Currently, our dental office in Kitsilano, Vancouver offer three main types of ‘direct’ fillings: amalgam(metal), composite, and glass ionomer.
Fillings are recommended to be replaced when they break, leak, or esthetic concerns are an issue for the patient. While we try to accommodate a patient’s request, sometimes we are limited by the environment the fillings are placed in and cost to the patient on what they can afford.
Amalgam fillings are the ones that contain mercury, but the type used in it is ‘inorganic’ meaning it is actually much less toxic than ‘organic’ mercury. Organic mercury bio-accumulates in tissues and eating a can of tuna gives you a higher exposure to toxic mercury than a silver filling would. The advantages of Amalgam fillings is that they seal very well when placed, even if there is moisture contamination from fluids in your mouth during the procedure. They are an excellent filling material when there is too much saliva or blood where the filling needs to be placed. They however are not the most cosmetic filling as they are silver/grey and are easily noticed against a white tooth. Also silver fillings are lock and key fit, meaning they fill the tooth by locking into place as it hardens, and is not actually ‘glued’ or stuck to the tooth which is was placed on. Another draw back is that in order to place a silver filling, the hole is recommended to be approximately 1.5mm deep so that the material has the needed bulk to be strong enough to avoid fracturing.
Composite fillings are a white plastic material that can actually bind/adhere to the teeth. This adhesion is compromised when there is any moisture contamination during the placement and they will leak. Well done composite fillings can last many years and also don’t need a required minimum thickness, so that tooth structure can be saved when placing them. Moisture control is paramount to the success of these fillings, which is achieved through the use of various isolation techniques: rubber dam, cotton roles, suction, and various instrument placement to prevent leaking into the cavity being filled. They do cost more than silver fillings, as they are more technique sensitive to place and a more expensive material to use. The advantages of a well placed composite filling is that the remaining tooth structure is held together by the filling as it is bonded to the tooth(instead of a lock/key fit with amalgam), less tooth structure is sacrificed in placing one, there is less temperature sensitivity as it is less likely to conduct hot/cold extremes like a metal filling would, and esthetics as it is white like your natural tooth colour.
Glass Ionomer fillings are the in between filling with respect to amalgam and composite. While they are coloured similar to a tooth, they are not as esthetic as a composite filling material. They do bind to the tooth and are able to be placed in less than ideal situations where moisture control is an issue(though not as good as a silver filling). They wear away more easily when exposed to the oral cavity, so they are not as durable as a composite or amalgam filling. They are recommended when moisture control is an issue, with esthetics and a lack of a lock and key fit that would allow an amalgam filling to be placed. They don’t require a minimum thickness, and thus most often used as a filling material when a cavity on a tooth is close to the gum line. Cost wise, they are the same as a composite filling.
At Accord Dental we do our best to inform our patients on what material would be the best option for you and as our patient you have the final say. And as always, estimates for all dental work is always provided/available free of charge.