In certain health systems, such as the NHS in the UK, amalgam continues to be the filling material of choice for the time being, due to it’s proven effectiveness and ease and speed of placement.
In private practice, it is used less often, but is particularly good where controlling saliva is difficult and composite would be likely to fail. It is also useful for repairing existing amalgams or where access is very difficult such as a wisdom tooth which you have decided to keep and where the ‘look’ is less important. In my opinion amalgam for these reasons still has its place in modern dentistry.
In private practice, composite is preferred, as the demand for natural ‘good looking’ fillings increases. Research nowadays is largely focused in this area. Composite is best for smaller fillings but has been used with success in larger cavities too, taking into account the limitations I have discussed. When many tooth surfaces have been lost and a natural tooth look is needed, a porcelain restoration in the form of an inlay or onlay (even a crown) is a better long-term solution with the best aesthetics. Because it takes longer to prepare and involves a lab stage to make the porcelain restoration, they are much more expensive than fillings.
Glass ionomer cements are useful in areas that are not highly visible for those of you who are high risk of decay
or as a temporary filling
to check how a tooth is going to respond to deep decay. It is also excellent as a lining material and useful for sticking in crowns and bridges.
Your dentist will advise you of the most appropriate filling material (or alternative) after assessing and discussing the following things:
- The amount of tooth remaining
- If the tooth has been root filled
- The importance of the tooth in your smile
- The position of the tooth
- Your ability to keep the filling dry (amount of saliva and size of your tongue)
- How far you can open your mouth.
- How quickly do you need it done?
- How important the look is to you?
- How long you want it to last?
- How much are you prepared to pay?
- Don’t be afraid to ask questions! As dentists, we want to do what is right for you and for you to be happy… this involves a two-way conversation. It is our job to answer your questions and concerns and educate you on the reasons something is or is not advisable or indeed possible.
- Occasions when posterior composites (white composite fillings for your back teeth) might not be the best choice:
- If the decay and cavity extend far underneath the gum
- Large restorations involving multiple cusps
- Poor moisture control
- Bruxism, heavy occlusion.
In these circumstances, it may be better to consider one of the alternative choices such as an amalgam, GIC, or for the extensively broken down tooth an inlays/onlay or crown.
- White fillings versus silver fillings
for more information.