Silver (Amalgam) fillings Silver fillings, also known as Amalgams, are an alloy of several metals ( Silver, Zinc, Tin etc. ) and mercury. Once mixed, they make a dental amalgam. This restoration has been used successfully for over 100 years. A common question when a filling is placed concerns its durability. The ADA says you can expect the filling to last about 15 years, but we have seen some fillings that have lasted longer. Some circumstances that can decrease the longevity involves restoring a large area of the tooth with an amalgam. The properties of the material do not support the tooth well, and when it fails the tooth structure around the filling will break, requiring a larger, more cohesive filling.
Periodically, reports are generated about the possibly of mercury toxicity from old existing silver fillings. To date, it is the opinion of the American Dental Association (ADA ) that there is no substantial proof that dental amalgam poses any threat to the safety of the dental public.The cost for an amalgam is based on the number of surfaces restored, & in most cases it is the most ecomonical material used.
Composites (Tooth colored) fillings Replaces decayed tooth structure or old filling material to look natural. The filling is mechanically and chemically bonded to the tooth making for a more cohesive restoration compared to amalgam. Composites preform the best when replacing small areas of decay, they are indicated for use in anterior, or small posterior fillings. The fillings are chemically bonded to tooth structure but normal varying temperatures of food create expansion & contraction that can prematurely cause failure, in especially larger composites. The ADA says you can expect the composite to last 5 - 10 years. The cost for a composite is about 10-15% higher than amalgam due to the cost of the materials & the technical excellence needed to place it.
Inlays/Onlays ( Concept) fillings Concept fillings are heat pressurized tooth colored fillings that are made by a dental lab. It is the most supportive of the fillings we have mentioned. It is not effected by expansion or contraction of the tooth, and it will tend to last the longest, about 15 - 20 years, in many cases. An Inlay is a term that applies to a filling that is placed inside the tooth, and an Onlay is placed over or around the prepared tooth. These restorations are only for use on back teeth.
This, unlike the other fillings discussed is a 2 visit procedure. The first visit lasts about an hour where the tooth is cleaned, an impression is taken and a temporary is made. The second visit lasts about 45 minutes and the Concept filling is cemented, and polished. Prior to the use of this tooth colored material Gold was used for Inlays/Onlays. Gold is certainly an option, however, due to Concepts superior esthetics it is the material of choice.
The cost of the Concept filling is usually 3-4 times that of a composite & the superiority of this material will be evident in its esthetics, wear, & durability.
Amalgam Removal Information (Supplied by Dr Freedenfeld’s office) Possible sources of Mercury include: Contaminated Shellfish or seafood A portion of the American Dental Associations (ADA) position on the safety of Amalgam is as follows:
For more information please contact the American Dental Association Mercury Treatment Establishing a Base Line Initial Treatment Phase
Mercury Amalgam Removal Be patient with yourself. This is a healing process not a quick fix. Rushing it will only aggravate your condition and increase the risks of long term complications. This is so because Mercury has strong affinity for sulfhydyl (-SH) sites on proteins and enzymes throughout the body and deposits in many tissues and organs. Due to the folding of the proteins the supplements & Chelating products have a tough time pulling the Hg off.
Inlay or Onlay - What to expect These are heat pressurized tooth colored fillings that are made An Inlay is a term that applies to a filling that is placed inside the tooth, and an Onlay is placed over or around the prepared tooth. To place the restoration we must prepare the tooth, many times just replacing the space provided by the last filling. After the preparation, and impression is made with a very accurate material. This impression is most important because it will be used in the lab to make your custom Inlay or Onlay. So it must be perfect. After the preparation and impression you may feel some discomfort in your gums at the base of the involved teeth, as the prep may have gone below the gum line. This discomfort is natural & will decrease with time. If you feel it’s necessary you may rinse with a warm water solution (1/2 tsp.: 8 ozs. of water). You are also wearing a temporary crown to protect the tooth until the permanent crown can be placed. You can brush all you want around this tooth but do not floss around it. This process requires that we use a certain type of temporary material, however this also makes the tooth more sensitive over the short run to cold and touching pressure. Avoid sticky food that may lift off your temporary, but should this happen call our office. We can replace this quite easily. The restoration will be tried in & inserted at the next appointment. We will lift off the temporary cleaning & disinfecting the tooth. The steps of insertion is an exacting process that bonds & strengthens the tooth. The bite & contacts will be checked before the work is polished. The resin cement is very strong that sometimes causes the tooth to be sensitive. It is not uncommon for you to experience cold or slight pressure sensitivity once it is inserted. The sensitivity may range from a couple of days to a few weeks For 24 hours after the cementation, avoid eating hard and/or sticky foods. Also do not floss that specific tooth during the first day. Protect your investment! Brush & floss daily; taking special care to remove plaque bacteria from the gum line of the teeth. These areas can still get cavities. If you have any questions, please feel free to call.
The following information is meant to be used as a guideline to help you understand what your options are. After we diagnose & determine the areas of necessary treatment, our office can help you make a decision.
Composites (Tooth colored) fillings Replaces decayed tooth structure or old filling material to look natural. The filling is mechanically and chemically bonded to the tooth making for a more cohesive restoration compared to amalgam. Composites preform the best when replacing small areas of decay, they are indicated for use in anterior, or small posterior fillings. The fillings are chemically bonded to tooth structure but normal varying temperatures of food create expansion & contraction that can prematurely cause failure, in especially larger composites. The ADA says you can expect the composite to last 5 - 10 years.
Inlays/Onlays fillings Concept fillings are heat pressurized fillings that are made by a dental lab. It is very supportive of tooth structure, therefore it can replace large amalgam restorations, in many cases. It is not effected by expansion or contraction of the tooth, and it will tend to last the longest, about 15 - 20 years, in many cases. An Inlay is a term that applies to a filling that is placed inside the tooth, and an Onlay is placed over or around the prepared tooth. These restorations are only for use on back teeth.
This is a 2 visit procedure. The first visit lasts about an hour where the tooth is cleaned, an impression is taken and a temporary is made. The second visit lasts about 45 minutes and the Concept filling is cemented, and polished. Prior to the use of this tooth colored material Gold was used for Inlays/Onlays. Gold is certainly an option, however, due to Concepts superior esthetics it is the material of choice.
Crowns A crown is a cover for a tooth weakened by decay or a large defective filling. It supports and protects the tooth from further breakdown.
What options do I have when choosing a crown? In most cases there are 3 types of crowns you can choose from:
Porcelain fused to metal crown (PFM) - Is the most widely used crown because of it’s strength and esthetics. The prepared tooth is covered with metal giving the crown it’s strength, and an opaquer layer plus porcelain esthetically matches the appropriate color.
All Metal Crown - Usually yellow gold or silver palladium is used. The benefits of this crown include durability and wear. The gums react favorably due to the proper contour & shape that is achieved. Longevity of this restoration is a plus since there is no risk of porcelain fracturing. This type of crown is usually placed on back teeth were esthetics is not a concern.
All Porcelain Crown - All porcelain crowns have superior esthetics because they allow light to pass through. They gain their strength by bonding the crown to the tooth. There are certain requirements as to how the procedure is done that restrict which teeth are good candidates for this restoration.
General Info This procedure takes 2 visits to complete. The first visit the tooth is shaped into a base for the crown to fit over. An impression is made of the tooth so that the crown will be an exact fit. A temporary crown is made & cemented in place until the next visit. On the return visit, the temporary crown is removed, and the permanent crown is fitted, adjusted, & cemented on the tooth.
Any questions or comments please contact our office.
Congratulations on receiving your new Silver ( Amalgam ) filling! The benefits of this filling material include its time tested durability to withstand the oral elements, it’s versatility and ease of placement allows this material to the most economical material used. If you’ve never had a silver filling placed before, I’d like to answer some general questions that may arise.
How was the filling done ? · Generally novacaine is used so we may work on the tooth comfortably. · Once the tooth is anesthetized the decay or defective filling is removed and the tooth cleansed, and disinfected. · We may have placed a thermal or medicinal lining under the filling. This will help the tooth heal &/or insulate it from temperature extremes. · In some circumstances, when more than one surface of the tooth is being restored, a band is placed around the tooth, with a wedge placed at the base of the tooth to allow for proper contour. · The amalgam is condensed in the prepared tooth, the filling is then carved and adjusted to your bite
What should I avoid? · When the filling is placed it goes through different stages of hardness as it is setting. The filling is the most vulnerable during the first hour, avoid eating or drinking fluids of extreme temperature. Be careful as the novacaine is wearing off, to avoid injuring your tongue, cheek, or lip. · Once placed, it takes almost 2 weeks for your new filling to become fully hardened. You may, however, safely chew on it after 24 hours. But please chew carefully !
What can I expect? In most cases when the novacaine wears off everything will feel normal, without any side effects. However, there may be circumstances when the tooth is healing you may feel various sensations, to include: · New silver fillings can be sensitive to hot and cold liquids and other foods for the first 4 - 6 weeks or in some cases even longer. If the sensitivity should continue for an extended period of time or if the discomfort is extreme, please give us a call so that we can evaluate the situation and prescribe the appropriate therapy. · Sometimes, due to the effects of the local anesthesia, it is quite difficult to make sure that your bite is exactly right. if you feel any discomfort in chewing, please let us know. A minor adjustment is usually all it takes to make you comfortable. Don’t wait too long! Teeth can become quite sensitive if the bite is “high”. You can generate in excess of 40,000 pounds per square inch when chewing on your back teeth. Fillings which have not had the appropriate amount of time to harden, or are “high”, cannot stand this kind of pressure and may break. If you have any question, please feel free to call at any time.
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Restorations