Which type of filling is most suitable for your teeth?

There are multiple type of filling materials that can be used as a restorative material in operative dentistry by a dentist depending upon different factors. Following are some most commonly used filling material nowadays which are used as restorative materials.

Silver amalgam

Composite

GIC( Glass ionomer cement)

Porcelain

Gold

There are multiple factors in which choice of material could get changed. These factors are type of tooth, patient preference, size of cavity, tooth location, aesthetic factor, retention factor, depending upon if patient is going for crown afterwards or not.

In this article, we’ll discuss all five filling material in detail, there advantages, disadvantages, indications and contraindications.

Silver Amalgam:

Where amalgam is the best choice:

Silver Amalgam is a mixture of mercury with silver,tin, zinc and copper. Silver amalgam is most commonly used in class I and Class II cavities. Class I cavities are present on posterior molar teeth. Pits and fissure on occlusal surface of molar and premolar teeth are called as class I.

While Class II cavities are present on molar but involve proximal walls of molars too not only occlusal. Amalgam is added in a bulk so for core buildup Amalgam is the best choice. Amalgam is one of the hardest material that is used in dentistry as restorative material.

So at points where there is heavy occlusal pressure, Amalgam is used. In mouth, there is saliva present which keeps everything inside wet. Some filling material such as composite and GIC cannot be used in wet condition if saliva cannot be controlled.

So Amalgam can be used in these conditions as well. If patients wants crowing after filling, amalgam is a better option than others depending upon the teeth. Some people came up with cuspal fracture of molar teeth.

In this condition, amalgam is the most recommended material with pins restorations. Amalgam is a dark color filling material. Teeth having caries on unaesthetic areas are indications for amalgam. These are some indications of dark silver alloy material.

Where Amalgam shouldn’t be used:

Nowadays, aesthetics is the prime concern of patient regarding teeth most of the time to make their smile pretty. Amalgam is not an aesthetic loving compound. Also Amalgam do require tooth preparation. Retention of this alloy material is attained by extensive tooth preparation.

Small carious part in class I and Class II is also restored by other material such as GIC and composite. People who has allergic reaction against mercury cannot be treated with silver amalgam as it contain mercury.

Composite:

Where composite is the best choice:

Composite consists of smaller particles, matrix, better bonding system, fillers and some other refined particles that have improved its retention and appearance. Composite is a universal filling material which can be used in all six types of cavities. Class I, II, III, IV, V, VI.

Its aesthetically one of the best material used in operative dentistry. There are pits and fissures present on posterior teeth which can be the potential site of caries due to its morphology. Flowable Composite can be used here as pits and fissure material.

To attach veneers, brackets, bridge and crowns composite should be used as cement material instead of GIC. Splints can be attached with teeth by composite. Teeth where heavy occlusion is not required, composite is the treatment of choice.

As described earlier some patients could be allergic to mercury, zinc, and other metal particles. Instead of Amalgam, composite should be used in these patients. There are two types of lesions, non carious and carious. Non carious lesions should be restored with composite.

Where composite shouldn’t be used:

Isolation is the first ultimate thing observed during patient examination. If salivation cannot be controlled on tooth, composite use is contraindicated. In this circumstance, amalgam is the best filling material choice.

At heavy occlusion areas, composite cannot be used due to its low compressive strength. Composite is just a restorative material who cannot be used in carious lesions. In those conditions, GIC should be the treatment of choice.

Patient suffering from anxiety and stress who grind there teeth without knowing at night cannot be treated with low strength filling material like composite. Filling will break down within a week in these patients. Amalgam is the best choice in bruxism patients.

Composite filling is complicated procedures as compared to other types. If operator is not experienced, either change the filling material choice or consult experienced doctor. Poor oral hygiene is also a contraindication of composite use.

GIC:

Where GIC is the best choice:

Glass ionomer is a tooth color filling material which contains silicate, and polyacrylic acid. Its use is quite similar to composite. GIC should be used as a restoration in non stress bearing areas. Class III and V cavities should be treated with GIC material.

Class III cavities are present on proximal surfaces of anterior teeth while class V cavity is present on gingival portion of all teeth. These are both non stress bearing areas. GIC is used to restore carious lesions. As it can release fluoride which can help in mineralising the teeth and stopping residual caries.

For temporary treatment, as a temporary restoration, GIC is the most common material used. It’s also used as cement under high strength filling material such as amalgam. To repair margins of crown, Glass ionomer is used very often. In primary teeth, fillings are done with GIC mostly.

Where GIC shouldn’t be used:

It’s contraindications are almost same as composite. It cannot be used in areas with heavy forces. Cusp replacement should never be done with glass ionomer cement.

Gold:

Where gold is the best choice:

Direct filling gold is the oldest filling material that is used in operative dentistry. Gold can be used in pits areas. Class I, Class V where aesthetics permit. Erosive areas can be treated with direct gold filling material. Proximal caries can be restored with gold.

Direct gold material can be used as retrograde filling material during root canal surgical procedures. Gold can be used in areas with heavy occlusal pressure. It’s compressive strength is quite good as compared to GIC and Composite.

Where gold shouldn’t be used:

Gold shouldn’t be used in very old patients. It requires two visits most of the time to set properly. So patient with medical condition, who cannot afford to come again shouldn’t be treated with gold as a filling material.

Periodontal weak teeth shouldn’t be filled with gold. Tooth with large pulp chamber is also a contraindication. Gold is very expensive in most region. Economically weak patients shouldn’t be treated with direct gold material.

Underdeveloped teeth shouldn’t be treated with gold. Gold cannot be used in high caries index patient who cannot maintain his oral hygiene. Direct filling of gold is also a technical procedure so operator with poor skills shouldn’t undergo the procedure.

Porcelain:

Indications:

Porcelain fillings are custom made which are also know as porcelain inlays, and onlays. These are mare in a lab. Fractures should be treated with porcelain filling. Large areas to restore is the most common indication of inlays and onlays.

Contraindications:

If patient is allergic to cement inlays and onlays, amalgam or other filling material should be used. High caries index patient cannot be treated with porcelain onlays. On anterior teeth, it can cause discolouration after sometime.

These are some five most commonly used filling material used in operative dentistry.