When a tooth needs to be filled there is no ideal filling material that adequately replaces the original tooth substance. The most common filling material used in the past has been amalgam (Silver Fillings). Amalgam is a silver grey material which often goes black in time. It is made of several metals including silver and mercury. It is easy to use and lasts well. Many patients and dentists have concerns with amalgam because of its appearance and toxicity. Research has shown that there is no more toxicity in an Amalgam filling then there is in a can of soft drink. There is no evidence to support that prolonged use of amalgam is any more dangerous than any other filling material used.

Tooth coloured fillings have been used for over 50 years for front teeth and in the past 30 years there have been significant developments in tooth coloured fillings for back teeth.

There are various types of tooth coloured fillings, the most commonly used is “Composite”” which is a plastic material with small glass particles in it. It is placed in one visit and sets instantly. There are also inlays which are fillings made by a dental technician and then glued into the cavity. These normally take two visits. They can be made of porcelain or a heat and pressure cured composite plastic material. Inlays offer a longer average life than composite fillings.

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Review

Tooth coloured fillings (composites and inlays) closely match the colour of the teeth and are better cosmetically than amalgam. They are bonded to the teeth with adhesives. Modern day composites are very durable. Porcelain and composite inlays are even more durable. Composites may also be the treatment of choice in small fillings in back teeth because they often require less tooth substance to be removed in their preparation. They take more time to do and the dentist needs to ensure that they are not contaminated with moisture when placing them. Composite fillings cost more than the equivalent amalgam filling. Inlays cost more than composite fillings.
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Disadvantages

Tooth coloured composite fillings are plastic and are likely to wear more quickly than amalgam. They are more brittle and not suitable or strong enough for some situations particularly when replacing a very large filling in a tooth. They also may need to be replaced more frequently. Inlays or even crowns are more appropriate for large restorations.

Plastic composite fillings may discolour or stain, although they can be polished or resurfaced relatively easily in most cases. Some patients experience more sensitivity after composite fillings. It is not always possible to predict whether a filling will be successful and sometimes further treatment is necessary. If a tooth doesn’t settle down after being filled a root treatment may be necessary.

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Alternatives

A more long lasting and better solution for large composite fillings may be a tooth coloured crown (cap) or a tooth coloured porcelain inlay. All of these are made by a dental technician and usually taking two visits to complete.

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