restoration. Each
of this method has its advantages and disadvantages, durability,
and visual aesthetics. The most common are the amalgam, resin-based
composite, porcelain-fused-to metal or PFM, cast gold alloy,
and full ceramic ones.
This is any mixture or blending of mercury with another metal
or with an alloy. These amalgams are commonly used in dental
Advantages of amalgam based fillings are:
- they are relatively cheap
- they are durable
- it has been proven to have a longevity
of up to 40 years under normal conditions
- it is a simple and
- have very good results
Sometimes, there are cases of fracture of the tooth cusp or
the amalgam may crack due to caries in the surrounding margins.
This will lead to the rest of the tooth to have a dark appearance
and the filling will have to be replaced.
Studies and discussions about the use of mercury in dentistry
have been unending. The use of mercury has been controversial
due to the toxic content of amalgams. Amalgam fillings revealed
to have an increase mercury blood levels. Mercury is considered
a very potent neurotoxin but mercury fillings are still considered
safe by most dentists and are thus being widely used as fillings.
Resin Based composite fillings
There are patients who do not want ant metal fillings especially
in areas of the mouth that are visible. In these cases, the filling
materials of choice are composites.
Since 1968, resin-based composites for dental fillings have
been around. Resin based composites fall into the category of
Class II Restoratives. A plastic resin and a filler of finely
ground glass-like particles make up a dental composite. These
materials are mixed together, blended and matched to the color
of the existing tooth.
There has been great improvement in the quality of resin based
composite since its introduction in 1968. Dentists have been
experimenting with its composition. Dentist will add particle
size fillers to arrive at a better substitute. Modern day resin
composites have then improved considerably. Well-trained dental
technicians can successfully use this filler through careful
meticulous handling. This filler can last for at least 10 years.
Problems to watch out for would again be postoperative tooth
sensitivity, open contacts, and the awful “white line” that
appears at the margins caused by shrinking of the area due to
Resin base composite is used as an alternative to amalgam. But
this type is not greatly successful because of the following:
- inability to withstand excessive wear
- postoperative tooth
- pulpal death
- frequent caries
- breakdown of the filling in contact with
Protein-Fused-to-Metal (PFM) Crowns
This is another type of filler. This is used to provide strength
to a crown or bridge. This type of restoration is very strong,
durable, and resistant to wear, because the combination of porcelain
and metal creates a stronger restoration than porcelain being
For more than 40 years, PFM crowns are used as a means of dental
restoration. The advantages of PFM are:
- it is visually appealing
- easy to administer
- has simple cleaning and preparation of
The disadvantages on the other hand are:
- causes abrasion to the adjoining tooth structure
less appealing when the gums start receding
PFMs can last for at least twenty years. But they lose their
aesthetic value after about 10 years. In terms of the price value,
PFMs are five to six times more costly than the amalgam or composite
resins. Even though they are known to be hassle free, they do
tend to break or chip away from the metal structure on which
it is fused. In addition, the join will be visible after a period
of time when the gum recedes, and this does not appear aesthetically
Cast Gold Alloy Restoration
This is the oldest method of tooth restoration. It has been
around for more than 100 years.
Centuries ago, people did not mind showing that bit of gold
sparkle in their mouth. But that has changed as more people are
reluctant to the idea of gold showing up in their smiles. As
a result, cast gold alloy restorations for inlays, overlays,
and fillings are losing their status and popularity.
Cast gold alloys have been proven to be the best in terms of
durability, non-toxicity and easy applicability. It is considered
to be the most advantageous type of filler where the metal will
not be visible, such as at the back teeth. Dental practitioners
should encourage their patients to go in for cast gold alloy
restoration wherever and whenever possible.
The only disadvantages for this type of filler are:
- the metal wearing out
- the tooth fragmenting at the juncture
- repeated attacks of
All Ceramic Restorations
Standard full ceramic restorations have been used for posterior
teeth as inlays, onlays, crowns, and fixed dentures, but the
durability and sturdiness is still questionable.
There have been a number of all-ceramic restorations that have
been introduced for years, but so far none has proven to be fault-free.
The only exception is the pressed ceramic restoration and some
of the computer aided milled ceramic restoration, which uses
zircon as its base.
The choice of the material has to depend on the consumer. Every
client should have a frank and thorough discussion with their
dental practitioner on every aspect of the treatment – the
advantages and disadvantages of each type of procedure, what
to expect after the procedure, and so on. A client can make an “informed
decision” regarding the cost, durability or longevity of
the filling and its sustainability to their present state of health.