What is a dental filling?
Dental Health and Tooth Fillings or tooth restoration is a dental treatment that allows for restoring masticatory and aesthetic function in teeth that have been injured by caries (“rotten tooth”) and worn or fractured by various traumas.
Dental Health and Tooth Fillings Obtaining or restoring a tooth is characterized by the reconstruction or restoration of the fractured part of the tooth or part affected by caries after its previous removal so that it does not progress, thus avoiding the destruction of the tooth and its subsequent loss or extraction.
The tooth’s restoration allows returning to the tooth its natural, anatomical shape, function, and, if possible, aesthetics.
When is it necessary to perform a filling?
It is necessary to perform a dental filling or restoration when the patient presents with a loss of the tooth’s hard tissues, whether caused by dental caries or by wear or fracture thereof.
Dental caries destroys hard tissues of the tooth, such as enamel and dentin, which often causes painful sensitivity to cold and other stimuli or, in more advanced stages, a toothache that can range from moderate to very strong by the reaction to stimuli (cold, hot, chewing) or even spontaneous appearance.
Given the high incidence of dental caries in the population, this cause is undoubtedly the most often leads to the need for dental restorations. After removing caries, the tooth is restored to obturate or “cover the hole” that has formed as a result of caries.
A broken tooth may have at its origin dental caries already with some progression, or else be a direct consequence of traumas (blow, fall, crack harder food, hit with teeth, fights, among others).
In these situations, the conditions will still be carried out, if the conditions still allow it, for dental restoration to recover its anatomical form and functionality.
In cases of very extensive destruction of the crown of the teeth, or when it is intended to correct anatomical defects of greater dimension, the confection of fixed crowns or even “pivots” is already considered, thus using the fixed prosthesis.
Filling – step by step
After the clinical examination by the Dentist, who in some cases needs to be supplemented with the radiographic examination (periapical X-ray or orthopantomography), if the presence of dental caries is diagnosed, the following measures are taken:
- Administration of local anaesthesia, but it may not be necessary in some cases;
- Removal of caries using drills and possibly dentin curets;
- Prepare a retentive cavity, and perform adhesive procedures to increase the retention of the restoration;
- Placement of filling or restoration material;
- Removal of excesses and verification of occlusion to not interfere in the articulation of dental arches.
The restoration of a front tooth is carried out under the same basic principles as that performed to a lateral or posterior tooth (from the back). However, in the face of aesthetic restorations, we will have to take more careful care in choosing the colour of the restoration material, as it should be as similar as possible to the colour of the patient’s tooth so that the presence of restorations is as invisible as possible.
Types of materials in filling
There are several types of restoration materials, and however, currently, the most used are composite resins (composite). The other most common shutter material is the silver amalgam (lead), formerly used on a much larger scale. However, because it is more unaesthetic and has in its composition mercury, which has generated some controversy for its eventual toxicity, it is not as used today. Other materials can be used, such as porcelain, but they are usually not the patient’s first option because they are expensive.
We can identify the following restoration materials:
The resin restoration or restoration with light-curing resin
(composite or sometimes popularly called “mass” or “white lead”) is the most used because it has a wide range of colours that allows a better approximation to the tone of
- the tooth, thus allowing to restore the natural appearance of the tooth. It is a material currently resistant, which, being of good quality, presents a minimal polymerization contraction, thus allowing to sealing well the margins or walls interface with the tooth.
- The restorations of porcelain or ceramic are even more aesthetic because, in addition to also allowing the choice of colour by the Dentist, this material has superior properties of transparency or translucency that gives them an aesthetic more faithful to
- that of natural teeth, in addition to the greater resistance. This type of restoration is made in a prosthesis laboratory through moulds made by the Dentist. In the end are
- applied or cemented to the natural teeth by the same, therefore more expensive or expensive for the patient. They are essentially used for the confection of crowns, pivots and dental veneers.
- The restoration of silver amalgam is much less aesthetic than the composite resin because the amalgam has a more or less dark grey colour, depending on its composition (silver metal colour). Despite the colour, it remains a material used with some frequency.
- It is very resistant and has a very good marginal sealing index and possible greater durability or resistance to fracture than composites in areas of greater wear due to chewing.
- The restorations with glass ionomer are white and a choice to be taken into account, especially in children with the same propensity to caries, because it has a good resistance, which combined with the property that has to release fluor, prevents in some
- way the recurrence of caries. Although it is also white, it becomes considerably inferior to the restoration with composite resin in aesthetics because it cannot get so close to the natural colour of the teeth; its transparency is much lower and tends to change its
- colour (yellowing) after a short time (1 to 2 years). As an additional limitation, it should be noted that its polymerization contraction is superior to that of composites, which does not promote such efficient marginal sealing.
- The cast metal restoration is little used because it is much more expensive than the amalgam in addition to presenting a silver metallic colour. It is sent for confection in the laboratory and is also very resistant.
See top photos of restored teeth, with before and after filling.
Does the filling hurt?
Restoration or filling is performed under local anaesthesia, which allows the patient not to feel pain during tooth restoration procedures.
There are situations in which this procedure can be performed without any anaesthesia without implying any pain or only a slight sensitivity while removing caries with the aid of drills, depending on the stage of evolution of caries, its location and the level of tolerance to pain specific to each person.
Risks and complications in filling
When filling, the patient is not supposed to be subjected to any risks and complications simply because they underwent this intervention. It should be noted that the restored teeth are not “immune” to caries, so they need to be continuously brushed/washed because the restoration does not gain caries. Still, the tooth itself can contract (gain) caries (recurrence) again.
The tooth may, in some situations, become sensitive after filling during the first days, especially in cases where it was necessary to broaden more closely with the dental pulp, subjecting it to an inevitable “aggression” and may therefore react. This sensitivity tends to regress. Naturally, that is, without any intervention in most cases.
For this reason, in cases where caries is very close to the pulp or when the patient already presents somewhat significant symptomatology, it is chosen to perform a temporary or temporary restoration in advance, waiting for the regression of symptoms and only after the definitive restoration is performed, if there is no associated pain or sensitivity.
If a tooth is still adored, i.e. if the symptomatology, whatever it is, worsens or continues for several days after restoration (provisional or definitive), then more invasive treatment should be considered, It should also be noted that there are cases in which, after endodontic treatment, it
is necessary to access the apex of the tooth when performing an apicectomy, for example, for removal of end bone lesions that form near the end of the root, forcing its cutting and consequent retrograde filling or reprobation.
However, it should not be confused with retrograde filling with endodontic filling. The latter aims to fill the root canal after canal treatment, filling the inside of the canals from which the dental pulp was removed.
In addition to possible toothache after filling, other uncomfortable situations may occur for the patient, especially if the restoration is poorly done, such as a possible injury to the pulp, causing pulpiti, in cases where the restoration becomes overflowing (in excess), which facilitates the
accumulation of bacteria in areas difficult to sanitize; problems or interference in chewing, in situations where occlusion was not correct; and there are cases in which the filling of the tooth falls, and this occurrence does not have to be exclusively a consequence of poor execution by the professional.
How much does a dental filling cost?
In a filling or restoration of a tooth, the price varies from clinic to clinic, depending on the extent of restoration. Only the Dentist can accurately calculate the value of a filling. However, it may be noted that, on average, the price of the consultation, considering the most frequent type of restorations, tends to be between 40 and 80