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Medical Forum / General / Dentistry / January 2006Choices in fillings/restorations
Hello. I'm planning to get some dental work this year. The plan is to to replace all the amalgam with better quality fillings, either porcelain or gold, and add braces after. Yesterday I had two amalgams replaced with porcelain onlays/partial-crowns. My dentist said these two needed to be porcelain to give the braces something strong to hold on to, and that porcelain bonds with teeth better than anything else because its porous and the cement can sink into it. He has also explained that because of this bond, porcelain strengthens the tooth more than other fillings. He said he is using a new porcelain which is closer to the density of natural teeth than previously used porcelain, so they shouldn't wear down opposing teeth. During his consultation he had a strong preference towards porcelain, over gold. I preferred gold because I have read many opinions on the web that gold outlasts anything else, and because it is non-toxic and a natural material. I have also read that gold seldom breaks and is ideal for back teeth. I am not worried about aesthetics. I want whatever is best for my teeth. I am wondering what I should do with the remaining fillings. The back bottom teeth are large fillings, I suppose they will be onlays/partial-crowns. One is the bottom left canine, the filling is along the gumline. The rest are fairly small, inlays I think, on forward teeth. My dentist said that composite is best for very small fillings because it allows me to keep more of my tooth. Other than that he doesn't oppose gold fillings for the rest, although he still recommends porcelain. I'm concerned that gold fillings may lead to cracked teeth. And I'm concerned that porcelain onlays on the back teeth may break. P.S. I have a minor tooth grinding habit. Any advice? Robert After reading more postings in this group, I want to add that my dentist used machine-milled porcelain. How fragile is this porcelain compared to gold? Its surface characteristics seem to be very similar to gold and ivory. > Hello. I'm planning to get some dental work this year. The plan is to > to replace all the amalgam with better quality fillings Do they need replacing? Some yes, most no. I haven't ever visited the dentist regularly. I'd like to, but history can repeat itself. I prefer to replace my fillings, with what is the most durable, now while I can afford it, instead of waiting until they need replacing and my financial situation is unknown. Replacing them all now should keep future dental visits less expensive. > Some yes, most no. I haven't ever visited the dentist regularly. I'd > like to, but history can repeat itself. I prefer to replace my > fillings, with what is the most durable, now while I can afford it, > instead of waiting until they need replacing and my financial situation > is unknown. Replacing them all now should keep future dental visits > less expensive. Some dentists would argue that it's not a good idea to replace restorations as a "preventative measure", so to speak, because each time you do so you some trauma is inflicted, occasionally resulting in the need for more dental work rather than less. Amalgam fillings can last for a very long time. For those fillings that do need replacing, if esthetics are not an issue, I'd say gold would be a better choice, although cerec isn't bad at all in terms of wear properties (as far as I can tell from what's accessible on PubMed). Please note that I'm not a dentist. What I like about the cerec porcelain is that it strengthens the tooth. What conditions cause a gold filling to come loose or leak, usually? What is it about gold fillings that makes them last longer than amalgam? > What I like about the cerec porcelain is that it strengthens the tooth. The only problem I can see with this line of reasoning, as a layperson, is that replacing a functioning restoration weakens the tooth (unnecessarily)... yes, composites r better for small fillings, because gold and porcelain, while they r considered permanent restorations, cause a lot of tooth structure to b lost. if u already have big fillings, then it mite b an option for u, tho. it is quite expensive for the onlays/inlays. we charge $220 ea. Torrie www.bikerchick.freehomepage.com Before reading about amalgam mercury health concerns, at my first visit with him, I said I wanted to replace the amalgam fillings. I think they're ugly, and they seem to have shrunk or compressed. They're all over five years old and their lifespan is running out. Another reason I want to replace them all is for the tax deduction... the government (in Canada) refunds income tax for medical expenses after spending 3% of my income. So it pays to have a lot of work done in the same year. I'm suspecting my dentist recommends porcelain to help pay for his cerec machine, even though I would agree with him that the porcelain fillings are a good choice, and I still trust him. For the same filling, he charges $85 for amalgam, $115 for composite, $700 for machine-milled porcelain, and $900 for gold (Canadian dollars). I think the porcelain is the only one with a warranty offered, for 10 years. I've recently read that gold foil lasts longer than cast gold (80 years compared to 30), I think its because there is a plywood effect. I plan to ask him about the gold foil next time I see him. It's too bad there is no porcelain-gold hybrid, a porous gold :) How about gold over porcelain??? I've read about porcelain over gold, but how about the other way around? The gold should withstand/cushion the impacts, while the porcelain bonds with the tooth. robert >Before reading about amalgam mercury health concerns, at my first visit >with him, I said I wanted to replace the amalgam fillings. I think [quoted text clipped - 17 lines] >other way around? The gold should withstand/cushion the impacts, while >the porcelain bonds with the tooth. Good thinking guy, but you are off in several areas. Gold foil won't happen unless he is a guy of my vintage well-versed in gold foil work. Try BONDED composite for good esthetics, no seepage under the restorations, and oh yeah, make sure he is well-versed in composite restorations! Joely >robert |
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