What Steps Are Involved in Filling a Tooth?
First, the dentist will use a local anesthetic to numb the area around the tooth to be filled. Next, a drill, air abrasion instrument, or laser will be used to remove the decayed area.
Next, your dentist will probe or test the area to determine if all the decay has been removed. Once the decay has been removed, the dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve. Generally, after the filling is in, your dentist will finish and polish it.
Several additional steps are required for tooth-colored fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that “cures” or hardens each layer is applied. When the multilayering process is completed, the dentist will shape the composite material to the desired result, trim off any excess material, and polish the final restoration.
What Types of Filling Materials Are Available?
Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, and glass materials called composite resin fillings.
Cast Gold Fillings
Advantages of cast gold fillings:
1. Durability — lasts at least 10 to 15 years and usually longer; doesn’t corrode
2. Strength — can withstand chewing forces
3. Aesthetics — some patients find gold more pleasing to the eye than silver, amalgam fillings.
Disadvantages of cast gold fillings:
1. Expense — gold cast fillings cost more than other materials.
2. Additional office visits — requires at least two office visits to place
3. 3 Aesthetics — most patients dislike metal “colored” fillings and prefer fillings that match the rest of the tooth.
Advantages of composites:
1. Aesthetics — the shade/color of the composite fillings can be closely matched to the color of existing teeth. Composites are particularly well suited for use in front teeth or visible parts of teeth.
2. Bonding to tooth structure — composite fillings actually chemically bond to tooth structure, providing further support.
3. Versatility — in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken, or worn teeth.
4. Tooth-sparing preparation — sometimes less tooth structure needs to be removed compared with amalgam fillings when removing decay and preparing for the filling.
What Are Indirect Fillings?
Indirect fillings are similar to composite or tooth-colored fillings except they are made in a dental laboratory and require two visits before being placed. Indirect fillings are considered when not enough tooth structure remains to support a filling but the tooth is not so severely damaged that it needs a crown.
During the first visit, decay or an old filling is removed. An impression is taken to record the shape of the tooth being repaired and the teeth around it. The impression is sent to a dental lab that will make the indirect filling. A temporary filling (described below) is placed to protect the tooth while the restoration is being made. During the second visit, the temporary filling is removed, and the dentist will check the fit of the indirect restoration. Provided the fit is acceptable, it will be permanently cemented into place.
There are two types of indirect fillings — inlays and onlays.
• Inlays are similar to fillings but the entire work lies within the cusps (bumps) on the chewing surface of the tooth.
• Onlays are more extensive than inlays, covering one or more cusps. Onlays are sometimes called partial crowns.
Inlays and onlays are more durable and last much longer than traditional fillings — up to 30 years. They can be made of tooth-colored composite resin, porcelain, or gold. Inlays and onlays weaken the tooth structure, but do so to a much lower extent than traditional fillings.
What’s a Temporary Filling and Why Would I Need One?
Temporary fillings are used under the following circumstances:
1. For fillings that require more than one appointment — for example, before placement of gold fillings and for certain filling procedures (called indirect fillings) that use composite materials
2. Following a root canal
3. To allow a tooth’s nerve to “settle down” if the pulp became irritated
Other Filling Types
1. Ceramics. These fillings are made most often of porcelain, are more resistant to staining than composite resin material but are also more abrasive. This material generally lasts more than 15 years and can cost as much as gold.
2. Glass ionomer is made of acrylic and a specific type of glass material. This material is most commonly used for fillings below the gum line and for fillings in young children (drilling is still required). Glass ionomers release fluoride, which can help protect the tooth from further decay. However, this material is weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts five years or less with costs comparable to composite resin.
Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials designed to cover the front surface of teeth to improve your appearance. These shells are bonded to the front of the teeth changing their color, shape, size, or length.
Dental veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stains better than resin veneers and better mimic the light reflecting properties of natural teeth. Resin veneers are thinner and require removal of less of the tooth surface before placement. You will need to discuss the best choice of veneer material for you with our dentists.
What Types of Problems Do Dental Veneers Fix?
Veneers are routinely used to fix:
• Teeth that are discolored — either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discolored the tooth
• Teeth that are worn down
• Teeth that are chipped or broken
• Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
• Teeth with gaps between them (to close the space between these teeth)
What’s the Procedure for Getting a Dental Veneer?
Getting a dental veneer usually requires three trips to the dentist – one for a consultation and two to make and apply the veneers. One tooth or many teeth can simultaneously undergo the veneering process described below.
• Diagnosis and treatment planning. This first step involves your active participation. Explain to your dentist the result that you are trying to achieve. During this appointment, your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take X-rays and possibly make impressions of your mouth and teeth.
• Preparation. To prepare a tooth for a veneer, your dentist will remove about 1/2 millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 1-2 weeks for your dentist to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed for an additional cost.
• Bonding. Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched — which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement, causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer’s placement.
What Are the Advantages of Dental Veneers?
Veneers offer the following advantages:
• They provide a natural tooth appearance.
• Gum tissue tolerates porcelain well.
• Porcelain veneers are stain resistant.
• The color of a porcelain veneer can be selected such that it makes dark teeth appear whiter.
• Veneers offer a conservative approach to changing a tooth’s color and shape; veneers generally don’t require the extensive shaping prior to the procedure that crowns do, yet offer a stronger, more aesthetic alternative.
What Are the Disadvantages of Dental Veneers?
The downside to dental veneers include:
• The process is not reversible.
• Veneers are more costly than composite resin bonding.
• Veneers are usually not repairable should they chip or crack.
• Because enamel has been removed, your tooth may become more sensitive to hot and cold foods and beverages.
• Veneers may not exactly match the color of your other teeth. Also, the veneer’s color cannot be altered once in place. If you plan on whitening your teeth, you need to do so before getting veneers.
• Though not likely, veneers can dislodge and fall off. To minimize the chance of this occurring, do not bite your nails; chew on pencils, ice, or other hard objects; or otherwise put excessive pressure on your teeth.
• Teeth with veneers can still experience decay, possibly necessitating full coverage of the tooth with a crown.
• Veneers are not a good choice for individuals with unhealthy teeth (for example, those with decay or active gum disease), weakened teeth (as a result of decay, fracture, large dental fillings), or for those who have an inadequate amount of existing enamel on the tooth surface.
• Individuals who clench and grind their teeth are poor candidates for porcelain veneers, as these activities can cause the veneers to crack or chip.
How Long Do Dental Veneers Last?
Veneers generally last between 5 and 10 years. After this time, the veneers would need to be replaced.
Do Dental Veneers Require Special Care?
Dental veneers do not require any special care. Continue to follow good oral hygiene practices, including brushing and flossing as you normally would.
Even though porcelain veneers resist stains, your dentist may recommend that you avoid stain-causing foods and beverages (for example, coffee, tea, or red wine).
Are There Alternatives to Dental Veneers?
Yes, alternatives to veneers include bondings and crowns. Veneers offer a nice intermediate option. Veneers may be best suited for individuals who want to change the shape of their teeth more than just a little bit — as is done with bonding — but not enough to require a crown.