Different types of dental fillings – where are the differences?
Cracks and holes in the teeth are usually caused by caries. The dentist can use a filling to repair the damage, the filling treatment is one of the most common dental treatments. The type of tooth filling and the material used depend above all on the extent of the damage and the location of the affected tooth, but also on the wishes and requirements of the patient.
When is a tooth filling necessary??
If the enamel or hard tooth substance is defective, a tooth filling is necessary. In the case of very small damage, such as chipping on the tooth enamel, it may be sufficient if the dentist smoothes the area a little (grinds it down) without subsequently applying filling material. With larger holes, however, the filling must be, otherwise pain and further damage to the tooth will result.
Indications for a filling therapy are:
- Caries damage (the classic "hole in the tooth")
- Broken / broken out places
- Erosion damage (e.g. tooth enamel attacked by acid or very badly worn)
- Damage to the neck of the tooth (e.g. dental caries or defects due to excessive brushing)
- Tooth damage from bruxism (gnashing of teeth)
If you notice one or more of these signs, you may need a tooth filling, so you should go to the dentist and have it examined:
- The tooth is particularly sensitive to cold, heat, sweet or sour
- You can feel a hole or other irregularity with your tongue
- You see an unusual discoloration
- The tooth is sensitive to pressure or touch
- They register an unfamiliar bad breath or have a bad taste in their mouth
- You already notice pulling or throbbing pain
Dental fillings: types and materials
A classic tooth filling is used in the dental practice to fill holes. In contrast, inlays (inlays) are made in the dental laboratory and are therefore considered dentures.
In the following, different types and materials of fillings are explained in more detail with their properties:
Amalgam fillings are still considered a classic in the repair of carious molars. For incisors and canines, the dark silver amalgam is not used for aesthetic reasons.
Amalgam is a mix of silver, tin, copper and mercury and one of the oldest dental materials. It can also withstand high chewing pressures, is durable and generally well tolerated. Nevertheless, amalgam fillings are not uncontroversial because of their mercury content. For preventive health protection, amalgam is therefore not used in children, pregnant women and patients with certain previous illnesses.
Composite fillings are often colloquially referred to as plastic fillings. However, modern composites consist of around 80 percent ceramic filings or filler particles (e.g. silica salt, fine glass particles) and only around 20 percent plastic. Tooth-colored composite fillings are therefore quite similar to ceramic fillings. They are durable, dimensionally stable and, due to their good aesthetics, also suitable for the treatment of incisors, canines and posteriors.
For small caries damage, a simple composite filling is usually sufficient. The doctor can insert a layered composite filling into larger or deeper holes. This is also possible in a single treatment session. To perfectly reproduce the natural tooth shade, the composite layers can have different shade intensities (multi-shade technique).
Gold inlays are mostly used when the chewing pressure and load are too great for amalgam or other filling materials or if the patient has allergies, incompatibilities or concerns about amalgam and plastic. They can be veneered with ceramic for better aesthetics, but for technical reasons a fine, golden border remains visible.
Ceramic inlays are made like gold inlays in the laboratory and then glued into the prepared tooth. You score with excellent aesthetics and body tolerance (biocompatibility), However, due to their extreme hardness under very heavy loads (e.g. grinding of teeth), they are more likely to break than fillings based on metal or plastic.
Glass ionomer cement (GIZ) and compomer
These two restorative materials are mainly used for temporary restorations, under-or restorations and as a replacement for amalgam in pediatric dentistry. In the meantime, GIZ fillings are also used more often as permanent solutions, because the material has been continuously developed in recent years. Today there are improved glass ionomers that are coated with a special varnish and adhere very well to the teeth. However, the further developed GIZ also wears out faster than other filling materials.
Compomer is a mixture of glass ionomer cement and composite. The composite content increases the abrasion resistance and breaking stability of the filling, so that it wears more slowly and lasts longer. In addition, compomer fillings enable better aesthetics.
Inlays as an alternative
Inlays are also known as inlay or inlay fillings and sometimes as indirect tooth fillings. In contrast to direct fillings, inlays are not “built into the tooth” in practice, but are first made in the laboratory and later used by the dentist. For an inlay, two appointments with the dentist are always required.
Inlays are usually made of gold or ceramic. Gold inlays score with excellent durability and high chewing comfort. Ceramic inlays bring the best aesthetics, but due to the hardness of the material, they can splinter or break if subjected to too much stress (e.g. extreme chewing pressure, night grinding of teeth).
Tooth filling or inlay? Advantages and disadvantages of tooth fillings
If there are small holes in the tooth, an amalgam or composite filling is the best choice. One of the advantages of tooth fillings is that it can repair minor damage with minimal loss of (healthy) tooth substance. In addition, tooth fillings are the fastest and easiest way to repair tooth damage. Because the dentist can make the filling directly in the practice, only one session is necessary.
However, compared to the inlay, the tooth filling has a lower strength and durability. So it can happen that a filling falls out again than an inlay detaches from the tooth. The inlay is therefore the better choice, especially for larger damages.
Tooth fillings: What does the health insurance cover??
The cash benefits include amalgam fillings in the posterior area as well as simple composite fillings in the anterior and visible areas. Children and adolescents under 18, pregnant women and patients with proven amalgam allergy (allergy test at a dermatologist) or severe kidney dysfunction (renal insufficiency) also get full restorations in the molar area.
If you don’t want a filling made of amalgam, but still want to save yourself the additional payment, you can ask the dentist whether a filling made of modern glass ionomer cement or compomer could also be used. Because the statutory health insurance companies cover the entire costs, as long as the filling does not exceed a certain size.
For other types of fillings or inlays, the statutory health insurance companies provide a subsidy, but what remains is a so-called personal contribution that the patient has to pay out of his own pocket. How high this is depends on the findings, the planned material and manufacturing costs and other individual factors. In the case of laboratory-made inlays, which – unlike fillings made in practice – are considered dentures, the dentist draws up a healing and cost plan that must be approved by the health insurance company before treatment.
You can also get addresses of reference dentists in your area
Advantages and disadvantages in comparison: how durable which tooth fillings are?
Of course, anyone who receives a filling also wants the repair to last as long as possible. The average lifespan of a tooth filling is between 8 and 11 years. According to the tooth report of the Barmer GEK 2015, however, almost every third filled tooth has to be treated again within the next four years – either to renew or repair the filling or because caries has formed at another point on the tooth.
Pain in a filled tooth is not automatically a sign of new tooth decay. In the case of older composite fillings in particular, it can also be the case that the filling material is "bitten through". Then the chewing pressure is transferred to the pain-sensitive dentin under the filling, which can lead to a short but very violent pain, especially when there is point stress (e.g. when biting a grain). And with metal fillings, pain can arise from heat or cold, because thermal stimuli are transmitted much better by metal than by mineral substances like natural tooth enamel, ceramic, composite or cement.
|restorative||durability||colour||For what teeth
|amalgam||7-8 years||silver to black-gray||Side / back teeth||complete|
|Composite ("plastic")||4-6 years||tooth color||All teeth||proportionally|
|Cement (GIZ)||1-2 years||tooth color||All teeth||complete|
|compomer||4-6 years||tooth color||All teeth||complete|
|Gold (inlay)||10-15 years||gold||Side / back teeth||proportionally|
|Ceramic (inlay)||8-10 years||tooth color||Side / back teeth||proportionally|
How long a tooth filling made of a certain material lasts can only be seen from statistics and given as an average value. In individual cases, fillings can last much longer – or break or fall out much faster. In addition to the material used, the position and the size, there is another very important factor that influences the durability of a tooth filling, namely oral hygiene. If you brush your teeth twice a day, also clean the interdental spaces and take good care of your gums, you can not only extend the life of your teeth enormously, but also that of your fillings.
Many follow-up treatments could be avoided with better oral hygiene. It is therefore very important that the dentist and patient not only select the most suitable filling method together, but that teeth and fillings are optimally cleaned and protected during daily dental and oral care.
Carrying out the treatment
Before a new filling can be inserted or manufactured, the tooth is first anesthetized locally. Then the dentist removes the caries or the diseased tooth substance with the drill and cleans the tooth. The further course of treatment depends on the type and material of the filling:
For tooth fillings made of plastic filling materials such as amalgam and cement, the dentist mixes the filling material and supplies the hole in the tooth directly in the mouth. Before that, an underfill is usually introduced to protect the tooth root. Composite fillings are irradiated with UV light so that they harden completely.
The dentist uses articulation paper (blue paper) to adapt the finished filling to the bite block. After the patient has bitten with different tooth or jaw positions, the doctor sees the points of contact and can determine whether and where he still needs to correct the filling. After treatment, the freshly filled tooth should be protected for a few hours as possible – so do not chew anything hard. Amalgam fillings take the longest time and are only fully hardened after 24 hours.
More preparation is required for laboratory-made tooth fillings (inlays): the dentist grinds the hole so that the walls are as smooth as possible, and then takes an impression. This serves as a template for the dental technician in the manufacture of the precisely fitting insert filling. With ceramic inlays or composite fillings, the tooth shade is also precisely determined. The tooth is provided with a temporary filling until the inlay is finished and can be glued in.
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