Amalgams Vs Composites: Which is The Better Choice?

When people think of fillings, they think of the silver, metal fillings that have been around for the last 150 years. However, with the new advancements made in dentistry, traditional amalgam fillings are no longer the only choice available, and today many dental offices also provide composite resin. We discuss both to help give you a better understanding.

Why Dental Fillings Are Important

Before diving into the pros and cons of the types of materials used for dental fillings, let’s discuss what a filling is, and why it is needed to maintain your oral health. Dental fillings are designed to replace decay in your tooth and restore a tooth’s appearance, strength, and structural integrity.

Although dental enamel is the strongest tissue in your body, it is still susceptible to bacteria. Bacteria feed on sugars and starches and releases an acid byproduct, which softens enamel, allowing even more bacteria to invade and break down your tooth and cause cavities. If left untreated, the bacteria can continue invading deeper into the tooth and reach the nerve of the tooth, which results in pain, infection, and the need for a root canal or tooth extraction.

When the cavity is small, your tooth can still be restored with a filling. Your dentist will remove bacteria and decay and thoroughly clean the tooth, before placing a dental filling into the prepared hole. This helps restore your tooth back to its original shape and function.

Pros and Cons of Amalgam Fillings

Commonly known as silver fillings, amalgam fillings are made from a variety of metals, such as silver, mercury, zinc, and copper. Compared to composite resin, this type of filling is more affordable and when properly cared for, can last up to 15 years. Because of the metal alloy used, amalgam fillings offer stronger resistance to wear, making them a superior choice for back teeth or larger areas of decay.

However, amalgam fillings have developed a bad reputation due to the mercury used, as some patients are particularly sensitive or allergic to it. Another downside is its appearance. Silver fillings are more noticeable, especially when you are laughing or smiling widely. Over time, amalgam filling can also stain the appearance of the entire tooth, making it appear greyish and less aesthetic. Lastly, large amalgam fillings can create stresses and fracture lines that can lead to large cracks in teeth.

Pros and Cons of Composite Resin Fillings

Composite fillings, also known as tooth-coloured fillings, are made from a combination of plastic and ceramic compounds. It comes in a range of tooth shades, which allows the dentist to blend the filling much better with your tooth, giving it a more natural appearance. It also requires less enamel removal and tooth preparation, allowing you to maintain as much of your natural tooth structure as possible.

The cons to composite fillings are its technique sensitivity and longevity. Composite resin fillings are more difficult to place than amalgam fillings as they are more moisture sensitive. Older versions of composite have been though to be not as resistant to wear as amalgam. However, as newer bonding techniques and stronger versions have been produced, composite resin fillings have proven to be very durable.

What is the right choice for me?

In the last 30 years, there has been a shift away from amalgam towards composite resin fillings. This shift has been brought about due to concerns about mercury toxicity as well as the general trend towards more aesthetic, tooth coloured fillings. In practice, most patients prefer tooth coloured fillings and are reluctant to accept amalgams.

At Dental Designs we make every effort to fill cavities with tooth coloured composite resin, as we believe that this filling option is the best because it is safer, less noticeable, keeps your teeth stronger and also has good longevity. In cases when a cavity is too large or located on a back tooth that encounters a lot of forces, we may recommend other treatment options such as an inlay or a dental crown.

This article was written by Dr Jo Ann Wong.

References:

Is It the End Of the Road For Dental Amalgam? A Critical Review
Arvind Shenoy - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813106/)
A Controlled Clinical Study Of Amalgam Restorations: Survival, Failures, and Causes Of Failure
Letzel H;van 't Hof MA;Vrijhoef MM;Marshall GW;Marshall SJ; - (https://pubmed.ncbi.nlm.nih.gov/2606273/)

Longevity Of Restorations in Posterior Teeth and Reasons For Failure
Hickel J; - (https://pubmed.ncbi.nlm.nih.gov/11317384/)
Direct Resin Composite Inlays/onlays: An 11 Year Follow-up
van JW; - (https://pubmed.ncbi.nlm.nih.gov/10785294/)
Development of gingivitis around different types of composite resin
(https://europepmc.org/article/med/3301912)
Microleakage Of Composite Fillings in Er,cr:ysgg Laser‐prepared Class Ii Cavities
Norbert Gutknecht-Christian Apel-Christine Schäfer-Friedrich Lampert - (https://onlinelibrary.wiley.com/doi/abs/10.1002/lsm.1064)

Dental Fillings - Why choose Ceramic Fillings over Regular Ones?

When we talk about restoring badly worn down or chipped teeth, the first thing that comes to mind is dental fillings. Most of us are aware of the tooth coloured composite fillings which are perhaps being most commonly used by dentists throughout the world for restoring damaged teeth. However, did you also know that there is another type of dental fillings available which are even stronger, naturally appearing and more durable than the conventional composite fillings? Yes, these are the indirect fillings, the inlays, and onlays.

What are Direct and Indirect Fillings?

However, before we discuss why inlays and Onlays are better than conventional filings, we must first understand the difference between the direct and indirect fillings.

Direct Fillings –. These tooth coloured fillings are placed directly inside the tooth after removal of the demineralized and damaged tooth structure. The most common types of dental fillings are the silver amalgam fillings and white fillings
- Dental Amalgam – these fillings are based on the mixture of powdered metal alloys with liquid mercury. These direct fillings have been used for restoring teeth for more than 100 years. However, their use has declined these days as research has indicated the possible toxic effect of mercury on the human body.
- White Fillings – these tooth coloured fillings consist of a mixture of resins and glass fillers. The best thing about these fillings is that they can exactly match the shade and colour of your teeth. Composite fillings are suitable for restoring small tooth defects, owing to their excellent aesthetics and sufficient durability.
Indirect/ Ceramic Fillings – as their name suggests, these ceramic fillings are not directly placed inside the tooth. Instead, your dentist will remove the damaged tooth structure and, in most cases, take a dental mould of the tooth, which is then sent to the dental laboratory. At the dental laboratory, this impression will be used to prepare the ceramic restoration. This process is time-consuming, requiring a longer time and at least 2 appointments. If the dentist has an intraoral scanner and chairside milling system, this process is much simplified. At Dental Designs Clinic, the dentist will make a digital impression of your teeth by using an intra-oral scanner, and the ceramic filling can be designed and made on the spot for immediate use in the mouth.

Indirect restorations include inlays, onlays, crowns, bridges, and veneers. Among them, inlays and onlays can also be used as fillings, and the advantage is that they are stronger and last longer than direct fillings.

What are Inlays?

Inlays are indirect restorations that are used for the restoration of grossly damaged or fractured teeth that cannot be restored with direct filling materials, but at the same time, they are not extensive enough to require a crown. Inlays are used in cases where the damage has not progressed into the cusps, which are the protuberances that are present on the biting surfaces of teeth.

Although numerous types of materials can be used for preparing ceramic inlays, at Dental Designs Clinic, we use high-quality materials that have been approved by European and American standards. Instead of leaving it to an external laboratory, we prepare inlays in our clinic by using the state of the art CEREC system. As such, we ensure that you will not only get a naturally beautiful and attractive smile, but they will also be functional, restoring your ability to chew and speak properly.

How are Ceramic Fillings Prepared with the CEREC System?

Here’s how we will give a beautiful smile with ceramic and hybrid ceramic inlays with the CEREC system:

Consultation – the first step, our dentists will perform a detailed examination of your teeth and current dental health status. We will prepare a comprehensive treatment plan for your you which will be customized according to your dental and aesthetics needs.
Tooth Preparation – in the next step, we will remove the cavities and damaged tooth surface. If the damaged tooth structure is too deep and there is a chance of accidental exposure of the underlying pulp, we will administer local anaesthesia to make you completely pain-free.
Impression Making – after tooth preparation, we will make a digital impression of your teeth with the special intraoral scanners of the CEREC system. This impression will then be fed into a special software which will help us in designing of an inlay which exactly fits the prepared tooth. The computer-aided design (CAD) software will also allow us to create the inlays which have the same shape and colour as your natural teeth.
Fabrication of the Ceramic Inlays – Finally, we will use 3-D computer-aided manufacturing (CAM) milling machine which will carve out the inlay from a ceramic or zirconia block. We will then insert the prepared inlay into the prepared tooth cavity just like a filling and bonded to the tooth with an adhesive cement.

Why we use the CEREC system for Preparing Ceramic Inlays?

You might now be wondering why we prefer digital inlays over conventional ones. So, here are a few reasons why CEREC inlays are better than direct fillings and conventional inlays.

Exceptional Precision and Fit – the CEREC inlays are prepared by using a state-of-the-art CAD-CAM Therefore, unlike the direct fillings and conventional inlays prepared in the laboratory, the CEREC inlays are prepared under highly precise and controlled precision. As a result, they will perfectly fit the prepared teeth, and they will prevent chances of development of secondary cavities.
Durability – the CEREC inlays are prepared from very high-quality ceramics. Therefore, they are quite strong and durable, even more than the tooth coloured composite fillings and conventional inlays. With proper care, you can expect these ceramic fillings to last for more than ten years.
Lifelike Aesthetics – with CEREC system, we can tailor-make each aspect of your inlays including their shape, thickness, colour, and Therefore, when we restore your damaged tooth with a ceramic filling made with the CEREC system, it will be virtually indistinguishable from your teeth.
Tooth Conservation – conventional inlays and amalgam fillings often require sacrificing healthy tooth structure. However, thanks to the CEREC system, we only need to remove the tooth structure which is damaged. Therefore, there is enough tooth structure remaining to prevent tooth fracture.
No Need for Making Physical Tooth Impressions – many patients dislike the taste or feeling of the impression material which is used to recording the shape and size of the teeth. This problem has been solved with the CEREC system. After preparing the damaged tooth, we use digital scanning for making an impression, which is like taking a video of the tooth with a camera inside the scanner. This digital impression is not only more accurate and precise, but it also reduces the inconvenience of the patients.
Enjoy a Same-Day Smile – conventional ceramic inlays need at least two sittings for their preparation and tooth restoration. This may take weeks before you can get your teeth restored. However, this is not the case with the CEREC system. Thanks to the CEREC machine, we only need a few hours to prepare your inlays. This means that you can enjoy the smile of your dreams in just a single sitting and that too, in under 2 hours.

While ceramic fillings are an excellent choice for restoring damaged teeth, but they can never be as strong and durable as your teeth. Therefore, the best filling is undoubtedly no filling at all! However, if you still need to get one of your teeth replaced, then ceramic inlays prepared with the CEREC system should be your first choice.

So, are you ready for enjoying a naturally pleasant and beautiful smile? Then book an appointment with our dentists today and let us take care of the rest.

References

Clinical Performance Of Cerec Ceramic Inlays: a Systematic Review
N. Martin-N.M. Jedynakiewicz - (https://www.sciencedirect.com/science/article/abs/pii/S0109564199000147)
The Clinical Performance Of Ceramic Inlays: A Review
Mark Bergman - (https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1834-7819.1999.tb00217.x)
Three-dimensional finite element analysis of strength and adhesion of composite resin versus ceramic inlays in molars
(https://doi.org/10.1016/S0022-3913(08)60029-3)
Considerations For Ceramic Inlays in Posterior Teeth: a Review
Christa Hopp-Martin Land - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666490/)
The Clinical Performance Of Cad-cam–generated Ceramic Inlays: A Four-year Study
Harald Heymann-Stephen Bayne-John Sturdevant-Aldridge Wilder-Theodore Roberson - (https://www.sciencedirect.com/science/article/abs/pii/S0002817715609953)
Molar fracture resistance after adhesive restoration with ceramic inlays or resin-based composites
(https://europepmc.org/article/med/11699740)