Why Use ANYTHING other than Silver Amalgams or Glass Ionomers?
Sometimes a restoration requires a stronger (yet unfortunately less decay resistant) bond afforded by strictly resin or composite resin materials. Additionally, the composite resin materials polish to a higher shine and are smoother than Glass Ionomers. Composite resins and resin cements absolutely have their place in dentistry under the correct circumstances, and are considered a "clinically acceptable" modality.
All things considered, we at Dr. Magnotta and Associates, DDS, FICOI always strive to use the appropriate material to match the goals of our patients considering their desires including longevity, esthetics, and durability.
Resin modified Glass Ionomers-Tooth Colored Material with Specific Placement
Dr. Magnotta & Associates, DDS, FICOI also uses RMGI fillings which are tooth colored, but have certain limitations on placement. Glass Ionomers do very well on the sides of teeth by the gumline. They are "decay resistant" because they release large amounts of Fluoride upon placement and are chemically speaking, considered a rechargeable reservoir for Fluoride. (See image of "Fuji II LC" for examples of applications).
This means every time great brushing takes place and the the filling will actually draw Fluoride into the glass ionomer material and release it overtime into the tooth! Dentists who fail to offer Glass Ionomer fillings unfortunately miss the opportunity for decay resistance. We like to provide our patients with the best possible options for their individualized needs, and feel proud to offer decay resistant materials with both the Glass Ionomer and Silver Amalgams. We also use decay resistant Glass Ionomer Cement to retain crowns, inlays, and onlays.
What About New Materials?
In this exciting time of discovery and invention, promising new dental materials can arise. The latest intrigues are the biocompatible materials being developed. Dr. Magnotta and Associates will always examine new materials to see if they are effective. However, newer is not always better. For example, the Compomer tooth colored materials of the 90's were touted to combine the benefits of the Composite Resin (esthetics) while releasing Fluoride like the Glass Ionomer. The esthetics were marginally better and they had no recharging of Fluoride like the Glass Ionomer. After much hype, most clinicians decided that the compomer was not a very good material and did not benefit their patients very well. Unfortunately, some dentists try to be trendy and gimmicky, even when there is not good evidence to support their claim and practices. We promise to follow the evidence and educate our patients so they can make the choice that best suits them.
Silver (Amalgam) Fillings
There are pros and cons to the materials dentists help their patients choose. On the biting surface of a back tooth, one of the best materials is the tried and true Silver Filling. They are very strong, but more importantly are resistant to recurrent decay. Below is an example where a different dentist placed a tooth colored (composite resin) filling in a tooth on a rather young person. Not too long after in the grand scheme of things, this filling had to be redone and was dangerously close to requiring a Root Canal. Had the Silver filling been placed from the beginning the tooth likely would not have required any treatment. In fact, when a 30, 40, sometimes 50 Year Old Silver Filling has to be replaced (to incorporate it into the new filling) when a cavity occurs next to the Old Silver Filling, we dentists often marvel at how little to no decay is present under the Old Silver Filling!!! Also it should be noted, there are no diseases linked to the amalgam fillings in spite of the hysteria generated in the 90s and unfortunately persists to some degree today.
Both domestic and international scientific communities agree that Silver Amalgam filling material is a valuable and safe material for children and adults. For more information please CLICK HERE:the ADA Council on Scientific Affairs position statement which can connect you with information from numerous, reputable scientific sources ON THE VALUE AND SAFETY OF THE SILVER AMALGAM FILLING. Additionally, explore this review article which says, there is "no convincing evidence pointing to any adverse health effects that are attributable to dental amalgam restorations besides hypersensitivity (allergies) in some individuals."
LONGEVITY AND DECAY
"The results of this review suggest that composite resin restorations in posterior teeth still have less longevity and a higher number of secondary caries when compared to amalgam restorations. In relation to fractures, there was no statistically significant difference between the two restorative materials regarding the time of follow-up." - https://www.ncbi.nlm.nih.gov/pubmed/26116767
"evidence to suggest that resin composites lead to higher failure rates and risk of secondary caries than amalgam restorations."- https://www.ncbi.nlm.nih.gov/pubmed/24971858
"Use of amalgam appears to be preferable to use of composites in... posterior teeth if longevity is the primary criterion in material selection."
-Joural of the American Dental Assn, Vol. 138 http://jada.ada.org June 2007
DECAY RESISTANT FILLINGS
(Dental Materials Explained)
INLAY/ ONLAY OPTIONS TO FILLINGS
Below is an example of an inlay which has a strong tooth colored restoration that is lab fabricated and then cemented in with glass ionomer (decay resistant) cement giving the strength required for chewing; acting as the best of both worlds. The cost is higher and sometimes insurance downgrades to only cover the cost of a filling, but if a patient wants a tooth colored restoration that is decay resistant, this is a great option!