Which fillings are better - materials used and tips for choosing

Requirements for filling materials

The main requirements that filling materials must meet, regardless of service life and purpose of use, are:

• Biological safety;
• Hypoallergenic;
• Easy to install and remove;
• Strength;
• Loyalty to medicines;
• Good resistance to mechanical loads and aggressive environments.

Modern dentistry has a large selection of filling materials.

In this regard, dentists quite often ask their patients questions regarding the choice of filling material, offering various types of dental fillings. To make it easier to make a decision, it is necessary to take a closer look at all types of fillings used in dentistry.

Which fillings are best for front, side and chewing teeth?

When treating incisors and canines, increased aesthetic requirements are imposed. Common materials:

• silicate cement composition;
• light-curing composite elements;
• glass ionomers.

Molars are not visible to the naked eye when a person talks or smiles. During therapy, dentists use masses that, after hardening, are able to withstand maximum loads without deforming. These include:

• photopolymers;
• amalgam;
• ceramic;
• cement;
• two-component composites;
• glass ionomer.

Temporary fillings

The second name for this type of dental fillings is diagnostic. Thus, caries damage can spread not only to the tooth enamel, but also to deeper tissues: dentin layers and pulp. Installing a temporary filling allows you to determine how deeply damaged the dental tissue is. In cases where we are talking about the development of pulpitis, the reaction to temporary filling material will be pronounced pain. Temporary fillings are used not only to detect pulpitis, but also as a sealing agent in case of long-term treatment, which involves the use of drugs placed in the cavity. Criteria that temporary filling materials must meet:

• Good performance in terms of tightness;
• the ability not to come into contact with drugs introduced into the cavity;
• ease of installation and removal;
• biological safety and hypoallergenicity;
• high curing rates in a short period of time.

The service life of temporary fillings ranges from several days to 3 weeks. Installing a temporary filling is similar to permanent filling and requires compliance with the same rules, namely:

• Filling is carried out after preparing (drying) the surface to be sealed;
• It is recommended to refrain from eating and drinking hot drinks for 1-2 hours.

In cases where the patient has been diagnosed with pulpitis, a temporary filling is installed in two layers. In this case, the top layer acts as a sealing gasket that isolates the pulp, and the second layer includes the drug.

It must be taken into account that temporary fillings do not have the same strength and resistance to mechanical loads as permanent filling materials. Due to this aspect, it is not recommended to brush your teeth too actively or eat solid foods until the temporary filling is replaced with a permanent one. An unpleasant bitter taste in the mouth and the presence of pieces of material may indicate partial destruction of the temporary filling. The destruction of the material can occur as a result of improper care, neglect of the doctor’s recommendations, or if the installed filling was of poor quality.

Types of temporary fillings based on the materials used

On water dentin

Kaolin powder diluted with liquid is used as a derivative material.

From dentin paste

To create a filling, a mixture of kaolin powder and peach oil is used.

Cement based

The basis of such a filling is zinc phosphate cement, which can withstand severe loads. In this regard, this type of temporary dental fillings is used in the treatment of chewing teeth, which account for the majority of all impacts.

Made from polymer materials

Pastes made from polymers have a light-curing mechanism.

Why use dental fillings?

Regardless of whether the tooth was mechanically damaged or as a result of caries, it must have a filling. The absence of a filling exposes the tooth to external factors. This, in turn, leads to further destruction and exposes the patient to pain.

When caries is advanced, pulpitis appears, which in turn leads to health problems. In such situations, endodontic treatment (root canal treatment) is necessary, which is more invasive and expensive than simply installing a filling.

Untreated teeth negatively affect the entire body. The bacteria that spread after it can disrupt the functioning of very important internal organs, including the heart and kidneys. This is a very serious problem, so the use of a dental filling is necessary. Even small cavities can quickly turn into much larger problems.

Permanent fillings

They are characterized by high strength and long service life. The service life of permanent fillings depends on the material of manufacture and the loads applied. In connection with the above, it is extremely necessary to compare as accurately as possible the level of expected load and the properties of the filling material. The main purposes of installing permanent fillings are:

• The need to seal cavities formed as a result of therapeutic measures;
• reconstruction of lost or damaged areas.

In some cases, damage to teeth (chips, cracks, etc.) can be compensated for without resorting to prosthetics, but through correction (reconstruction) using filling materials. Requirements for permanent filling materials:

• Biological safety and hypoallergenicity;
• High levels of aesthetics;
• The ability to withstand mechanical loads without losing its qualities.

Which material to prefer

The dental compositions described above have their own characteristics, advantages and disadvantages. Which filling do you prefer? Which is better - light or chemical (ordinary)? The choice will depend on financial capabilities and the location of the tooth in the oral cavity - posterior molar or frontal.

It is preferable to place fillings made of durable, indelible compositions on posterior chewing molars. For example, metal, glass ionomer or nanocomposite materials.

If we consider from an aesthetic point of view, it is better to put light or ceramic fillings on the front teeth, which are identical to tooth enamel and are invisible when smiling. Light dental products are characterized by a certain fragility, and therefore cannot withstand heavy chewing load on the rear molars.

To restore a chipped or damaged tooth in the front rows, light fillings are used. Using a composite material, you can completely restore the shape of a tooth, which will look organic. A distinctive feature of the light composite is the versatility of choosing a color to match the tone of the natural enamel of the teeth.

If we consider the quality of the composition from the standpoint of durability, then the most durable materials are metal and photocomposite - a service life of more than ten years. All other trains last from four to five years.

Sources used:

• Klyomin V. A., Borisenko A. V., Ishchenko P. V. Combined dental fillings. MIA, 2008
• Practical therapeutic dentistry" (Nikolaev A.)
• Scheller-Sheridan C (8 May 2013). Basic Guide to Dental Materials. John Wiley & Sons.
• https://www.dentalhealth.ie/

Types of permanent fillings for teeth

Modern types of fillings in dentistry are distinguished by great variety, which is expressed in the levels of strength and durability, hardening speed, aesthetic appeal (the possibility of the most accurate imitation of natural tooth enamel). The pricing policy for different types and types of dental fillings is built based on the qualities of the filling material, and almost always meets the price-quality criterion.

Cement fillings

This type of filling has an affordable price and fairly good resistance to mechanical loads. Medical cement has good adhesion and hardens quickly. However, it must be taken into account that cement usually has a higher density than natural tooth tissue. In this regard, one of the negative aspects of using such fillings is the possible wear of the dental tissue adjacent to the filling material, which can lead to the development of secondary caries.

Depending on the basic composition, there are two types of fillings made from medical cement: mineral and polymer.

Mineral fillings

As the name suggests, the composition of such fillings is based on minerals of natural origin:

Zinc phosphate cements

They are a powder containing oxides of zinc, magnesium, aluminum and silicon. Mixing the powder with an aqueous solution of phosphoric acid leads to the formation of a substance that does not dissolve in the oral cavity. Phosphate cement fillings are generally not used for surface sealing. The main direction of their use is filling of canals and the lower layer. The service life of fillings made from zinc phosphate cements usually does not exceed 2 years. The advantages include low cost. The disadvantages of zinc phosphates include: low strength, aesthetic unattractiveness, poor adhesion.

Silicate cement

The material contains aluminosilicates and orthophosphoric acid. A distinctive feature of this type of cement is the ability to release fluoride ions, which serve to prevent the development of secondary caries. The use of this type of filling is not advisable in cases where deep filling is necessary, since it requires the installation of a gasket that protects the dental pulp from the toxic effects of released free phosphoric acid. Silicate cement has the necessary transparency and smoothness, which allows it to be used for filling front teeth.

Silico-phosphate cements

They are a combination of silicate and zinc phosphate. This composition makes it possible to minimize the manifestation of shortcomings that occur in each of the components separately. Thus, the combined material has higher strength and better adhesion to tooth tissues.

Polymer fillings

Fillings consisting of polymeric materials are usually divided into:

Glass ionomer

They are a combination of crushed glass, fluorides and polyacrylic acid. Hardening occurs as a result of a chemical reaction. The most modern glass ionomers harden under the influence of a special lamp. The use of these types of light fillings does not imply any restrictions on food intake. You can eat and drink immediately after the filling material is installed. The advantages of GIC include: good adhesion, hydrophobicity, plasticity (usually they do not have problems with modeling), aesthetic appeal and the ability to release fluoride ions, which are a prophylactic agent. The disadvantage of this material is its fragility, leading to rapid abrasion. The service life of GIC fillings usually does not exceed 3 years.

Polycarbonate cements

They are an analogue of zinc phosphate, improved by enhancing adhesive properties, better biocompatibility and less tendency to dissolve. The main target areas are: fixation of orthodontic structures, filling of baby teeth in children. Almost all cement fillings are chemically cured materials. The main areas of use are:

• Children's dentistry;
• Temporary filling;
• As a fixative in orthodontics.

Plastic fillings

This type of filling has become quite widespread. It compares favorably with cement materials in a number of positive qualities. Advantages of plastic fillings:

• Higher plasticity rates than cement;
• Fast hardening;
• Good hardness and strength;
• Chemically resistant;
• Correctness regarding oral tissues;
• Aesthetic appeal.

Plastic fillings vary depending on the materials used. It is customary to distinguish:

Acrylic fillings

They have aesthetic appeal and, thanks to a wide range of shades, can be used even on visually visible areas of the dentition. It must be taken into account that plastic is a porous material. In this regard, it is not recommended to install acrylic fillings for deep caries damage. This is due to the fact that the porous surface of the filling can become a favorable environment for the accumulation of bacterial plaque, which can lead to a number of serious diseases. In addition to the above, such fillings are not recommended for smokers and people who regularly consume foods with large amounts of coloring substances. Exposure to coloring pigments can radically change the color scheme of the filling.

Epoxy fillings

As the name suggests, they are made on the basis of epoxy resins. They have good strength and durability. They have a less pronounced toxic effect than acrylic materials. The main disadvantage is the tendency of such materials to darken after 2-3 years. In this regard, the main intended use of epoxy-based fillings is filling chewing teeth. Disadvantages of plastic fillings:

• Tendency to settle. Even modern materials show noticeable shrinkage after 2-3 months;
• Change in color under the influence of dyes;
• Toxicity.

Amalgam (metal) fillings

The material is an alloy of metal and mercury. Silver, copper and tin are most often used as metal components. The choice of metal is individual and different clinics may use different metals. Amalgam filling material has good strength and durability. Advantages of amalgam fillings:

• Not subject to corrosive damage;
• Has fairly high plasticity;
• Has high strength indicators;
• Virtually indestructible;
• If silver is used as a metal component, the composition has antiseptic properties.

Despite a fairly large number of positive qualities, amalgam fillings are used extremely rarely. This is due primarily to the toxicity of the mercury contained in the composition and a number of difficulties that arise during the work process.

In addition to the above, amalgam filling material has other disadvantages:

• Allergenicity;
• Unattractive appearance;
• Poor adhesion to tooth tissues;
• Low adhesion rates;
• A dark color that can give an unattractive tint to the entire tooth.

There are a number of absolute contraindications to the use of such materials:

• The patient has metal structures;
• Age restrictions;
• Individual intolerance and tendency to allergic reactions;
• Dental units located in the visual visibility zone.

The service life of amalgam fillings can be up to 10 years.

Ceramic fillings

Recognized as one of the most aesthetically attractive and reliable filling materials. Most often, ceramic fillings are installed using the inlay method, which completely follows the shape of the tooth. Such fillings have practically no disadvantages, but are used quite rarely. This is due to the high cost and rather long production time in laboratory conditions. The service life of such fillings can exceed 10 years.

Light-curing (photopolymer) fillings

The composition of the material used for the restoration of chewing teeth includes particles of silicon and zirconium. For the treatment of hard-to-reach areas, fluid-flowing composite materials are appropriate. During the work, the material is applied layer by layer until the tooth surface is completely restored. A dental ultraviolet lamp is used to harden the material. Photopolymer fillings are recognized as one of the highest quality filling materials. The advantages of light fillings include:

• Almost complete visual identity with natural teeth;
• High levels of strength and durability;
• Aesthetic appeal;
• Possibility of selecting the required shade characteristic of natural teeth;
• Almost complete biological safety of the material;
• Resistant to shrinkage and abrasion;
• Long service life from 5 to 15 years.

A relative disadvantage of light seals is their price, which significantly exceeds the cost of the previously listed materials.

Composite fillings

The material used includes plastics and inorganic fillers. This combination in the composition allows you to achieve good ductility and adhesion, expand the color range and enhance the strength characteristics of the material. It is customary to distinguish several main types of composite fillings:

Light-curing

An ultraviolet dental lamp is used to harden the material.

Chemically curable

The material contains porcelain, which extends the life of the filling and increases its strength. Composites of this type are characterized by uniform hardening and good adhesion to tooth tissues.

Gutta-percha

A material used exclusively for filling the roots of teeth. Gutta-percha is characterized by increased strength, durability, lack of shrinkage and abrasion.

Composite compounds

Chemically cured composites were invented as an alternative to simple cement fillings. The composition of the composite includes porcelain, which gives greater strength to the cement. Also, according to their composition, composites are divided into three types:

1. acrylic-containing;
2. resin (epoxy);
3. light-curing.

Of the listed compositions, the acrylic-containing composite has the greatest strength. These fillings are characterized by wear resistance, are little susceptible to abrasion, however, they have a toxic effect on the body. Due to toxicity, acrylic is contraindicated in many patients. Acrylic also often provokes the formation of pulpitis. Another negative feature of acrylic is its high absorbency, due to which the risk of caries increases significantly.

Resin composite material is not highly wear-resistant and durable, however, it is non-toxic and harmless to the body. The disadvantages of resin structures include a change in color after a few years: the fillings darken. Another feature of resin (epoxy) fillings is their excessive fragility: they can break off and be “eaten.” Therefore, it is better not to use epoxy composition on primary chewing molars. Epoxy composite also provokes the development of pulpitis, just like acrylic.

The light-curing composite gains its strength from a halogen lamp. They are also called photopolymer or solar-cured. The disadvantage of this material is the complexity of installation: polishing and grinding of the material is necessary. The filling must be polished every six months to maintain the original tone of the material.

What other disadvantages are typical for this material? These include the following properties of the filling:

• shrinkage after curing;
• possible chipping of the crown wall;
• poor-quality hardening of the material.

The filling can shrink up to five percent of its original volume, which significantly reduces the effectiveness of protecting the tooth. Even with slight shrinkage of the filling, there is a high probability of chipping of the adjacent wall of the dental crown. Due to the technical difficulties of working with a halogen lamp, the hardening of the material may be incomplete - only 70%.

An innovation in modern dentistry is a nanocomposite, the structure of which consists of tiny particles. The nanocomposite is characterized by high adhesion to tooth tissues, providing reliable protection against infection and the spread of caries.

Criteria for choosing a filling

When choosing a filling, you need to consider the following aspects:

• The degree of expected load;
• Size of the surface to be filled and general accessibility;
• Requirements for aesthetic appeal;
• Biological safety level;
• Process depth;
• Patient's age.

Light fillings are recognized as the most popular and have virtually no negative qualities. In terms of characteristics, only ceramic fillings can surpass them. It is worth considering that the latter are significantly more expensive than all other filling materials. Filling materials used for the treatment of baby teeth deserve special attention. Most often, cement fillings are used in this direction.

This choice is due to the fact that baby teeth are subject to replacement and, as a rule, deep caries is not typical for them. Accordingly, the main negative properties of cement fillings are not important for them. Any questions you may have can be discussed with your doctor. He will also determine which material is more appropriate to use in this case.