Fillings/Tooth Restorations

This information is provided to help you make decisions about the use of materials for fillings/tooth restorations in your mouth.  Many types of metals are used in dentistry for the replacement and rehabilitation of oral surfaces.  Most of these metals are considered to be inert when placed in the body, while others have been criticized as potential toxins or allergens to some people.  Plastics and ceramics are used commonly as tooth restoratives, and these have not had adverse biologic responses.  The following information will help you make decisions about the type of fillings/tooth restorations you prefer to be placed in your mouth:

Restoration of parts of single teeth (fillings):  Silver amalgam has been used for over 150 years for the restoration of teeth.  This alloy contains silver, tin, copper, zinc, and about 50% mercury.  It has been a highly successful but unsightly material.   Use of mercury in the body has been criticized since its inception, but amalgam use is still supported by the American Dental Association and other groups world-wide.  A few people in the overall population may be allergic to the elements in silver amalgam.  However, you have several options:

  • Silver amalgam:  Average longevity is about 15 years, has a silver color, has a low initial cost, and is best in small-medium sized restorations of posterior teeth.
  • Gold inlays and onlays:  Average longevity is 20 years to life, has a gold color, has a moderate-high initial cost, and may be used in any size restoration in any location where metal is not displayed.
  • Resin (plastic) – direct one day placement:  Average longevity is 10-15 years, is tooth colored, has a moderate cost, and is best used in small-medium sized restorations for any teeth.
Tooth before removing defective filling

Tooth before
removing defective
filling

 

Tooth after replacing with a resin,  tooth colored filling

Tooth after replacing
with a resin,
tooth colored filling

  • Resin (plastic) – indirect two appointment placement:  Average longevity is 10-15 years, is tooth colored, has a moderate-high initial cost, and is best in medium sized restorations for posterior teeth.
  • Ceramic indirect – two appointment placement:  Average longevity is 10-15 years, is tooth colored, has a moderate-high initial cost, and is best in moderate sized restorations for any tooth.

Crowns or Fixed Prosthesis (Bridges):  Gold alloys have been used for many years for the construction of crowns or fixed bridges.  They provide excellent, strong, long lasting service, but two major types of alloys are now available:

  • High noble metal:  Mostly gold but also palladium, silver, and occasionally platinum, zinc and copper.
  • Noble metal:  Mostly palladium, but also silver and gold.

All of the above metals are used either as the sole constituent of a crown or as a thimble on which porcelain is fired (baked).  Most people have no biologic response to any of the categories of metals, but a few people have adverse tissue responses to the base metals.  If you have known allergies to metals, please discuss them with Dr. Tully.  We usually use noble or high-noble metals.  Bridges (fixed prosthesis) are strongest when metal is used with or without porcelain on it.  Your choices for crowns or fixed prosthesis (bridges) are:

  • Metal alone (high noble, noble, or base metal):  Average longevity of 20 years to life, is a gold or ‘silver’ color, has a moderate to high initial cost, and may be used in any area where metal display is not objectionable.
  • Porcelain fused to metal:  Average longevity of 10-15 years, is tooth colored, has a moderate to high initial cost, and may be used in any area where extreme stress or grinding habits are not present.
  • Ceramic, non-metal containing crowns (bridges are not advisable, constructed from ceramic along):  Average longevity is 10-15 years, has a moderate to high initial cost, and may be used in any area where extreme stress or grinding habits are not present.

We will inform you about the best type of restoration for your teeth, and we will discuss your questions.  Thanks for helping us to make this important decision.