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Direct Fillings

After dental decay is removed from the tooth, the resulting cavity needs to be filled to prevent sensitivity and pain, as well as to restore function back to the tooth. There are several different types of fillings that can be placed directly in the mouth.
Amalgam fillings have been in use for more than a century. Despite being one of the more controversial restorative materials, it is one of the most thoroughly researched and extensively tested. Dental amalgam contains silver, tin, copper, zinc and mercury. In comparison to other restorative materials, amalgam is durable, easy to use, resistant to wear and relatively inexpensive. Amalgam is less sensitive to moisture contamination compared to composite resin (white) fillings, and can be used in areas where it is difficult to keep the cavity dry during the placement of the filling, such as deep cavities that extend below the gum line. Furthermore, it can withstand high chewing forces, and are useful for restoring back teeth where chewing forces are the greatest.
Composite resin fillings are white fillings which have become more popular. They are composed of a glass or quartz filler in a resin matrix, producing a white, tooth-coloured material. Composite resin fillings offer improved aesthetics, but they are less durable than amalgam and may need to be replaced more frequently than amalgam fillings. It generally takes longer to place a composite resin filling compared to an amalgam filling as the material is more technique sensitive. Also the tooth has to be dry to prevent moisture contamination, which can affect the bonding of the filling material to the tooth.
The chewing surfaces of your back teeth are not flat. There are usually grooves on the surfaces of the teeth. When these grooves are deeper, it is difficult to keep debris out of them, making the teeth more vulnerable to dental decay. Dental sealants are a special plastic coating that can be placed on the surface of the teeth to prevent plaque and bacteria from being lodged in these grooves, protecting the teeth from dental caries. Sealants are usually placed in children as soon as their adult molars begin to come through, but adults can certainly benefit from them as well.

Indirect Fillings

Inlays and onlays are indirect fillings. Compared to direct fillings that can be placed in one visit, indirect fillings are fabricated in a dental laboratory, and require two appointments. The advantages of indirect restorations are that since they are made in a controlled environment (outside the mouth), the contours can be shaped better and closer fit of the restorations to the teeth can be achieved. These factors contribute to the higher success rates and longevity of these restorations. They are however more costly than direct fillings and require two visits.

During the first appointment, the tooth is prepared and an impression of the tooth is made. A provisional restoration is placed to prevent pain or sensitivity from the tooth. The impression is then sent to the dental lab where the dental technician makes the restoration. During the second appointment, the provisional restoration is removed and the definitive restoration is delivered.

Several different types of materials can be used for the fabrication of indirect restorations. Cast gold is the longest lasting, with restorations being able to last from 6 to 20 years or longer. This is followed by porcelain, which may be in service anywhere from 5 to 15 years. Composite resin can also be used, but is less durable than cast gold or porcelain. However it is also more economical than the other two materials.

Inlays vary from onlays in terms of their size. For smaller cavities, inlays would be adequate to restore the teeth to function. However as the cavities get larger, the stiffness of the teeth decrease, and onlays are required to reinforce the teeth to prevent them from fracturing under chewing forces.


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