Dental Aesthetic with White Filling II (On Back Teeth)

Nowadays, more and more people want to have not just a strong and lasting filling but looks good and really look like tooth structure. They don't thier fillings to be seen by others.

Below are the clinic pictures of white fillings on the posterior (back) teeth.

Case 1

A large cavity in the molar and premolar teeth

Composite (White filling) was used to replace the missing tooth structure of the molar and premolar teeth

Case 2

A very extensive decay almost eaten up the whole molar tooth

White filling was used to build back the crown part of the tooth

Case 3

Another case of large cavity in the molar

It can be treated with white filling which result in highly aesthetic filling

Case 4

A case of old silver (amalgam) filling which had chipped-off

The tooth was restored with white filling

Case 5

Another case of multiple silver filling which were old

 Composite filling was used to replace the silver one, making the fillings difficult to be recognized

Case 6

Caries over the molar teeth (The first and second molar teeth)

The teeth were replaced with white fillings !!

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Dental Aesthetic with White Filling

White filling or composite resin is getting more and more popular currently as it can produce a very nice aesthetic result. Previously silver filling (amalgam) is preferred due to low cost, easy to handle and it has a good mechanical properties (amalgam is strong and durable). However, current composite resin is as strong and durable as amalgam and on top of that, it produce a 'hard to see restoration' on the tooth making it a preferred choice for dentist and patient. Anyway, Nobody wants their filling to be seen!!

Composite resins are composed of Bis-GMA monomers or some Bis-GMA analog, a filler material such as silica and in most current applications, a photoinitiator. Dimethacrylates are also commonly added to achieve certain physical properties such as flowability. Further tailoring of physical properties is achieved by formulating unique concentrations of each constituent.Unlike Amalgam which essentially just fills a hole, composite cavity restorations when used with dentin and enamel bonding techniques restore the tooth back to near its original physical integrity.

The composite resin set with multiple shade/colour to match the tooth colour

Dental composite resin

Here in our clinic, we have multiple shade (or colour) to be chosen to mimic the original colour of the tooth in the mouth. For every restoration, we use different shade for each 'layer' during restoration. 

Below are some of the cases done in our clinic.

Restoring Composite Resin

(Illistration in great depth)

An old amalgam was removed from a upper right molar and the tooth was ready for filling placement

Firstly, the enamel surface of the molar was treated with phosphoric acid 35%

Then, it was followed by the dentine which was located at the center of the tooth

Next, the cavity was cleaned and dried. A thin layer of adhensive solution was applied over the cavity

Light cure unit was used to activated the adhesive which was photo-sensitive

A metal band was used to wrapped around the molar

The metal band was checked to ensure that there was no gap between the tooth and the metal band. This was to prevent the filling material from overflow out from the cavity.

'Dentine shade' composite resin was placed at the center of the cavity to cover the darkish stain in the dentine area.

The composite was light-cured to make it harden

Next, 'enamel shade' composite was placed over the 'dentine shade' composite (layering technique) to get the translucency effect.

'Enamel shade' composite was placed at the side-wall of the molar and was cured (with light-cure unit)

The metal band was removed and more composite was placed at the side-wall of the molar so to achieve a nice contour and bulbosity.

This was the result after the composite harden

The composite excess was removed with a rotary white stone

 The restoration was checked to look of  any interference with the lower teeth during biting and chewing (with a bite registration tape)

And the red markings from bite registration tape was removed

Finally, for aesthetic reason, grooves and fissures was make on the tooth surface

And 'stain' composite was placed on the fissure to make it looked like the neighboor teeth

 Lastly, light-cure unit used to harden the rest of the composite

The restoration was polished to make is glossy and shining

The Final Result!!

Before and after picture.

Replacing old silver (amalgam) restorations with composite restorations

This young gentleman came complaining of sensitive to hot and cold at his bottom right molars. On examination, he had a few siler fillings which cracked and had gaps noted at the margin fo the fillings.

The siler fillings were removed and replaced with white fillings. The fillings match with the colour of the tooth  very well as if there was no filling done!!

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Dental Filling

What is dental fillings?

Dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. Basically... material used to fill up cavity in the tooth after the decay was removed from the tooth.

How Fillings Work

Most cavities discovered during a dental examination will need to be treated. In general, if a cavity has broken through the enamel and is into the underlying dentin, or is able to be probed with an explorer, it has undergone cavitation and requires treatment. Early dental cavities that have not spread to the dentin or have undergone cavitation should not be treated, as they can be healed or re-mineralized with fluoride.

The goal of treating cavities involves two basic principals:
1. Removing the decayed portion of the tooth

Tooth decay

After the decay portion is removed and ready for filling

2. Rebuilding the missing tooth structure with a filling material.

Filling material is used to replace missing tooth structure due to decay

The dentist usually begins the procedure with an injection of local anesthetic if the decay is deep and very sensitive. A high-speed dental drill is needed to remove the decay and prepare the tooth for the filling. Depending on which material is used, the dentist will vary the tooth preparation accordingly.

 Dental drill (High-speed handpiece)

Decay is removed with a high-speed dental drill

After the tooth has been prepared, a liner (Dycal®)is often used to reduce tooth sensitivity.Dycal is a compound containing calcium hydroxide, and is used in deep cavities to stimulate the dentin to regenerate and protect the dental pulp. In deeper fillings, a base is used in addition to the liner. Common bases used under dental fillings are glass ionomer cement and zinc phosphate cement. The main purpose of the base is to insulate the tooth from temperature changes in the mouth.

The dentist and patient can then choose a number of different materials to fill the tooth, but the most common are silver (amalgam), white (resin), porcelain or gold. These materials are layered on top of the liner or base to finish the process of rebuilding the tooth.

After a tooth has been filled, it is not unusual for the tooth to be sensitive for a day or two. In general, the deeper the filling, the more likely the tooth will have prolonged sensitivity, especially to cold food or beverages. Most fillings should be completely comfortable within two weeks. In some cases, the filling will be built up too high, and a second appointment is needed to shave down the filling to a comfortable level. If sensitivity lasts more than two weeks, it may indicate that there is a void under the filling. Prolonged discomfort may also indicate a tooth that has an infected pulp, and requires root canal therapy.

What Dental Material is Best for My Teeth?

Dental Amalgam

Silver (Amalgam) Filling

Every dental material used to rebuild teeth has advantages and disadvantages. Dental amalgam or silver fillings have been around for over 150 years. Amalgam is composed of silver, tin, copper, mercury and zinc. Amalgam fillings are relatively inexpensive, durable and time-tested. On the flip side, they are considered unaesthetic because they blacken over time and can give teeth a gray appearance, and they do not strengthen the tooth. Some people worry about the potential for mercury in dental amalgam to leak out and cause a wide variety of ailments, but research does not bear this fear out.

Advantages:

• Cheap
• Strong
• Lasting
• One visit

Disadvantages:

• Not aesthetic (Silver colour)
• Blacken over time and can give the teeth a gray appearance
• Contain mercury
• Required deeper cavity to retain amalgam
• No chemical bonding to tooth structure

Composite Resin

White (Composite Resin) Filling

Composite resin, or white fillings have been around for about two decades. Composite fillings are composed of an organic polymer known as bisphenol-A-glycidyl methacrylate (BIS-GMA), and inorganic particles such as quartz, borosilicate glass and lithium aluminum silicate. They have the advantage of requiring a more conservative tooth preparation (less drilling required), can have a strengthening effect on the tooth and are very aesthetic, virtually blending in with the tooth. Composite fillings are the material of choice for repairing the front teeth. On the down side, they are more technique-sensitive for the dentist to place, and are highly susceptible to decay in the future if placed improperly. They usually cost more than an amalgam. Despite this research composite fillings are considered safe, and like the other dental filling materials, they are approved by the American Dental Association.

Advantages:

• Highly aesthetic - it can be used to improve aesthetic
• Can be used for shallow cavities 
• Chemically bond to tooth structure
• One visit

Disadvantages:

• Technique sensitive (required dry surface for filling adhesion)
• Can result in tooth sensitivity (due to shrinkage of the composite)
• The strength of composite is lesser than amalgam
• Required replacement or repair due to staining, chipping, wear and tear 
• Cost more than amalgam

 Porcelain inlay/onlay/crown

Porcelain onlay used to formed back missing tooth structure

Porcelain crown is used to

Porcelain is sometimes used for dental fillings called onlays or inlays. Porcelain is a non-crystalline glass composed of silicon and oxygen. It has the advantage of being highly aesthetic, and is the restoration of choice for people who place the highest value in the appearance of their teeth. Porcelain has the disadvantage of being brittle, and, therefore, susceptible to breakage. It is also even more technique-sensitive to use than composite; requires two dental visits to place the filling; and costs significantly more than amalgam or composite fillings. Porcelain can also cause accelerated wear of the opposing tooth when biting.

Advantages:

• Highly aesthetic
  
• Strong
• Lasting
  

Disadvantages:

• Required to scarified more tooth structure for retention
• The retention of the porcelain is depends on the cement used to 'glue' the porcelain to the tooth
• Porcelain is brittle and susceptible to breakage
• Required two visits 
• Can cause accelerated wear of the opposing tooth when biting
• Expensive

Gold Inlay

Gold onlay

Gold is sometimes used for dental fillings, most commonly as an inlay. Gold is not used in its pure form, but as an alloy containing 75 percent gold, as well as copper, silver, platinum, palladium and zinc. Gold is extremely durable; fairly aesthetic, it does not damage the opposing tooth when biting, and is very well tolerated by the gums and other intraoral tissues. A well-done gold filling can last two to four times longer than any other dental material and might be considered the "gold standard" for dental fillings. Gold inlays, like porcelain inlays, take two dental visits to complete and are also much more costly than amalgam or composite. They are also not nearly as aesthetic as composite or porcelain. In addition, gold inlays are fairly difficult to prepare and place.

Advantages:

• Durable
  
• Strong
• Lasting
• Very well tolerated by the gums and other intraoral tissues (bio compatibility)
• Does not damage the opposing tooth when biting (as compared to porcelain)

Disadvantages:

• Not aesthetic
• Difficult to prepare
• Required to scarified more tooth structure for retention
• Expensive because it is GOLD

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