Dental fillings (restorations) are procedures to repair a damaged or decayed tooth. This is called restorative dentistry (as opposed to cosmetic dentistry). The most common type of restoration is a dental filling, which may be amalgam (silver), composite resin (white) or other materials, like ceramic dental fillings. Crowns may be used when a filling will not be enough to strengthen the tooth, such as after root canal treatment or Apicoectomy. The other form Inlays and Onlays are similar to dental crowns, but cover smaller areas. Restorations require drilling, either with traditional tools or through microabrasion.

A composite resin is a tooth-colored plastic mixture filled with glass (silicon dioxide). When they were introduced nearly 50 years ago the dental composites were confined to the front teeth because they were not strong enough to withstand the pressure and wear generated by the back teeth. Since then, composites have been significantly improved and can be successfully placed in the back teeth as well. The improved composite resins are made of a resin filled with microscopic porcelain particles. Similar in color and texture to natural teeth, the fillings are less noticeable, and much more attractive, than other types of fillings. This material is used as a filling material for either posterior or anterior teeth. Composites are not only used for restoring decay, but are also used for cosmetic improvements of the smile by changing the color of the teeth or reshaping disfigured teeth.

A tooth is prepared for a composite filling by removing any decay with either a drill or air abrasion (click on "technology" for an explanation of this dental equipment). The tooth is given etching with a gentle acid (about the strength of lemon juice) to make it rough to accept a bond and a bonding agent is placed on the tooth. The composite material is layered into the cavity preparation and hardened with a curing light. After the filling material is placed and sculpted (polished), occlusal (bite) adjustment is performed. Tooth colored resin fillings blend well with the surrounding teeth and enhance a bright, youthful smile.

Silver Amalgam Fillings:
It is since many decades that Silver (mercury) fillings have been used in dentistry. Amalgam is the traditional filling material that has been the basic restoration material in dentistry. To place a silver filling, decay is removed with a drill, and undercuts are made into the tooth to lock the metal in place. Amalgam is placed in the tooth, packed, and carved. The filling remains soft for twenty-four hours, so care must be taken with chewing for a while. Recent and ongoing research shows that due to the expansive nature of this material fractures and cracking of teeth occurs. Silver amalgam is composed of silver mixed with other metals such as copper, with mercury added to keep the material soft while working it.

Advantages: The least expensive type of restorative material, amalgam is easy to work, inexpensive, and durable. Silver amalgam can be placed in a wet environment; saliva does not affect a silver filling’s success. Amalgam fillings are strong and can withstand the forces of chewing. They are inexpensive and convenient, and the filling procedure can be completed during one dental visit.

Disadvantages: Amalgam does not look natural as it doesn't match the color of your teeth. So amalgam can not be used where a filling is visible while smiling. The need to make undercuts destroys sound tooth structure, although it is possible to use a special bonding agent with amalgam that minimizes the need for undercuts. Teeth restored with old silver fillings also don’t reflect light therefore give the appearance of darkened, gray teeth. Amalgam fillings can corrode over time, causing discoloration where the filling meets the tooth. Silver amalgam fillings do not provide support for the rest of the tooth and are more subject to fracture than a bonding filling.

Controversy: The mercury in silver amalgam has not been proven to cause any side effects except in persons with specific metal allergies. However, it is known that after placement of a silver filling, there is a rise in mercury level in that person for a period of time. Additionally the mercury in these fillings has been shown to have systemic effects on the immune system. There has been no proven correlation between this and any adverse health effects, as exposure from fillings is comparable to what people get from other sources in the environment. Still many dental clinics refrain from providing the silver fillings services.

Should I change all my silver fillings to tooth colored fillings?

It is not advisable to change all the silver fillings to tooth colored fillings unless a cavity or cracks in old silver amalgam fillings present so warrants. The actual drilling process to remove silver fillings may be irritating to the tooth so unless it’s necessary. Hence, it is not advisable to undergo unnecessary dental treatment.

Dental Bonding:
Broken tooth is repaired quickly, easily and inexpensively. Dental Bonding is an excellent way to repair or change the shape or color of teeth, particularly front teeth. Another method of handling esthetic problems is cosmetic bonding. The broken tooth is restored with a composite resin filling material, no anesthesia is required, and no tooth structure is removed. The result is an excellent restoration that improves the patient's appearance. Bonding is usually a one-appointment procedure that starts with a careful matching of the color of the bonding materials to your tooth color.

The discolored front teeth or surface defect are applied composite resin to cover up these areas. Your teeth are lightly roughened and a gel is applied to ensure that the bonding materials will adhere. Then the bonding material is applied, sculpted and hardened with a high-intensity light. The final step is a careful polishing of your new teeth. It can also be used to close small spaces (Diastemas closure) between teeth.

Quality Alternatives:
Resin Bonding is most cost effective and can do almost anything to improve esthetics of front teeth in particular. But the final appearance is not quite as good with Resin Bonding as it is with Veneers. In the short to medium term however resin bonding represents a cost effective cosmetic solution. Composite bonds stain more easily and therefore require proper care and regular cleaning. In order to ensure the longest possible duration of the bonding, composites should be brushed and flossed daily. Common staining elements include coffee, tea, tobacco, foods and candy. Composite bonds, however, are not as durable and long-lasting as veneers and crowns and may need to be re-touched or replaced in the future. Porcelain Veneers can be used to close spaces between your teeth, lengthen small or misshapen teeth, or whiten stained teeth. And if your teeth are chipped or beginning to wear, veneers can protect them from damage and restore their original look.