Amalgam Fillings

Invisible white fillings vs Silver Mercury amalgam fillings.

More or less every one of us has a filling in our mouth. Some have the regular mercury amalgam fillings (the grey/silver ones) and others have composite fillings (the white ones).
A filling is a way to close the gaps created by tooth decay (caries). To make things simple we have to see what tooth decay is. Tooth decay is a disease that destroys at first the enamel of our tooth and then keeps going inwards to dentin the next layer in our teeth. Eventually, tooth decay makes its way to the pulp chamber and that is when we start to have pain symptoms – and we all know that this sort of pain is really unbearable.
Unfortunately we cannot regenerate all this tissue that tooth decay took apart. What we can do though, is to stop the disease from destroying more tooth tissue and avoid all the disease’s complications.
These complications are:
A. Complete destruction of the tooth. In this case the tooth requires a proper root canal therapy and then a full coverage crown. Otherwise if the corruption is too excessive the tooth must be extracted.
B. Tooth decay reaches the pulp (nerve). This is called pulpitis. The pain is extreme and unbearable, it becomes stronger with cold and hot streams, the pain intensifies at night and it endures for a prolonged time. In this case the tooth also needs proper root canal treatment and possibly a full coverage crown.
As you can see the consequences are extremely awful (loss of tooth, root canal therapy, full coverage crowns) and hey cost a decent amount of money as well, so it is better to avoid them by simply taking care of our teeth and visiting our dentist every six months in order to fix all the current problems that we have in our mouth and avoid further corruption of our teeth.
Teeth infected with tooth decay can be easily spotted by our dentist during our regular six month visit. Even a patient can spot tooth decay if it is in a visible place on his/her teeth since our teeth are by default white. If you see black-brown spots on your teeth then that is probably a sign of tooth decay.
Teeth that have decay (caries) don’t necessarily give pain symptoms, at least not straight away. Tooth decay gives usually little pain symptoms when you are eating sweets, something cold or hot the pain is not really strong and it doesn’t last for a long time. As soon as the stimulator (sweet, cold or hot) has passed the pain goes away straight away or after two three seconds.
Many people avoid going to the dentist office because they are afraid that it will be painful. Well today we can say with certainty that pain is a thing of the past.
All procedures in dentistry today are painless. Every act in the dental office is done under proper anesthesia. You don’t even need to be afraid of the needle any more. Before the injection the gums are treated with anesthetic gel and literally you will not feel a thing during the injection. Besides today needles are so thin that you wouldn’t feel anything even without the anesthetic gel. As soon as the anesthesia takes place the dentist proceeds with the removal of all the decayed tooth tissues, and continues with the rebuilding of the tooth’s structure with the materials of his choice.
What most people don’t know is that there is no reason to prefer black/grey mercury amalgam fillings to white composites fillings any more, since today composite resin fillings are equally strong as amalgam fillings, they are more aesthetic, and most of all the actually create a chemical bond with the tooth’s tissues something that amalgam fillings cannot achieve.
Yes it is true, mercury amalgam fillings hold on to the tooth only mechanically, there is no chemical bond whatsoever to hold the filling in place. If you add up the fact that mercury amalgam fillings are metal so there is always some micro leakage since heat and cold change the metal’s volume, you can see why today more and more dentists avoid using amalgam in their practice (and as you have noticed I am one of them…). Composite resin white fillings are “glued on” to the teeth there is a strong chemical bond, it is not just a matter of holding on to the tooth mechanically as it is with mercury amalgam fillings and let’s face it there is no comparison to the aesthetic appearance of a (proper) composite resin white filling to that of a mercury amalgam filling.
More and more patients are visiting their dentist to have their mercury amalgam fillings removed. This procedure is becoming more popular due to worries about health risks associated with small amounts of mercury leaking from the amalgam over time.
Amalgam filling, colloquially known as black filling, was a material that has been prefered by many physicians until 10 years ago and was relatively easier-to-implement. Since it was durable and long-lasting in mouth, it has been accepted both by the physician and the patients. But two properties of this product is not much approved; Its color and Mercury component. People had questions about the color in terms of aesthetic, and about mercury in terms of health. There were no material to replace amalgam before. But especially during these last 10 years, thanks to the development of materials in dentistry, materials (White filling – Composite – Porcelain) proven to be more aesthetic and healthier have been started to be used in clinics.
Could you please speak of the development of white fillings?
Two different materials are used for aesthetic fillings, colloquially known as white fillings; composite and ceramic.
At first, composite fillings have been used only for aesthetic purposes in the front teeth. Thanks to the recent developments, their stability has been increased and now they are used for chewing teeth as well. Thanks to the development of bonding materials that bind the composite filling and the tooth, the possible sensitivity has been minimized and it has become longer-lasting in mouth. Therefore, white fillings are used more and in different cases.
Ceramic (porcelain fillings and crowns) is a safe filling material used for both front and back teeth due to its aesthetic appearance and durability. However, ceramic materials are prefered for dentures (crowns, dental bridges) as well.
What are the stages of implementing a filling and a crown to a patient?
Tooth with a cleaned decay is prepared in accordance with the filling principles, and the measure of the lower and upper jaw of the patient is sent to the laboratory together with the closing wax. Ceramic restoration which is received within 3-4 days from the lab is tested in patient’s mouth and its heights are measured and the final compatibility is controlled. After the problems are solved, it is sent to the lab for polishing. The tooth sent by the technician is cemented to the patient’s mouth.
As far as we understand, due to the current methods the patient is supposed to visit your clinic for at least 2-3 times.
If everything works out all right, a patient should visit the physician for at least two times.
Can you inform us about the recent developments regarding the Ceramic Restoration?
In particular, with the use of technology in dentistry there have been very important developments in Denture and Ceramic Restorations as for in many dental treatment areas.
One of them is the CAD-CAM system which enables us monitorize the teeth with special cameras, design the fillings or dentures on computer as 3D together with the patient, and produce the fillings or dentures and implement them into the patient's mouth in the same session instead of measuring the patient's mouth and sending it to the technician.
What are the advantages of CEREC CAD-CAM system for the physician and the patient?
Patients visiting the clinics during their treatment is mostly complaining about “taking a measurement”. In particular, nausea reflex due to the oral contact of the measurement tools disturbes the patients and prevents the physicians from measuring easily and clearly. This effects the compatibility of the restoration and visiting sessions of the patient. Since with the CEREC (Ceramic Reconstruction) system patient’s mouth is digitally measured and no additional tools are used, nausea reflex is completely annihilated.
The most frequent problem a physician encounters is the compatibility of the restoration to the dental tissue. Another advantage of the 3D digital system is that the error margin is almost little if any ( 25 micro metre /half of a barba).
The most important advantage both to the physician and the patient is that the fillings and crowns are completed in a SINGLE session. Now, time is much more valuable for all of us.
Well, how long does this procedure last? Namely, how long exactly does cleaning of the decay in patient’s mouth and implementation of the restoration last?
Thanks to the Digital Ceramic Reconstruction system, it’s possible to prepare a single restoration in a perfect compatibility to the dental tissue and cement it to the patient’s mouth permanently in 30-60 min. per case.
Well, are only fillings and crowns implemented with this technology?
As I have mentioned before, technology provides us with the new developments day by day. CEREC system is present for 26 years and in particular for the last 3 years new programs have been developed which facilitates and accelerates all of these stages of the treatment. Thus, the Clinicial Cerec System that could make a SINGLE member crown in the beginning is now able to make multi-member bridges, ZIRCON lower structures, ZIRCON upper structures, upper structures of the implants (personal abutment) and crowns with improved aesthetical properties.
How common and safe is that system?
Although the system is brand new in our country, it’s been long used in many countries, in particular in Europe and in the USA. For example, 3.500 clinics in Germany and 14.000 clinics in the USA uses this treatment. Not only private clinics but leading Dentistry Faculties of the world conduct and publish studies using this system as well. We have invaluable studies which prove the reliability of this system. Much to my knowledge, Ege Univ., Hacettepe Univ. and İstanbul Univ. Dentistry Faculties are among the universities which use this system and conduct studies.
Regular and continuous training is provided to obtain the most effective treatment with this system. As there are some universities and private institutions abroad that offer this training, in the near future these trainings will start to be offered in Turkey as well. The most important piece that ensures the reliability is the camera with blue light which is on the device and enables to take measurement digitally. Since the tooth and the surrounding tissue is monitorized digitally by this system, the error margin of the measurement is diminished to zero. The error margin of the device which makes the dental crown and cuts the specially prepared blocks is 25 micron, namely one third of our barba. In dentistry, this error margin is almost equal to the “zero error”. When we evaluate the results of the studies and the technological opportunities in this sense, the system is highly reliable. Therefore, the use of this system is increasing expeditiously worldwide.
If you are wondering whether a composite resin white filling can take the pressure since in the past everybody said that “white fillings don’t last; they can’t take the pressure on the molars”, you can rest assured. Today composite fillings are at least equally strong to amalgam if not better.
Composites are totally reliable materials and are used throughout the world. There are two groups of composite white fillings, light curable composite white fillings and chemical curable white fillings.
Chemical curable white fillings harden a few minutes after the mixing of the ingredients. This sort of composite resins are used in very few cases since they are not so easy to work with and the result is not always as good.
Light curable composites on the other hand stay soft until a special light falls on them for a certain period of time making them very flexible to use in all cases, the dentist can use many shades on one tooth to create white fillings that are indeed invisible.
Both kinds of composites have their uses. Chemical curable composites are used most of the time to create temporary crowns and bridges or when light curable composites cannot be used.
Sometimes teeth after getting a filling can be sensitive. Usually this passes in due time – say 24 hours, but if the pain continues to hold on after 48 hours you should seek your dentist’s advice. It is possible that the tooth cavity was deep enough and the tooth’s nerve could not stand the stress of the procedure.
Is this system sufficient for aesthetic success and stability that you’ve mentioned before?
For every crown we make, we pay attention in particular to two topics; Aesthetic and Stability. These are the two factors that our patients expect as a must. In this system, privately developed porcelain and zircon blocks are used for the production of the crowns and the laminates. In our treatment, if aesthetic is at the forefront we use private color layer porcelain blocks, if stability is at the forefront then we use zircon blocks. Recently produced transparent zircon blocks are both very stabile and prefered for the cases with aesthetic purposes. Studies demonstrate that crowns and aesthetic laminates endure and stay in the mouth for 8-10 years. In terms of aesthetic, since it’s completely porcelain, almost a natural dental tissue is reconstructed. For those interested (I especially recommend to individuals who are interested in technology), they can find thousands of video and very detailed information regarding this topic if they search the words "CEREC" or "CAD-CAM Systems" through internet search engines, e.g Youtube.

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