Dental Fillings in San Antonio, TX

Tooth-Colored Restorations (Resin or Porcelain)

There are many advantages to tooth-colored restorations. Resin fillings, porcelain inlays, and porcelain onlays are bonded to the teeth, creating a tight, superior fit to the natural tooth and are more natural in appearance. In instances where much of the tooth structure has been lost, porcelain inlays and onlays are typically preferred over resin and amalgam fillings due to their strength and how they are fabricated.

Quick definitions:

Direct Resin (composite)—These fillings are placed directly in the tooth at the same appointment. They are tooth colored and are placed as a soft putty or thick liquid into cavity preparation in increments. Once an increment is in place, an ultraviolet light is used to harden or set the resin. Once the resin is placed, it is filed down and polished to match the patient’s bite and look natural. This is the most common type of filling placed in most offices.

Indirect Resin (composite)—Indirect means that an impression of the cavity preparation is taken and the resin filling is then fabricated in the dental laboratory on a model (copy). The resin restoration is either milled using CAD/CAM technology or made by additive technique, as direct resins are made. Once fabricated, it is then bonded in place during a second appointment.

Inlay—Fabricated indirectly as an indirect resin. Takes two appointments. Can be made of porcelain, resin, or gold

Onlay—Similar to an inlay, but covers over one or more cusps (points) of a tooth

Since the resin used in tooth-colored restorations contains fluoride, this can help prevent decay. The resin wears like natural teeth and does not require placement at the gum line, which is healthier for your gums!

The result is a beautiful smile!

Dental Amalgam or Silver fillings

Dental Amalgam was once the most commonly used dental filling. It has been used for over 150 years. It is a mixture of mercury with a metal powder that consists mostly of copper, tin, and silver. Amalgam has many advantages over other restorative materials, such as low cost, strength, durability, ease of placement, and bacteriostatic effects.

Amalgam is still used in dentistry for a number of reasons. It is relatively easy to use and manipulate during placement; it remains soft for a short time, so it can be packed to fill any irregular volume, and then forms a hard compound. Amalgam possesses greater longevity than other direct restorative materials, such as composite. On average, most amalgam restorations serve for 10 to 12 years, whereas resin-based composites serve for about half that time. However, with recent improvements in composite material science and a better understanding of the technique-sensitivity of placement, it should be noted that this difference is decreasing.

There are circumstances in which composite (white fillings) serves better than amalgam; when amalgam is not indicated, or when a more conservative preparation would be beneficial, composite is the recommended restorative material. These situations would include small occlusal restorations, in which amalgam would require the removal of a more sound tooth structure, as well as in “enamel sites beyond the height of contour.”

The American Dental Association Council on Scientific Affairs has concluded that both amalgam and composite materials are considered safe and effective for tooth restoration.

Silver fillings have many drawbacks. The edges of the silver filling can wear down, become weak, or break. This results in the tooth not being protected and lets cavities get started once again.

Silver fillings, depending on when and how they were placed, can tend to absorb moisture and expand over time. With age, the metal of a silver filling expands, contracts, and can split. When a large silver filling has been in place for many years or decades, this expansion may cause fractures leading to sensitivity, decay, root canal, all of the above, and even extraction. Our philosophy is not to replace every silver filling we see; patients need to be aware of the makeup of these restorations and what risks might be ahead. Our office has many patients who have silver fillings that have been in place for 30 years or more and are still functioning well.

Silver fillings contain 50 percent mercury. They can corrode, leak, and cause stains on your teeth and gums.

A significant disadvantage is that silver amalgam fillings are dark and are a significant blemish in patient aesthetics.

This material also broadcasts a bluish black tint through the tooth dentin and enamel, which makes the tooth much darker than the adjacent teeth.

Fortunately, silver fillings can safely be replaced with Tooth-Colored Restorations.

Our office rarely uses amalgam (silver) fillings; there may be times when they are a good option. Most often, this is when achieving isolation and a dry field is too difficult. Bonded (tooth colored) resin restorations ARE technique sensitive and require a clean, dry field. Dental bonding is not much different than painting. You would not paint a fence out in the rain, right? So the same for dental bonding. Once a tooth has been prepared, cleaned, and rinsed, any contact from oral fluids can significantly weaken and/or prevent bonding. This lack of bonding can lead to issues such as sensitivity, decay, and potentially root canal therapy.

Replacement of amalgam fillings is desirable when an adjacent tooth is to be crowned. If we select an appropriate shade for you, but which is much lighter than the amalgam-filled tooth next to it, then the two teeth are in color contrast, and the result is greatly compromised for esthetic value. It is best to address the amalgam at the same time we are providing a dental crown next to it.

The overall result is a younger and more attractive smile, while at the same time creating a long-lasting, healthy result.

Replacing Silver Fillings with a Tooth Colored Restoration

You can have your silver fillings replaced with tooth-colored restorations (either resin fillings or inlays and onlays). While resin fillings can be done in one appointment, inlays and onlays usually require two appointments.

Your First Appointment:

1. The old filling is removed along with any additional decay.
2. An impression is made of your teeth. A model of your teeth is made and sent to the lab.
3. A temporary onlay is placed on the tooth.

At the lab, a resin is carefully placed into the model of your teeth. It is then designed to look natural.

Your Second Appointment:

1. The temporary onlay is removed.
2. A conditioning gel is placed on your tooth to prepare it for the new onlay.
3. Bonding cement is placed on the tooth, and a high-intensity light bonds the resin to the tooth.
4. The tooth is then polished.

Your teeth are restored to a natural look and feel, they are stronger, and the tooth is protected!