6-Types of Dental Filling Materials
- Composite White Fillings (Plastic + Glass Powder)
- Silver Metal Fillings (Amalgams)
- Ceramic (Porcleain -Solid Glass Like material)
- Micro-filled, 3D printed Resins used for Fillings: this is a new material used to create onlays, veneers or crowns.
- Gold (Yellow gold or Silver gold) -alloy of gold, copper and other metals
- Glass Ionomers (Plastic + glass powder -releases fluoride)
The 2023 #1 Best Dental Filling Material
The short quick answer is: the best dental filling material is made of dental ceramic (porcelain). These fillings are typically billed and referred to as Porcelain Onlays/Inlays.
But in real life clinical situations, at times this can be a difficult question to answer and the type of filling needed may change during the course of clinical treatment. In order to determine your best filling material, there are many patient specific factors that need to be considered first. For this reason, it’s optimal to understand all of the material choices before treatment begins.
Know your best dental filling options before treatment begins
A wise, forward thinking doctor whose goal is to provide the optimal treatments, will explain treatment options before treatment begins and update treatment options after the clinical removal of decay and evaluation of cracked or weak tooth structure (excavate and evaluate). In other words, your best dental filling type and design should be determined after your tooth has been prepared clinically and after the doctor has taken the time to review the quality and quantity of remaining tooth structure.
10 Anatomical and Clinical Diagnostic Parameters To Consider When Choosing Dental Filling Materials
(The following topic’s details are regarding back molar teeth which are used to crush and chew food)
- The size of the functional area on the tooth being restored with the filling and the quality of remaining tooth available to hold the filling in place. If you have lost a lot of tooth from wear, trauma, acidic breakdown, decay etc. or have weakened hypo-calcified enamel or numerous tooth cracks, a stronger more durable filling material will be needed. As an example, a larger filling will receive more force than a smaller filling, and a poor quality weakened tooth will offer less support and less retention for a restorative filling material.
- The type of tooth or area of the mouth where the filling is being placed, i.e., crushing, chewing molars receive a lot of force and stronger filling material like porcelain will statistically have a better chance of success.
- In addition to normal functional forces, many patients present with add additional tooth to tooth forces called parafunctional forces. These are additional forces that occur during the daytime or nighttime habits (parafunctional habits, i.e, Bruxism/tooth grinding, clenching, cheek, fingernail and lip biting etc.). The presence of tooth wear facets (strong wear patterns on teeth) is suggestive evidence for additional function. More forces on teeth means a decreased life span for a filling. As a side note, these increased forces also accelerate the loss of tooth supporting bone.
- Each person’s unique ability for saliva to neutralize acids and rebuild re-mineralized tooth structure should be considered.
- Types of Foods and oral Acids. Certain foods require more chewing and cause more tooth wear over time, i.e, a person who eats a lot of nuts and grains or has a habit of chewing gum excessively. Sugary and acidic foods (plus GERD or general flow of acid fluid or gas from the stomach to mouth) can chemically breakdown tooth structure. Acidic erosion is more common than one might think. The dentist will typically see clinical evidence as dissolved patches of tooth structure.
- Color: Do you want a natural looking tooth colored filling or is a metal filling ok? Would you accept a metal restoration if this type of material would be more durable and if it were in a less visible area of your mouth?
- Depth of Filling: Another factor to consider is how deep or close to the nerve the existing filling or decay is. If the filling is dangerously close to the nerve, long term, it could be in your best interest to choose a filling that is less likely to leak and will last for a long period of time. All fillings have a need to be changed. The idea is to place a restoration that is less likely to need replacement in years to come. This is important because any dental work (drilling) near the nerve is cumulatively traumatic to the nerve. This is true even if the drill does not physically hit the nerve. Logically, a stronger, longer lasting restoration could be viewed as a preventative investment to avoid future potential tooth nerve trauma ( increased chance for a Root Canal) because it will not need to be replaced as often verses the weaker type single visit dental restorations. In addition, a stronger, longer lasting restoration will reduce the potential for tooth loss due to fracture.
- The cost of a dental restoration is a huge parameter that needs to be considered. In general: “Onlays cost 6 times as much and are estimated to last 4 times as long.”
- Number of visits needed to make a dental restoration: Porcelain or gold Inlay/ Onlay restorations are typically hand made. During the first visit, your dentist will prepare your tooth and impress a mold or scan of your tooth. This mold will be sent to a lab for fabrication. Usually this process will take about two weeks. A second visit is required for the delivery or seating of the final restoration. Some porcelain restorations can be milled in the dental office and as of 2023 , Micro-filled, 3D printed onlays or crowns can be printed in just a few minutes and placed during just one visit. The patent for Micro-filled, 3D printed onlays or crowns is quite new but studies have shown that these Micro-filled materials outperform common traditional composite materials in breaking force and chewing simulations.
- Generally your own unique history of dental health problems is considered when recommending what type of dental filling is best for you. Your dental history is a strong indication of your commitment to increase the life span of your fillings.
Life Span Notes
Nothing man-made will last a life time. Natural parts of your body, like your teeth, may not last you a lifetime. This is the reason why we provide crowns and fillings, etc.
Life Span is affected by:
-
- Good Diet
- Good Oral Hygiene routine
- Seeing Dentist Regularly
- Parafunction
Technical Filling Material Properties
- Can Release Fluoride ion: Over time, the natural tooth structure releases water which then combines with the released fluoride ion to decrease tooth breakdown
- Coefficient of thermal expansion and contraction close to the thermal expansion and contraction of natural tooth structure
- Bondable strength to tooth structure or other dental materials. A material that is acid etchable is best: Benefits of Acid Etching: Cleans bondable surface and increases surface irregularity and surface bonding area.
- Compressive strength and diametric tensile strengths
- Chemical and light curable. Controlled setting time to prevent rapid dehydration and tooth nerve sensitivity.
- Bonds to both Dentin and Enamel
- Radio opaque (shows up solid on X-rays): Some filling materials don’t show up on x-rays and can mimic holes from decay or open areas under fillings or crowns.
- Bio compatible with surrounding gums
Less Technical Comparison Of Dental Filling Materials
White Plastic Fillings
| Color | Durability | After Visit Sensitivity | Cost | Patient sensitivity to material |
|---|---|---|---|---|
| Yes! These look very natural. | Recently the ADA updated the average life of a white plastic fillings: 2.5 – 5 years. | Yes, but at our office we use glass ionomers and a 2 step dentin primer and bonding liquid under our composite fillings, which greatly reduces long term sensitivity. | More expensive than Silver Fillings. | Non-known |
Short note from Dr. L:
Long story short, these fillings are plastic. Composite resin is a tooth-colored plastic mixture filled with glass (silicon dioxide). The glass is added to create a slightly higher rate of wear which is said to be similar to traditional silver fillings. Often when I share the fact that these fillings are plastic and the ADA shares that they last for 2.5 – 5 years, patients ask me, “Why do dentists use these fillings”? The answer is simple: cost/insurance restrictions, convenient one visit fillings, and lack of knowledge. The best tooth colored alternative to composite fillings is “Pressed Ceramic” which is more expensive and the most accurate porcelain fillings require 2-visits. These single visit white fillings should not be used in patients who are cavity prone or have a history of failed fillings and ideally should only be used to fill small cavities. At our office we will offer the best dental fillings for each specific situation but will also offer all choices based on the patient’s wishes. We also offer same visit Micro-filled, 3D printed Resin Dental Fillings as a better choice verses composite fillings. Composite fillings are less successful when the filling extends to the sides of the tooth. Porcelain is still better, but the Micro-filled, 3D printed fillings are a great alternative to composite. It’s important to note that composite fillings that go on the sides of teeth or extend in between teeth are more difficult to place.
Silver Metal Fillings (Amalgams)
| Color | Durability | After Visit Sensitivity | Cost | Patient sensitivity to material |
|---|---|---|---|---|
| Silver metallic in color | Average 10- 15 years.
(This material has been used for dental fillings for more than 150 years) |
Very uncommon and usually due to a high bite. | Low | There is no scientific evidence of any measurable clinical toxic effects [of dental amalgam].” (American Academy of Pediatrics).
At our office each patient is presented with the ADA facts and we will use the material that you choose! (Please read ADA Myths and Facts sheet) |
Short note from Dr. L:
Silver single visit fillings have certainly withstood the test of time. I usually recommend this material when the filling is small to medium in size. Typically, I will recommend this type of filling in non-visible areas of the mouth to restore cavities on the chewing surface of the upper back teeth. I will also recommend silver fillings when patients have financial concerns or when discussing treatment options for lower back teeth.
Single visit metal fillings are not recommended for large fillings or to replace the sidewalls of teeth because they may crack. After 10-15 years the marginal area will chip away and need to be replaced.
Micro-filled, 3D printed Resins
| Color | Durability | After Visit Sensitivity | Cost | Patient sensitivity to material |
|---|---|---|---|---|
| Yes! These look very natural. | Studies have shown thats these Micro-filled materials outperform common traditional composite materials in breaking force and chewing simulations. | Yes, but at our office we use glass ionomers and a 2 step dentin primer and bonding liquid under our composite fillings, which greatly reduces long term sensitivity. | More expensive than composite fillings but less expensive than the porcelain | Non-known |
Short note from Dr. L:
Micro-filled, 3D printed Resins are a great one visit alternative to composite restorations when the dental filling extends in between the teeth. Creating an ideal interpoximal anatomical form and making tight tooth to tooth contacts by hand is very difficult. The interpoximal root emergence form can press too hard on the gums or leave too much space allowing food, stain or non esthetic gaps between teeth. Again, this form by the gums is very difficult for a dentist (technique sensitive). 3D printed fillings are created by a computer from an intraoral scan and printed on a 3D printer. Dr. Landers uses Sprint-ray 3D printing; no doubt one of the world’s leading technologies in 3D printed fillings.
| Color | Durability | After Visit Sensitivity | Cost | Patient sensitivity to material |
|---|---|---|---|---|
| Silver or Gold metallic in color | Average 15- 40 years. (This material has been used for dental fillings for over 150 years). One problem: gold fillings are not bonded and have a tendency to get loose over the years and need to be cleaned and re-cemented. |
Very uncommon and usually due to a high bite. | Typically 6 times as much as a single visit filling. | Non-known |
Note from Dr. L:
This is the best dental restorative material available in dentistry, but it’s application is limited due to esthetic nature of gold when viewed in a patient’s smile. Gold is very strong when it’s thin and subsequently can be used to cover weakened tooth structure without the need to remove much tooth structure. With all other dental materials, the dentist will need to reduce the tooth in order to create a certain thickness for the material to withstand the chewing forces without breaking.
Porcelain White
| Color | Durability | After Visit Sensitivity | Cost | Patient sensitivity to material |
|---|---|---|---|---|
| Tooth Color | Average 15 years. (I would guess that the pressed ceramic used at our office will last a little longer) |
Very uncommon and usually due to a high bite. | Typically 6 times as much as a single visit filling | This is the least toxic of any filling we use. We will use Zirconium for any patients who are environmentally sensitive. |
Note from Dr. L:
This is the material that I have chosen to restore my own teeth. It’s the best of both worlds because it is the strongest and most cosmetic dental restorative material available. One example of dental restorative material we use is a long lasting tooth colored material known as “Empress”. It is used to replace missing tooth structure and is the material of choice to form Crowns, Veneers and Dental Onlays. Non-metal Empress Tooth colored material is of the hardest pressed ceramic material available with the best tooth-like properties. When more strength is needed, especially with implant procedures, we use the strongest tooth colored material “Zirconium”. Zirconium type restorations are not as cosmetic or “tooth-like” as the Empress pressed ceramic and cannot be used for all dental restorations.
Glass Ionomers Fillings
| Color | Durability | After Visit Sensitivity | Cost | Patient sensitivity to material |
|---|---|---|---|---|
| Yes! These look very natural. | Glass ionomer fillings have many uses in dentistry but are typically not used on chewing surfaces because they wear away from chewing forces. These fillings bond the best to root dentin. 2.5-5 years, | Little to no post treatment sensitivity from the glass ionomer.
Patient may however experience transient post treatment sensitivity from drilling, retracting cord, dental etchant, or trauma from the dental needle.
|
Typically not very expensive | Non-known |
Short note from Dr. L:
Glass ionomers fillings bonds to both Dentin and Enamel. Root surfaces are typically mostly dentin, with some possible enamel. So it is important to use a glass ionomer for tooth root fillings i.e., cover root lesions. Root lesions are typically from acidic breakdown, decay, abfraction, or an improper “scrubbing like” brushing technique. When these fillings are placed they have a tendency to dissolve from acids and wear away from aggressive brushing, so it’s best to look at these fillings as short term covers to protect tooth roots from further breakdown. Depending on a patient’s specific oral conditions and hygiene habits, these fillings will need to be changed often.
Types of Dental Restorative Options: Fillings, Crowns, and Onlays
One Visit Dental Fillings (White Plastic Vs. Silver Metal)
Dental filling materials are used to fill in holes in teeth. As the hole gets larger or extends on the sides of the tooth, filling materials can be pushed to their limits. Generally, these fillings are wonderful if there is enough surrounding tooth structure to support the dental filling. In short, they function best when they are placed into a tooth hole or cavity with strong tooth structure on all sides. White plastic composite fillings or amalgams are generally not strong enough to cover a thin, weakened, or cracked tooth. Additionally, fillings are not strong enough to replace an outer wall of missing tooth structure on the cheek or tongue side.
Crowns Vs. Onlays
When we speak of dental restorative fillings, generally speaking, the public thinks of the typical “drill and fill” type of treatment. At our office, however, our patients benefit from newer dental technologies. These technologies, which have evolved, allow our patients to receive more aesthetic fillings, with more conservative treatment, and more precise marginal seal. Consequently, we can offer esthetic tooth like restorative fillings that are stronger and longer lasting.
Often patients will ask, “What is an onlay and how does an onlay differ from a crown”? Both a crown and an onlay are indicated when there is extensive tooth loss or to hold together cracked or thin tooth structure. This is achieved by covering and replacing the chewing surface with a dental onlay or crown. This coverage will hold together fragmented parts of your tooth. Long term crowns and onlays will protect the tooth from fracture. The technical difference lies in the shape of each restoration but the term crown is often used to describe an onlay that replaces more than 65% of the tooth.
Crown
A crown will typically cover both the chewing surface and circumferentially wrap around the entire tooth. Crowns are generally used when there is more extensive tooth loss or after root canal therapy. Since crowns completely cover the tooth on all sides, they are used to correct any problems that you might have with alignment.
Our Treatment Philosophy
At our office, more often than not, our patients who have lost large portions of tooth to dental decay or fracture will receive a conservative dental onlay restoration rather than a crown.
Onlays replace the tooth structure that you have already lost, i.e., the space left after your old filling and broken-decayed tooth structure has been removed. Your remaining sound tooth structure is shaped and an impression is made. The impression is sent to a dental technician where a custom restoration is made. It’s called an onlay or overlay because it covers the top of the tooth. Crowns cover the top AND WRAP AROUND the broken down tooth. In contrast, and in order to make space for a crown, the dentist must circumferentially cut back your tooth in addition to reducing the top of your tooth.
Note that, sometimes, there is good reason to do a full coverage crown. Crowns are needed when it is clinically established that there is not enough tooth remaining to retain an onlay, or there are stress fractures on remaining tooth structure that are in a vertical direction of the tooth root. Crowns can also be used to correct tooth position problems. If you absolutely need a crown, the hollow spaces from your old filling and missing broken-decayed tooth is filled and bonded together with a core dental bonding material first and the crown is circumferentially shaped for a crown.
Dr. Landers always starts out conservatively and will clinically move in the direction that is best for you.
