Dr. Wineman is dedicated to protecting, improving and then maintaining your oral health. Because of the wide variety of dental procedures, it is important to talk openly with your dentist. Let Dr. Wineman know of any changes to your health since your last visit. This will help him recommend the best treatment options for you. This sheet outlines the most common filling options that are available in our office and will help you decide on the right choice for you. Dr. Wineman will recommend the best treatment option but the ultimate decision rests with you, the patient.

Amalgam: Dental amalgam is a mix of approximately 35-43% mercury combined with other metals including silver, copper and tin. Dental amalgams have commonly been called “silver fillings” because of their silver color when they are first placed. Today, amalgam is most commonly used in the back teeth. It is one of the oldest filling materials and has been used (and improved) for more than 150 years. Dental amalgam is the most thoroughly researched and tested filling material.

Advantages:

1. Strong, durable and stands up to biting force;
2. Can be placed in one visit;
3. Normally the least expensive material;
4. Self-sealing with minimal-to-no shrinkage and it resists leakage (leakage occurs when a filing does not completely seal, permitting bacteria and food debris to “leak” and promote new decay behind or beneath the filling);
5. Resistance to further decay is high;
6. Frequency of repair and replacement is low;
7. Amalgam is the only material that can be placed in a wet environment, especially important when treating small children or special needs patients.

Disadvantages:

1. While agencies like the U.S. Food and Drug Administration (FDA), the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO) have not found evidence of harm from dental amalgam, there are some who have raised concerns about the very low levels of mercury vapor released by amalgam;
2. Amalgam scrap (waste leftover after repairing a cavity) contains mercury and requires special handling to protect the environment;
3. Amalgam can darken over time as it corrodes. This does not affect the function of the filling, but many find it less attractive than tooth colored materials;
4. Placement of amalgam requires removal of some healthy tooth;
5. In rare cases, a localized, allergic reaction, such as inflammation or rash may occur.

Composite (resin): Composite is a mix of acrylic resin and powdered glass-like particles that produce a tooth-color filling. This type of material may be selfhardening or may be hardened by exposure to blue light. Composite is used for fillings, inlays and veneers. It is frequently used to replace a portion of a broken or chipped tooth.

Advantages:

1. Color and shading can be matched to the existing tooth;
2. Composite is a relatively strong material, providing good durability in small to mid-sized restorations that need to withstand moderate chewing pressure;
3. Composite may generally be used on either front or back teeth;
4. Fillings are usually completed in a single visit (exceptions noted);
5. Moderately resistant to breakage;
6. Often permits preservation of as much of the tooth as possible;
7. Low risk of leakage if bonded only to enamel;
8. Does not corrode;
9. Moderately resistant to further decay, new decay is easy to find;
10. Frequency of repair or replacement is low to moderate.

Disadvantages:

1. 1. This type of filling can break and wear out more easily than metal fillings, especially in areas of heavy biting force. Therefore, composite fillings may need to be replaced more often than metal fillings;
2. Compared to other fillings, composites are sometimes difficult and time-consuming to place. They can not be used in all situations;
3. Composite generally is more expensive than amalgam; may not be covered by some insurance plans;
4. May require more than one visitfor inlays, veneers and crowns;
5. May wear faster than natural dental enamel;
6. May leak over time when bonded beneath the layer of enamel;
7. In rare cases, a localized, allergic reaction such as inflammation or rash may occur.

Porcelain (ceramic): All-porcelain (ceramic) materials include porcelain, ceramic or glasslike fillings and crowns. They are used in inlays, onlays, crowns and cosmetic veneers. Porcelain fused to metal is another application for this material and has similar properties as described below with the notable exceptions of increased durability due to the metal substructure, the necessity for more tooth removal for that substructure and, in rare cases, a localized allergic reaction may occur.

Advantages:

1. Tooth-colored with excellent translucency. The color looks similar to natural tooth enamel;
2. Very little tooth is removed when used as a veneer, more tooth is removed for a crown;
3. Good resistance to further decay if it fits well and properly bonded onto natural tooth structure
4. Is resistant to surface wear but can cause some wear on opposing teeth;
5. Resists leakage because of precise shaping and fitting;
6. Does not cause allergic reaction.

Disadvantages:

1. Material is brittle and prone to cracking under biting force;
2. May not be recommended for molars;
3. Generally, requires a minimum of two appointments to complete;
4. High cost, similar to gold.

Gold Alloys: Gold alloys contain gold, copper and other metals that result in a strong, effective filling, crown or bridge. They are primarily used for inlays, onlays, crowns and fixed bridges.

Advantages:

1. Excellent durability, does not crack under stress;
2. Good resistance to decay if it fits well;
3. Minimal amount of tooth structure needs to be removed;
4. Wears well, does not cause excessive wear to opposing teeth;
5. Resistant to corrosion and tarnishing;
6. Resists leakage because it can be shaped and fit very precisely.

Disadvantages:

1. Gold is normally the highest cost material;
2. A minimum of two appointments is required to complete the restoration;
3. Not tooth colored; gold is a great conductor of thermal changes perhaps making the tooth more sensitive to extreme temperature changes while eating or drinking;
4. In rare cases, a localized allergic reaction such as inflammation or rash may occur.