Modern Dental Materials and Techniques Create More Natural Smiles

Thanks to advances in modern dental materials and techniques, dentists have more ways to create pleasing, natural-looking smiles. Dental researchers continue their often decades-long work developing materials like ceramics and polymer compounds that look more like natural teeth. As a result, dentists and patients today have several choices when selecting materials to repair missing, worn, damaged, or decayed teeth.

These new materials have not eliminated the usefulness of traditional dental materials, such as gold, base metal alloys, and dental amalgam. That’s because the strength and durability of traditional dental materials continue to make them helpful in filling the back teeth, where chewing forces are most significant.

What’s Right for Me?

Several factors influence dental restorations’ performance, durability, longevity, and cost. These factors include the patient’s oral and general health, the components used in the filling material, where and how the filling is placed, the chewing load the tooth will have to bear, and the length and number of visits needed to prepare and adjust the restored tooth.

With so many choices, how do you know what’s right for you? To help you better understand what’s available, here are the advantages and disadvantages of commonly used dental restorations.

The ultimate decision about what to use is best determined by the patient in consultation with the dentist. Therefore, before your treatment begins, discuss the options with your dentist.

Types of Dental Restorations

There are two types of dental restorations: direct and indirect.

Direct restorations are fillings placed immediately into a prepared cavity in a single visit. They include dental amalgams, glass ionomers, resin ionomers, and some resin composite fillings. The dentist prepares the tooth, places the filling, and adjusts it during one appointment.

Indirect restorations generally require two or more visits. They include inlays, onlays, veneers, crowns, and bridges fabricated with gold, base metal alloys, ceramics, or composites. During the first visit, the dentist prepares the tooth and makes an impression of the area to be restored. The impression is sent to a dental laboratory, creating dental restoration. At the next appointment, the dentist cements the restoration into the prepared cavity and adjusts it as needed.

Amalgam Fillings

Used by dentists for more than a century, dental amalgam is the most thoroughly researched and tested restorative material among all those in use. In addition, it is durable, easy to use, highly resistant to wear, and relatively inexpensive compared to other materials. For those reasons, it remains a valued treatment option for dentists and their patients.

Dental amalgam is a stable alloy that combines elemental mercury, silver, tin, copper, and possibly other metallic elements. Although dental amalgam continues to be a safe, commonly used restorative material, some concern has been raised because of its mercury content. However, the mercury in amalgam combines with other metals to render it stable and safe for use in filling teeth.

While questions have arisen about the safety of dental amalgam relating to its mercury content, the major U.S. and international scientific and health bodies, including the National Institutes of Health, the U.S. Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.

Because amalgam fillings can withstand very high chewing loads, they are particularly useful for restoring molars in the back of the mouth, where the chewing load is most significant. They are also helpful in areas where a cavity preparation is difficult to keep dry during the filling replacement, such as deep fillings below the gum line. In addition, amalgam fillings, like other filling materials, are considered biocompatible—they are well tolerated by patients with only rare occurrences of allergic response.

Disadvantages of amalgam include possible short-term sensitivity to hot or cold after the filling is placed. In addition, the silver-colored filling is not as natural looking as tooth-colored, especially when the restoration is near the front of the mouth and shows when the patient laughs or speaks. And to prepare the tooth, the dentist may need to remove more tooth structure to accommodate an amalgam filling than other types of fillings.

Composite Fillings

Composite fillings are a glass or quartz filler mixture in a resin medium that produces a tooth-colored filling. They are sometimes referred to as composites or filled resins. Composite fillings provide good durability and resistance to fracture in small-to-mid-size restorations that must withstand moderate chewing pressure. As a result, less tooth structure is removed when the dentist prepares the tooth, resulting in a smaller filling than an amalgam. Composites can also be “bonded” or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth.

The cost is moderate and depends on the size of the filling and the technique used by the dentist to place it in the prepared tooth. It generally takes longer to place a composite filling than what is required for an amalgam filling. Composite fillings require a cavity that can be kept clean and dry during filling, and they are subject to stains and discoloration over time.

Ionomers

Glass ionomers are translucent, tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that may be beneficial for patients who are at high risk for decay. In addition, when the dentist prepares the tooth for a glass ionomer, less tooth structure can be removed, resulting in a smaller filling than an amalgam.

Glass ionomers are primarily used in areas not subject to heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mainly used in small non-load-bearing fillings (those between the teeth) or on the roots of teeth.

Resin ionomers also are made from glass fillers with acrylic acids and acrylic resin. They also are used for small, non-load-bearing fillings (between the teeth) and on the root surfaces of teeth, and they have low to moderate resistance to fracture.

Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Nevertheless, both types are well tolerated by patients with only rare occurrences of allergic response.

Indirect Restorative Dental Materials (Two or more visits)

Sometimes the best dental treatment for a tooth is a restoration made in a laboratory from a mold. These custom-made restorations, which require two or more visits, can be a crown, an inlay, or an onlay. A crown covers the entire chewing surface and sides of the tooth. An inlay is smaller and fits within the contours of the tooth.

An onlay is similar to an inlay, but it is larger and covers some or all chewing surfaces of the tooth. The cost of indirect restorations is generally higher due to the number and length of visits required and the additional cost of having the restoration made in a dental laboratory. Materials used to fabricate these restorations are porcelain (ceramic), porcelain fused to a metal-supporting structure, gold alloys, and base metal alloys.

All-Porcelain (Ceramic) Dental Materials

All-porcelain (ceramic) dental materials include porcelain, ceramic, or glass-like fillings and crowns. They are used as inlays, onlays, crowns, and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the tooth’s enamel. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel.

All-porcelain restorations require a minimum of two visits and possibly more. The restorations are prone to fracture when placed under tension or on impact. The strength of this type of restoration depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear, but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough.

Porcelain-fused-to-Metal

Another type of restoration is porcelain-fused-to-metal, which strengthens a crown or bridge. These restorations are very strong and durable.

Combining porcelain bonded to a supporting metal structure creates a more substantial restoration than porcelain used alone. However, more existing teeth must be removed to accommodate the restoration. Although they are highly resistant to wear, porcelain restorations can wear opposing natural teeth if the porcelain becomes rough. In addition, there may be some initial discomfort with hot and cold. Finally, while porcelain-fused-to-metal restorations are highly biocompatible, some patients may be allergic to some types of metals used in the restoration.

Gold Alloys

Gold alloys contain gold, copper, and other metals, resulting in a strong, effective filling, crown, or bridge. They are primarily used for inlays, onlays, crowns, and fixed bridges. In addition, they are highly resistant to corrosion and tarnishing.

Gold alloys exhibit high strength and toughness that resists fracture and wear. This allows the dentist to remove the least amount of healthy tooth structure when preparing the tooth for restoration. Gold alloys are also gentle to opposing teeth and are well tolerated by patients. However, their metal colors do not look like natural teeth.

Base Metal Alloys

Base metal alloys are non-noble metals with a silver appearance. They are used in crowns, fixed bridges, and partial dentures. They can be resistant to corrosion and tarnishing. They also have high strength and toughness and are resistant to fracture and wear.

Some patients may show allergic sensitivity to base metals and some initial discomfort from hot and cold. However, gold alloys do not look like natural teeth due to their metal color.

Indirect Composites

Crowns, inlays, and onlays can be made in the laboratory from dental composites. These materials are similar to those used in direct fillings and are tooth colored. One advantage to indirect composites is that they do not excessively wear opposing teeth. However, their strength and durability are less than porcelain or metal restorations, and they are more prone to wear and discoloration.

Ready to Help!

Our expert team at Grove Smiles Dentistry is ready to help you and your families address tooth pain and restore and strengthen function for healthier teeth and gums for life.

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This entry was posted on Saturday, April 29th, 2023 at 9:34 am and is filed under Dental Articles. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.