When patients have a cavity that is not too large, there are four options to “fix” or restore the tooth. These options are silver amalgam, composite, porcelain and gold.
Silver amalgam restorations are extremely durable and hold up very well on back teeth. Our experience has shown that amalgam restorations may last decades. If anyone suggests removal of a silver amalgam restoration ask “Is the filling broken, is there decay or is there some other good reason to replace?”. It is fine to replace silver amalgam restorations because of your cosmetic desires. Your options if you want “white” fillings are composite and porcelain. In patients with high decay rates, we would suggest silver amalgam versus composite (plastic) restorations. Often, we place silver amalgam restorations in teenage patients if they seem to be struggling with decay. Later in their mid-twenties they can replace those restorations with composite, porcelain or gold. Silver amalgam restorations are completed in one appointment.
Composite fillings are plastic restorations that are also placed in one appointment. The advantage of composite restorations is their colour. Disadvantages include breakdown of bond to the tooth with time, they wear faster than other restorations and are technique sensitive to place to achieve good contours and contact with adjacent teeth. Whenever possible, a dental rubber dam should be used when placing composites to prevent contamination from the humidity and saliva in the mouth. When we see new patients to our practice, we see a higher failure rate of composite restorations than the other choices. However, often this is related to the fact the previous composite restorations were not placed using the rubber dam. We find that composite restorations hold up very well on front teeth but on back teeth, silver amalgam, porcelain or gold maybe a better choice.
Porcelain restorations are the happy medium of colour and strength. Placing porcelain usually involves two appointments. The first appointment is to remove the decay, prepare the inlay or onlay restoration and take an impression or scan. The dental laboratory fabricates a piece of porcelain that is bonded in place at the second appointment. Current porcelain restorations are very strong, have good colour and hold up well to wear. Porcelain restorations have a higher fee than composite (plastic) fillings but will last much longer in most cases.
Finally, gold restorations are the “gold standard” that all other materials are measured. Gold has many advantages that include gold fillings/castings will not break or fracture, gold does not absorb oral fluids, gold does not oxidize, gum tissue responds very favourably to gold and gold restorations can last a lifetime. Gold fillings are usually referred to as inlays or onlays depending on how much tooth structure they replace. There are fewer and fewer dentists trained how to prepare and deliver gold restorations. Dr. Hess is the Director of the Tucker Institute at the University of Washington School of Dentistry. Once a year, the Tucker Institute hosts dentists from around the world for a week long course to educate them on the Tucker Technique.