Direct Restorations – Your One-Visit Options 

Last week I talked about the two general categories of filling materials – direct and indirect.  Today I will review the direct materials that can be placed in one visit.  They are appropriate in teeth that need small to moderate fillings where less than 50% of the tooth structure is missing. 

Composite Fillings

I absolutely love composite fillings.  When a filling is appropriate it is the material I utilize the vast majority of time.  They are absolutely beautiful and will “disappear” into a tooth when properly placed.  Composite fillings are a mixture of acrylic resin and finely ground glasslike particles that produce a tooth-colored restoration.  Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations.  Often, less tooth structure is removed when the dentist prepares the tooth for a composite filling than with other types of material because they are “bonded” or adhesively held in a cavity, allowing the dentist to make a more conservative repair to the tooth.  The time required to place a composite filling is usually longer than what is required for an amalgam (silver) filling.  Composite fillings require meticulous technique and a tooth that can be kept clean and dry during the filling process.

Amalgam Fillings

Used for well over a century, dental amalgam is the most thoroughly researched and tested restorative material among all those in use.  It is durable, easy to use, highly resistant to wear and relatively inexpensive in comparison to other materials.  For those reasons, it remains a valued treatment option for many dentists and their patients.

Questions have arisen about the safety of dental amalgam relating to its mercury content, but the major U.S. and international scientific and health bodies—including the National Institutes of Health, the U.S. Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others—have been satisfied that dental amalgam is a safe, reliable and effective restorative material.

Amalgam fillings can withstand very high chewing loads and can last for years when properly placed, but there is a greater tendency towards short-term sensitivity to hot and cold temperatures after an amalgam filling is placed.  I rarely place amalgam any more, not because I think it is a bad material, but because I see more advantages to the tooth-colored composite materials.  Composites also look a lot prettier as well!

Ionomers (Glass and Resin)

Glass ionomers are tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities.  Glass ionomers can release a small amount of fluoride that may be beneficial for patients who are at high risk for decay.  They have a low resistance to fracture though and are mostly used in small non-load bearing fillings or root surfaces of teeth.

Resin ionomers are also made from glass filler with acrylic acids and acrylic resin.  Just like the glass inomers, they are used for non-load bearing fillings and have low to moderate resistance to fracture.

All Ionomers are rarely used in stress bearing areas because they experience high wear when placed on chewing surfaces.  Both glass and resin ionomers mimic natural tooth color but can appear somewhat opaque since they lack the natural translucency of a natural tooth’s enamel.

I hope this helps you better understand your choices when it comes to direct filling materials.  Next week I will discuss the indirect restorations.