Tooth-colored composite fillings

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Advantages:

1. Aesthetics - the shade/color of the composites can be closely matched to the color of existing teeth; is particularly well suited for use in front teeth or visible parts of teeth

2. Bonding to tooth structure - composite fillings actually chemically bond to tooth structure, providing further support to the tooth

3. Versatility in uses - in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken or worn teeth

4. Tooth-sparing preparation - sometimes less tooth structure needs to be removed compared with amalgams when removing decay and preparing for the filling

Disadvantages:

1. Lack of durability - composite fillings wear out sooner than amalgams (lasting at least 5 years compared with at least 10 to 15 for amalgams); in addition, they may not last as long as amalgams under the pressure of chewing and particularly if used as the filling material for large cavities

2. Increased chair time - because of the process to apply the composite material, these fillings can take up to 20 minutes longer than amalgams to place

3. Additional visits - if composites are used for inlays or onlays, more than one office visit may be required

4. Chipping - depending on location, composite materials can chip off the tooth

5. Expense - composite fillings can cost up to twice the cost of amalgams

In addition to tooth-colored, composite resin fillings, two other tooth-colored fillings exist--ceramics and glass ionomer.

Direct Restorative Dental Materials

FACTORS	AMALGAM	COMPOSITES Direct and Indirect	GLASS IONOMERS	RESIN- IONOMERS
General Description	A mixture of mercury and silver alloy powder that forms a hard solid metal filling. Self-hardening at mouth temperature.	A mixture of submicron glass filler and acrylic that forms a solid tooth-colored restoration. Self- or light-hardening at mouth temperature.	Self-hardening mixture of fluoride containing glass powder and organic acid that forms a solid tooth colored restoration able to release fluoride.	Self or light- hardening mixture of sub-micron glass filler with fluoride containing glass powder and acrylic resin that forms a solid tooth colored restoration able to release fluoride.
Principal Uses	Dental fillings and heavily loaded back tooth restorations.	Esthetic dental fillings and veneers.	Small non-load bearing fillings, cavity liners and cements for crowns and bridges.	Small non-load bearing fillings, cavity liners and cements for crowns and bridges.
Leakage and Recurrent Decay	Leakage is moderate, but recurrent decay is no more prevalent than other materials.	Leakage low when properly bonded to underlying tooth; recurrent decay depends on maintenance of the tooth-material bond.	Leakage is generally low; recurrent decay is comparable to other direct materials, fluoride release may be beneficial for patients at high risk for decay.	Leakage is low when properly bonded to the underlying tooth; recurrent decay is comparable to other direct materials, fluoride release may be beneficial for patients at high risk for decay.
Overall Durability	Good to excellent in large load-bearing restorations.	Good in small-to-moderate size restorations.	Moderate to good in non load-bearing restorations poor in load-bearing.	Moderate to good in non load-bearing restorations; poor in load-bearing.
Cavity Preparation Considerations	Requires removal of tooth structure for adequate retention and thickness of the filling.	Adhesive bonding permits removing less tooth structure.	Adhesive bonding permits removing less tooth structure.	Adhesive bonding permits removing less tooth structure.
Clinical Considerations	Tolerant to a wide range of clinical placement conditions, moderately tolerant to the presence of moisture during placement.	Must be placed in a well-controlled field of operation; very little tolerance to presence of moisture during placement.
Resistance to Wear	Highly resistant to wear.	Moderately resistant, but less so than amalgam.	High wear when placed on chewing surfaces.
Resistance to Fracture	Brittle, subject to chipping on filling edges, but good bulk strength in larger high- load restorations.	Moderate resistance to fracture in high-load restorations.	Low resistance to fracture.	Low to moderate resistance to fracture.
Biocompatibility	Well-tolerated with rare occurrences of allergenic response.
Post-Placement Sensitivity	Early sensitivity to hot and cold possible.	Occurrence of sensitivity highly dependent on ability to adequately bond the restoration to the underlying tooth.	Low.	Occurrence of sensitivity highly dependent on ability to adequately bond the restoration to the underlying tooth.
Esthetics	Silver or gray metallic color does not mimic tooth color.	Mimics natural tooth color and translucency, but can be subject to staining and discoloration over time.	Mimics natural tooth color, but lacks natural translucency of enamel.	Mimics natural tooth color, but lacks natural translucency of enamel.
Relative Cost to Patient	Generally lower; actual cost of fillings depends on their size.	Moderate; actual cost of fillings depends on their size and technique.	Moderate; actual cost of fillings depends on their size and technique.	Moderate; actual cost of fillings depends on their size and technique.
Average Number of Visits To Complete	One.	One for direct fillings; 2+ for indirect inlays, veneers and crowns.	One.	One.

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