By Robert Endicott
I hate white fillings. There, I said it. I hate amalgam ones even more.
That might upset quite a few dentists me saying that. But I think there are good reasons why I CAN say that.
Lets take Amalgams. They are not bonded (glued) into the teeth. So you have to undercut everywhere, which takes away healthy tooth and undermines the strength of the restoration. The fillings contain Mercury and whilst there is no evidence of harm to patients, it is dirty, mucky stuff and very few people actually like it.
They can last for years, no doubt, but I spend all day removing the things because of the cracks they cause to the natural tooth structure. The material expands and contract over time, changes shape, ledges appear, edges chip and wear and then cracks appear in the teeth.
We regularly see little tiny amalgam fillings causing damage like this.
When the teeth crack, they often need root canal treatment and a crown to keep them going long term.
Does that mean we should remove all amalgam fillings? We actually release more mercury taking the things out AND have to remove more tooth. Just make sure that your fillings are getting regularly inspected and get them replaced when they start showing signs of breakdown.
I use an Operating microscope in my office and check around filling edges and photograph each tooth with an Amalgam filling. We chart every problem with that filling. Every examination after that, we can then compare the look of the tooth and if there is any deterioration, we can then advise on its replacement.
Why do I dislike white fillings?
They are a swine to put in! They are very "technique sensitive", they need very clean disinfected tooth material to seal and bond to properly. Trying to do this in a humid mouth full of saliva is very difficult.
Once the cavity is drilled, the filling has to be put in a layers bit by bit, really carefully and set. Each layer shrinks a little when cured so you have to do it in stages.
The tooth is overfilled and then ground down. Because it is liquid plastic it is hard to get a really tight contact between the teeth.
Huge ones don't last that long as they wear down, little ones a great.
I do lots of them, I recommend them to my patients, especially the smaller ones. They average 5-7 years life and really well done ones can last for donkeys years.
In the hands of a skilled practitioner, they are extremely effective and save teeth for years. I wouldn't be without them.
BUT, for large fillings I recommend stronger alternatives, like CEREC.
CEREC is easy!
Once the tooth is prepared, it is scanned into the computer using an Infrared scanning device. The restoration, crown, veneer, filling, onlay - whatever, is designed on the computer and milled out of solid porcelain in about 20 minutes. During this time, as a patient, you can relax, have a drink, read the paper, anything else but have loads of fingers in your mouth rebuilding your tooth by hand.
The restoration is then glazed or polished and bonded easily into the tooth precisely. 9 times out of 10 the bite is perfect, just a little tweak maybe needed.
Being reinforced porcelain, is is incredibly strong, much stronger than plastic white fillings. We even put a 10 year guarantee on our CERECs.
Job done, you walk out with a new crown or filling, no second visit, no temporaries to fall off, no more jabs, the restoration is ready to be used almost immediately.
I have placed over 2000 of these in the last 4 years, with a 97% success rate. We have found through this experience that it is so much easier as a patient to have CERECs done than white fillings.
I've got two of them myself and they are great.
I've put a video on youtube, go to http://www.youtube.com/watch?v=YJNeOhf1eg4 more info about CEREC is found at http://www.quay.tv
So in the future, if you have to have a filling replaced, your options could be amalgam, plastic, CEREC porcelain or Gold. If you want the best, go for CEREC or Gold everytime.
Rob
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