With new materials being invented all the time the usage of amalgam fillings is rapidly declining. The new materials such as composites and porcelain offer a much more aesthetically pleasing result.
In this example an old amalgam filling is replaced using a composite filling.
This information is provided to help you make better decisions about the use of materials and tooth restorations in your mouth. Many types of metals are used in dentistry for the replacement and rehabilitation of oral structures. Most of these metals are considered to be inert when placed in the body while others have been criticised as potential toxins orallergens to some people. Plastic and ceramic are used commonly as tooth restoratives and have not had adverse biologic responses.
Your dentist will give you advice on advantages and disadvantages of each type to allow you to make an informed decision. The best type for you will depend on how big the restoration is, whether it is in a visible part of the mouth and cost.
Silver amalgam (an alloy that contains silver, tin, copper, zinc, and about 50% mercury) has been used for approximately 160 years for the restoration of teeth. It has been highly successful but is an unsightly material. Use of mercury in the body has been criticized since its inception, but amalgam use is still supported strongly by the American Dental Association and other groups worldwide. A small percentage of people in the overall population may be allergic to the elements in silver amalgam. You do have several options:
Average longevity is 15 years, silver colour; low initial cost; best in small-to-medium-sized restorations of posterior teeth.
Gold Inlays and Onlays
Average longevity 20 years to life; gold colour; moderate-to-high
Resin Composite (plastic)
Average longevity 10-15 years; tooth-colored; moderate cost;
Average longevity 10 years. Tooth-colored, fluoride containing plastic type filling. Not very strong, so wears down quickly. Good for fillings in kids teeth, or as a temporary filling, or in a patient with a lot of decay.
Average longevity 10-15 years; tooth-colored; moderate-high initial cost; best in moderate-sized restoration for any teeth; two-appointment placement.
Crowns or Fixed Prosthesis
Gold alloys have been used for many years for the construction of crowns or fixed bridges. They provide excellent, strong, long-lasting service. Two major types of alloys are now available:
a. High Noble Metal – Mostly gold, also palladium, silver; occasionally platinum, zinc, copper.
b. Base Metal – Mostly nickel also chrome or cobalt and other base metals.
All of the above metals are used either as the sole constituent of a crown, or as a base on which porcelain is fired (baked). Most people have no biologic response to the base metals. If you have known allergies to metals, please tell us. We usually use high-noble metals. The cost of these is somewhat higher than base metals.
Porcelain Only Crowns
Pure porcelain crowns are now being used more extensively in aesthetic areas.
Your Choices for Bridges
a. Metal Alone (high-noble or base metal) – Longevity 20 years to life, gold or “silver color; moderate-to-high initial cost; may be used in any area where metal display is not objectionable.
b. Porcelain Fused to Metal – Longevity 10-20 years; tooth-colored; moderate-to-high initial cost; may be used in any area where extreme stress or grinding habits are not present.
c. Ceramic Non-Metal containing crowns (anything over a three-unit bridge constructed from ceramic alone is not advisable). – Longevity 10-20 years; moderate-to-high initial cost; may be used in any area where extreme stress or grinding habits are not present. Used when aesthetics is important.