Fillings

Let us start with the simplest and most common procedure performed in the dental office-FILLINGS.

Removing the decayed or damaged tooth structure from the tooth and replacing it with a filling is the most basic procedure done by dentist all over the world.  When I started in dentistry, silver amalgams were the norm and the early white composite self curing resins for the front teeth.  The age of repairing a chipped tooth with a resin was just getting started with the invention of the Nuva light.  We thought that this was greatest.  We could now treat the enamel surface of a fractured tooth and bond on a white filling.

The silver fillings were placed into the tooth after placing a liquid varnish and sometimes if the decay was deep, a liner of calcium hydroxide.  The teeth were always sensitive to cold after the fillings.  What we now know is that the varnish did nothing and the calcium did very little.  The cold sensation was not caused by the conduction of cold through the silver filling but rather from micro leakage between the filling and the tooth.  This would reduce over time due to the oxidation of the filling to seal the margins.

The white fillings had its own set of problems caused by the shrinkage of the material as it set.  This caused micro leakage and recurrent decay.  The other problem with the early composite material was the large particle size of the fillers within the resin.  “Plucking” which is the plucking or falling out of the large particles on the surface caused microscopic craters.  These craters would pick up stain and the material would look yellow.

Over time great leaps in technology and material science were developed.  The reduction of the particle size to make the polished surface more enamel like and the greatest advancement was the discovery that the tooth structure could be totally etched and bonded.  This allowed us to bond to the inside of the tooth as well as the outer enamel.  This also stopped the micro leakage and the teeth were not sensitive after placing the fillings.  This is a very technique sensitive procedure and required more time to place the fillings and new problems to overcome.  The resulting fillings of today are a completely different animal than in days past and far superior.

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