When people are looking to replace amalgam fillings, or need a new filling, I’m often asked to explain the difference between a restoration and a filling.
I’m also asked to explain the benefits of tooth coloured versus silver amalgam fillings, particularly for people who are concerned about the health risks.
You know, these are good questions. And most patients wouldn’t know the difference until their dentist explained it to them.
And that’s what we’ll do in this blog, so you have the information you need to make an informed decision.
Does your dentist restore teeth or do fillings?
Now some people might say I’m getting technical, but I argue there is a difference between the two.
To understand this difference it helps to understand each in more detail, so let’s explore what a tooth restoration is.
Technically, I’ve fixed thousands of teeth throughout my dental career.
But really, for me, a filling has never been a filling.
As a dentist who cares about the longevity of a patient’s tooth, I don’t really do fillings.
I prefer to think of it as performing is a tooth restoration.
In layman’s terms, for me, a filling means I’m simply plugging a hole in the tooth.
By contrast, a tooth restoration is restoring a tooth as close as possible to its original form and function; so the tooth not only looks great but it functions optimally again, and in harmony with the adjacent and opposing teeth.
That’s a big difference to a simple filling, which might be an immediate ‘quick-fix’, rather than a long term solution.
This means, if you’re focused on long term outcomes, a tooth restoration is the way to go.
Direct v. Indirect Tooth Restoration
When it comes to tooth restoration, you should understand there are direct and indirect restorations.
So which should you choose?
Before making a decision about either, there are some key considerations.
With a tooth restoration, we want to know if:
- The materials used are safe (are they biocompatible?)
- It will look good (does it look like the original tooth?)
- The restoration will promote good oral hygiene (is it easy to clean and resistant to bacteria?)
- It will be cost effective (financially and importantly, from a biological perspective)
- It will last the distance (the timing for when it will need to be replaced?).
It’s my practice to give consideration to all these factors when performing a tooth restoration.
As a dentist advising patients on the best options for a tooth restoration, I feel it pays to understand as much as possible.
Direct Tooth Restoration
A direct tooth restoration is made directly in the mouth during a single visit to the dentist.
A direct restoration is usually made from one of two materials – composite resin or glass ionomer cement (GIC).
Both composite resin and GIC are biocompatible – which means they can be used safely by humans.
Aesthetically, they have significant appeal. Both are tooth coloured, so they look very natural in the mouth. This makes them quite different to amalgam fillings, which are dark, silver and easily noticeable.
On the downside, they are not the most enduring solution, so long term, costs can add up. These costs apply financially, as well as biologically.
GIC is not strong enough to last a long time in a large cavity and because of its formation, composite resin will shrink as it sets. Over time, this has the effect of pulling on the tooth at the joins and creating stress.
While this might be okay for a small hole (relative to tooth size), it can create issues for a larger holes or restorations.
A bigger hole will naturally have a greater volume of filling material. Ultimately, this leads to more shrinkage and less tooth to absorb the stresses caused by the shrinkage.
In some instances, it will mean a filling needs to be replaced.
Each time this happens, the tooth is weakened. Eventually, the damage caused to the tooth by repeated fillings can be so significant, a crown is needed to repair the tooth.
Indirect Tooth Restoration
An indirect restoration is made outside the mouth, i.e. in a dental laboratory or by specialised equipment in the practice.
Usually prepared with porcelain or ceramic materials, indirect restorations produce a better quality outcome for patients.
While it takes longer to perform – an indirect tooth restoration is done over two visits – an indirect restoration is superior to one placed directly.
An indirect tooth restoration:
- Lasts longer than a direct restoration
- Supports the tooth more effectively (thereby promoting the tooth’s longevity)
- Looks fantastic!
- Is a very conservative option in terms of biological cost (long term).
Because of the technique and material used, an indirect tooth restoration overcomes the issues of shrinkage experienced with direct materials.
Materials used for indirect tooth restoration are among the healthiest and most hygienic available in dentistry. They also allow the restoration to be made to the ideal shape and contours of the tooth.
Where visibility and access to the tooth might be an issue when working directly in the mouth, an indirect restoration overcomes these challenges.
By working on the restoration in full light, and with access from all angles (rather than in a patient’s mouth), a dentist (and technician) can design and refine the ideal solution.
At the second visit, the restoration is bonded in place, allowing the tooth to be reinforced from within (better than any direct restoration can).
By contrast to a direct tooth restoration, no stress is placed at the join or within the tooth.
Another big plus for indirect tooth restorations is they are more durable than direct restorations.
Although initially more expensive than a direct tooth restoration, the financial cost is comparable when you consider the number of times a direct tooth restoration may need to be replaced.
Additionally, no cost consideration would be complete without accounting for the biological cost of replacing fillings, which can be significant.
The biological cost of indirect tooth restoration over a lifetime is lower than a direct tooth restoration. This means it’s better for the tooth because it doesn’t need to be replaced as often. Ultimately, the benefit to you is you’re more likely to keep your tooth for life.
Have questions about your fillings or tooth restorations? Or are you thinking about replacing your silver amalgam fillings? Let us know and one of our dentists will get in touch to discuss the best option for your tooth restoration.
Owned by Dr Les Jabbour, Define Dental is located in Benowa. As the Gold Coast’s premier dental practice that’s been providing quality dental care to local residents longer than any other, Define Dental offer a vast range of dental treatment options for everyone including, teeth whitening, dental implants, veneers and more.