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Questions about Materials for Restoring Teeth

  1. Are there different materials used for fillings as opposed to crowns?
  2. What are the best materials to use – that last the longest?
  3. What are the least expensive ways to fix teeth?
  4. Is silver-amalgam a healthy material to put in my mouth?
  5. Are plastic fillings healthy in my mouth?
  6. Is porcelain a good material to put in my mouth?
  7. Is gold a good material to put in my mouth?
  8. I got a porcelain crown and from the start didn’t really match the other teeth well – it was the same color but just looked different somehow – what could be the problem, the dentist wasn’t much help with this?
  9. Why do I have to pay so much more for plastic fillings when they seem to take much less time than the old silver fillings?
  10. Do the plastic fillings last as long as the old silver fillings?
  11. Do porcelain crowns last as long as gold crowns?

Answers about Materials for restoring teeth:

  1. Are there different materials used for fillings as opposed to crowns?  Yes.  Dentists typically either use silver amalgam or composite resin for fillings, and gold or ceramic for crowns.  The filling materials are able to be placed into the cavity preparation in the tooth after the decay is removed, and it sets in place like plaster on the wall.  For crowns the materials are made in the lab on models of the tooth as it is prepared to receive this INDIRECT restoration. ……………….BACK to questions
  2. What are the best materials to use – that last the longest?  For fillings the material that lasts the longest is silver amalgam, hands down.  The disadvantage is the appearance, but if the dentist POLISHES it, the way they are supposed to, it looks shiny and silvery instead of black, and that is much better.  For posterior crowns the material that lasts the longest is gold, hands down.  Again the appearance for some is objectionable, but gold crowns can often be done so as to minimize or even eliminate the possibility of seeing it conversationally.  For anterior crowns it must be tooth colored, and a handcrafted porcelain crown with metal substructure or coping (ceramometal or porcelain-fused-to-metal, PFM) will last the longest.  This longevity is due to the marginal adaptation, how well the crown fits to the tooth preparation around the edges…………………BACK to questions
  3. What are the least expensive ways to fix teeth?  Well – that depends on the particular situation, and how we determine cost.  For example, you might spend more now, and if the restoration lasts far longer than the alternatives, then OVER TIME you save a lot of money.  In general, if a crown is needed, the up-front cost is about the same for gold and all-ceramic and ceramometal crowns.  Over the long run the gold will be the most economical, ceramometal next and all-ceramic will be the least cost effective.  For fillings the composite resin restorations cost more than silver amalgam, but the silver amalgam will last far longer, making it the most cost-effective…………………BACK to questions
  4. Is silver-amalgam a healthy material to put in my mouth.  For much more detail on this, go to the section on amalgams.  But, the short answer is YES – it is definitely a healthy material.  I wrote the proposal for and executed the data collection for the largest study ever done to evaluate the health effects of silver amalgam restorations, and there was clearly nothing of concern for a typical person.  In terms of mercury exposure for people living in this modern world, eating swordfish is of much greater concern.  The ADA has clearly stated for decades that there is no reason NOT to do amalgam restorations due to the mercury content, in fact it is malpractice for a dentist to tell a patient that amalgams should be replaced because of any health concern.  This does not stop many dentists from making such a statement anyway, because there can be a lot of money in replacing silver amalgam restorations!……………….. BACK to questions
  5. Are plastic fillings healthy in my mouth?  Other than the fact that they have to be replaced rather frequently, with attendant risks of cutting more tooth structure each time, the systemic health effects are likely minimal.  There have been some questions about hormonal interactions in women, but these are not likely to be of concern…………………BACK to questions
  6. Is porcelain a good material to put in my mouth?  There is little alternative for anterior, front tooth crowns.  For posterior, back teeth there are choices, however.  The problem with porcelain or any ceramic is always the abrasivity against the opposing teeth.  These ceramic materials are ROUGH, especially when they have been in the mouth for some period of time.  They wear away the opposing tooth structure…………………BACK to questions
  7. Is gold a good material to put in my mouth?  I often tell patients that if gold were tooth colored that is all we would use in dentistry.  It is THE material with least problems for us.  It is kind to the opposing tooth, it requires less cutting down of the tooth for making the crown, the margins of a gold crown are very well adapted to the prepared tooth so there is the least likelihood of decay starting again at these margins.  It is a GREAT material for dental restorations – but it is a gold-colored material.  However, if it is done so that it cannot be seen, there are no possible objections to gold at all!………………..BACK to questions
  8. I got a porcelain crown and from the start it didn’t really match the other teeth well – it was the same color but just looked different somehow – what could be the problem, the dentist wasn’t much help with this?  The problem is most likely that the transparency of the crown was off.  As you get older, the enamel of your teeth becomes more transparent, and more of the yellowish color of the dentin layer of the teeth is seen through it.  This COLOR can be well matched by the dentist, but if the crown is not as transparent, it will not look as though the light were penetrating into the tooth and coming back out from the inside.  This would seem to be a subtle difference, but in real-life, makes a huge difference in appearance…………………BACK to questions
  9. Why do I have to pay so much more for plastic fillings when they seem to take much less time to do than the old silver fillings?  Good question!  The fact is you should NOT have to pay more.  Dentists charge more for composite resin fillings, and insurance companies are willing to reimburse them more money for these, because they ARE SUPPOSED to take longer to do.  In fact, to do them well – so they last their expected lifetime – they REQUIRE more time and it is justified to charge more money.  Over the last three decades materials manufacturers have developed new approaches save time for the dentist, so the dentist will always select the newer approach.  Many dentists don’t’ understand the sensitivity of the filling to their technique and the lifetime of the average filling is getting shorter and shorter when it does not need to be.  AND, of course, dentists will charge for the composite resin filling AS IF it took longer to do!  It is ironic that you can pay the same for a composite resin filling that will last only 5 years as for one lasting 15!  Amalgam fillings are done with a very well established technique that has remained unaltered over the decades, and a skilled dentist can do them reliably and quickly, so there is no need to charge a lot…………………BACK to questions
  10. Do the plastic fillings last as long as the old silver amalgam fillings?  NO!  The typical composite resin filling in the dental practice community these days will last 5 – 7 years, whereas it should last 15.  The typical silver amalgam filling will last 20 years, but can last your lifetime…………………BACK to questions
  11. Do porcelain crowns last as long as gold crowns?  NO! The all-porcelain crown will often have to be replaced because it is doing too much damage to the opposing teeth, or it is getting more decay along the borders or margins of the crown that do not adapt well to the tooth preparation, or they will fall off because of the reliance on sensitive adhesive technology.  Ceramometal, porcelain-fused-to-metal, crowns will last longer because the metal substructure makes it possible to get better adapted margins, but not as well adapted, especially on the facial, visible, side as for gold.  Gold is literally the “gold standard” when it comes to longevity for crowns – it has by far the best marginal adaptation, and does not grind down the opposing teeth…………………BACK to questions