After the broken-down substance of a carious tooth has been thoroughly removed, the affected area is cleaned and filled with a composite filling material. The tooth's natural form and normal function are restored, and the occurrence of additional structural damage is prevented.

Amalgam     Zahnf_Plombe

What are the materials used in fillings?

1.  Amalgam (black fillings) is an inexpensive and easily workable filling material. It has been used for almost 200 years. Amalgam is not an composition, but a chemically unstable mixture of 50% mercury and 50% of silver, copper, tin, zinc, etc.

2.  Composite materials (white fillings) experience an increase in demand due to their pleasing appearance. This modern filler is made out of a combination of glass materials, synthetic resin, and hardener.

When using composites, the exact color of the teeth can be chosen. This allows the filling to blend in perfectly with your natural teeth. Fillings located in the frontal area of the oral cavity need replacement after a few years, as composites may discolor by the consumption coffee, tea, or tobacco.

Glass ionomer cements and compomer cements are also used for fillings (a mixture of composite and glass ionomer). Glass ionomers are well tolerated, but resist existing chewing pressures only for a limited amount of time. Thus, making compomer materials a good alternative to glass ionomer cements.

Which filling materials are best for me?

The eternal question: amalgam versus plastic.

Amalgam as substance is considerably more workable, and cavities are easier/better filled. However, preparation requires more care and often the sacrifice of healthy tooth structures. A severely damaged tooth would be more prone to breaking.

Composites are different: the compound is literally glued to the tooth, and only the decayed substance is removed. The adhesive acts as a stabilizer in a greatly weakened tooth, which improves its internal strength.

Is it true that Amalgam is toxic?

You need to decide for yourself...
Many books have been written about amalgam. Virtual "amalgam wars" were fought about its safety. On one hand, it is considered to be completely harmless, and its use is still recommended in several European countries. In Scandinavian countries, on the other hand, it has been classified as harmful, because of its poisonous mercury content. This resulted in its ban as a filling material.

Amalgam fillings are classified as a toxic waste after their extraction. This could be interpreted to mean, that the only safe storage place for amalgam is either in people, or at the hazardous waste site...

What are the disadvantages of Composites?

If a composite filling (without liner) reaches the proximity of a nerve, an irritation (with associated pain) may ensue. In case of nerve death, a root canal becomes unavoidable. A liner may prevent this, and diminish the toxicity at the same time.

Shrinkage occurring during the hardening process of composites (with a blue light) calls for the application of a layer-by-layer technique. Larger fillings require multiple layers of material to be set and hardened in sequence. The emergence of crevasses on the sides of a large fillings can not be completely avoided, and indicate inadequate sealing.

Are there alternatives to fillings?

Yes, there are inlays, onlays, and crowns.

Gold fillings (gold inlays or gold onlays) are made in a dental laboratory. Gold inlays are well-tolerated by the gums and are mainly recommended for their durability (with good oral hygiene up to 15 years - in most cases even longer - 50 year-old gold inlays are not uncommon).

Gold inlays are modeled by a dental technician and are based on the occlusion (the bite) of the patient. This ensures proper comfort during mastication.

For those reasons, many dentists (and patients) consider gold to be the best filling material of all. Regrettably, gold is the most expensive of all options.

White inlays and onlays are made out of porcelain (in a dental laboratory) and are glued on the inside or outside of the tooth. Their color is matched to the natural hue of the teeth, allowing for a nearly perfect result. Theoretically, a restoration can cover the entire structure of a tooth, but is, because of that, more susceptible to fractures. In general, inlays and onlays do not stain or discolor, and are very durable.

A weakened top of a tooth requires crowning to avoid further damage to its structure.