Dentistry-Online

Tooth filling

introduction

Teeth destroyed by caries cannot be rebuilt by the organism. The defects must be closed with a tooth filling.
Unfortunately, the term seal is often used as a synonym for the filling. This word is derived from the Latin term for lead, and lead really has no place in the oral cavity. Therefore, this erroneous name should finally disappear from the vocabulary.
Also e.g. If a piece of molar tooth breaks off, a filling may be necessary.

What is a seal?

The term seal is a colloquial term that describes a tooth filling made from amalgam. The word comes from a time when primarily amalgam fillings were placed. The word origin is the Latin word "Plumbum", which means "lead" in German.

Although amalgam fillings are rarely placed any more, the word is incorrectly used by a large part of the population to describe a filling, regardless of the material. The laying of an amalgam filling used to be called "sealing". The term is no longer up to date.

Furthermore, the word seal is also used outside of dentistry to designate a lead seal for containers and housings. This seal shows whether the item has been opened.

What materials are there for a tooth filling?

Overview of the different filling materials

definitive tooth filling materials:
- Composites (plastic)
- amalgam
- Gold (as inlay)
- Ceramic (as inlay)

provisional tooth filling materials:
- Cements (e.g. glasinomer cement)
- Compomers (plastic)

Silicate cements

For years, silicate cement was used to fill the anterior teeth. It was available in different colors so that it could also meet aesthetic demands. However, the polishability was not optimal because the silica cement has a relatively rough surface. The durability of such dental fillings was not particularly good either, as small particles broke out over time. Stone cement was available for the posterior region. A very resistant filling material and an alternative to amalgam. Silicate cement and stone cement are no longer used today because there are better alternatives.

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amalgam

Tooth filling with amalgam has been used as a filling material for the posterior region for many years. This combination of mercury and silver filing is easy to work with as a plastic material, is easy to model and, when hardened, can withstand chewing pressure. However, amalgam has fallen into disrepute because of its mercury content, which, however, is not justified. The minimum intake of mercury is far exceeded by some foods. Mercury vapors used to be created when mixing amalgam because it took place in a mortar. Today, however, mixing takes place in closed capsules, so that this risk is no longer present either. However, tooth-colored fillings are not possible with amalgam.

For more information, read our topic Amalgam filling.

Composite

Composite, english composite, is a filling material that consists of an organic plastic base, matrix, with inorganic fillers. Since silicate cement did not fully meet the requirements for a filling material, alternatives were sought. At first they experimented with pure plastic. The fillings were ideal for polishing, but had the disadvantage of shrinking when they set and changed color over time. That is why the plastic was mixed with finely ground glass or ceramic particles and thus reduced shrinkage. This composite called macrofiller with a grain size of 5m made polishing difficult because it had a relatively rough surface. The next step was the installation of silica, so-called microfillers with a particle size of 0.2 m. This resulted in a significantly higher filler content, but very good polishability did not significantly reduce shrinkage and was not sufficiently abrasion-resistant.

The latest development is the hybrid composite. It connects larger fillers with microparticles in the spaces between the macroparticles. As a result, the proportion of plastic was reduced even more, which does not completely eliminate the polymerisation shrinkage, but further reduces it. If you first had to mix the material from two components, the introduction of the light-curing composite resulted in the elimination of mixing and a significant reduction in the setting time.

In order to improve the connection with the tooth enamel and thus avoid the marginal gap, a processing system was developed that ensures an intimate connection between the filling and the enamel. To do this, the enamel edge is etched with phosphoric acid and, after rinsing with water, an adhesion promoter Bonding called, applied and only then put the final filling.

Glass ionomer cement

Glass ionomer cement is less suitable as a filling material because it has a lower abrasion resistance and is difficult to polish. In addition to being used as an underfilling material, it is also used to attach tooth crowns. The advantage of glass ionomer cement is that it bonds chemically with the hard tooth substance.

inlay

Probably the best restoration of a posterior cavity is the inlay. Inlays are made of either gold or ceramic. The production takes place outside the oral cavity in the dental laboratory. This requires an impression to be taken after cavity preparation. The cavity must not have any undercuts so that the finished inlay can be inserted without difficulty. The inlay is cemented in with phosphate cement or glass ionomer cement. With a gold or ceramic inlay, a stable, abrasion-resistant restoration of cavities in the posterior region can be achieved. Ceramic inlays have the advantage over gold inlays that they match the tooth color.

In contrast, the stability of a gold inlay is better. However, the supply of a cavity with an inlay is associated with much greater effort, which of course is also reflected in the price.

Read more on the topic: Inlay tooth

Gold hammer filling

In addition to the gold inlay, the gold hammer filling is the best way to fill a cavity with a filling. This method of filling teeth is very old, but is rarely used today. In contrast to the inlay, this filling is done directly in the tooth. Gold foil or sponge gold is used, both of which are inserted in portions into the mostly small cavities with a tamping instrument. The plugs are used to connect the individual layers to one another, resulting in a filling with an ideal edge design.

Due to the large amount of work involved, this type of filling therapy is only rarely used, and it is also very expensive because only pure gold and no alloy can be used. However, the durability of such fillings is very high.

Tooth filling lost

Losing a filling either indicates that the attachment by the adhesive elements has not been carried out properly, or that caries has formed under the filling, which has loosened the adhesive bond from tooth to filling.
If the person concerned loses his filling, the general rule is that it will be replaced with a new filling as soon as possible. If the lost filling is on a root-filled / root canal-treated tooth, losing it can primarily not cause any discomfort, since the tooth is dead and can no longer feel anything due to the missing nerve tissue. In this case, filling is often not enough, as root-filled teeth should be crowned promptly, as the loss of the nerve tissue makes them brittle and easier to break off. The crown prevents the tooth from breaking off.

In the case of teeth that have not been treated at the root and where the filling is loosening, complaints often occur because the tooth lies “naked” at the point of the filling and is not protected. Cold drinks or food in particular cause pain, which is why the filling should be restored as soon as possible. Furthermore, the tooth is more easily attacked without a filling and the nerve in the nerve chamber can become inflamed. Therefore, you should go to the dentist as soon as possible after losing the filling. The same applies to milk teeth: if a filling has been lost, it should be restored as quickly as possible, since milk teeth are even more prone to caries due to their anatomical structure.

You can find more on the subject at: Tooth filling fell out

Pain after filling the teeth

Feeling of pressure:

After a filling, some patients complain of the feeling of pressure on the tooth.
On the one hand, it can have its cause in the new one Filling material is in the tooth, which easily irritates the nerve. This feeling should be gone after three days.
On the other hand, a prolonged feeling of pressure can be an indication of a beginning Inflammation of the roots and should be clarified by a dentist.

Duration of pain:

Toothache after a filling last when they occur some days on. How long such pain lasts also depends on the depth of the carious lesion. Is the Caries Has already penetrated very far into the tooth and the dentist therefore has to grind very close to the pulp, that's one mechanical irritation through the drill and grinding more likely and also stronger, the pain lasts longer.
In extreme cases, the toothache can be after the filling several weeks last. If the pain persists, the dentist should be visited again in order to be able to definitely rule out other causes of pain.
Toothache after a filling can also occur in the first few days permanent occur and are mostly described as pulling pains.

Only at night:

Toothache after a filling occurs in some patients only at night. The explanation for this phenomenon is basically very simple: patients take one at night lying position a. In this position, the head is at the same height as the rest of the body and is therefore supplied with more blood. A increased blood flow in the mouth increases the release of certain inflammatory mediators in tissues. These inflammation mediators bind to pain receptors in the mouth, causing the pain. Due to their binding to the pain receptors, pain signals are sent to the brain, which now lead to the sensation "pain" being transformed. Pain after a filling at night is nothing unusual and should soon go away on their own.

What to do if the filling is too high

If a newly placed filling or an inlay is too high, the dentist speaks of interference contact. The clenching is not even, but the first thing the patient strikes is the raised tooth, which over time leads to discomfort due to the overload. The tooth is subjected to far too much stress and this can lead to pain. For this reason, the occlusion is checked each time an inlay is inserted or a filling is placed in order to avoid any preliminary or interference contact.

If the patient has been anesthetized for the treatment, he can only feel whether something is disturbing when the local anesthesia no longer works. If the patient feels something disturbing, he should make an appointment with the treating dentist immediately. This then grinds in the interfering contact in order to restore even clenching.
If the person concerned leaves the interfering contact as ignored and suppresses the condition, severe discomfort can arise in the tooth, the masticatory muscles and the temporomandibular joint, as the masticatory system tries to compensate for the previous contact. The result is increased crunching, which can also lead to neck, ear and headaches.

A piece of the tooth filling has broken out

In most cases, the same applies to the breaking out of parts of a filling as to the complete loss. The filling must be restored promptly. The dentist then decides whether the filling will only be repaired or whether it will be removed completely in order to place a new filling.

If only a small piece has broken off, it may well be that it is sufficient to smooth the sharp edge and polish up the filling again. In the case of root-filled teeth, however, the possibility of crowning should also be considered here in order to avoid further breaking off of the filling or the tooth.

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What happens if you accidentally swallow a tooth filling?

If a filling or an inlay comes off, there is always a risk of swallowing it. Swallowing is inherently harmless. Due to their small size, it is unlikely to cause digestive disruption or clogging of the digestive tract. The filling is so small that it can move freely down the digestive tract and is then excreted.

If the inlay has been swallowed, attention must be paid to the stool so that it can be reattached after cleaning and disinfection, otherwise the inlay would have to be rebuilt. When breathing in the filling or its fragments into the windpipe, hiccups or a strong coughing urge often arise until the foreign body is pushed out of the windpipe again. If this does not succeed, a doctor should be consulted.

Tooth filling during pregnancy

A filling can be placed during pregnancy, but the timing should be considered. The most stable part of pregnancy is the 2nd trimester (4th to 6th month of pregnancy). The risk of organ damage to the child in the first trimester or premature birth in the last third of pregnancy is increased, so that no dental treatment should take place during this time.

Drilling a filling is always associated with stress for the mother, which also affects the unborn child. Therefore, treatment should occur in the second trimester, if at all. It should be noted that amalgam should not be placed during pregnancy due to increased side effects.
In addition, the expectant mother should be positioned on her left side and with a slightly elevated upper body so as not to obstruct the flow of blood to the heart. When administering local anesthesia, products with a high protein binding must be used and the vasoconstrictor addition should not exceed 1,200,000.

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What do discoloration of the tooth filling indicate?

A discoloration of fillings is realistic with plastics, as these can wear off after some time after laying. This is characterized by the fact that food coloring (e.g. from tea, coffee, red wine, beetroot, etc.) but also nicotine can be deposited in micropores on the surface of the filling. Typically, the edge changes color the fastest.
In general, tooth crowns can discolour when the pulp dies. The tooth then appears grayish; this can also shine through small plastic fillings.
Ceramic inlays or gold inlays usually do not discolour in this way.

Cost of a tooth filling

Filling materials vary in price and some require an additional payment beyond the health insurance subsidy.
It applies here that the statutory health insurances in the front teeth area take over the high-quality plastic, the composite, completely. Different regulations apply in the posterior region. Many health insurances cover the costs up to the first small molar (first premolar).
In the posterior area, the amalgam, cement and compomer are considered to be free of co-payments for patients with statutory health insurance; However, only the amalgam is suitable as a definitive filling in the posterior region in order to withstand the chewing loads. Cements and compomers are too soft and therefore not recommended as a long-term solution.

However, if the patient does not want the amalgam but the composite, he has to make a private additional payment, which is chosen differently for each dentist. The affected area of the filling is often decisive. A multi-surface filling is more expensive than a single-surface filling. The co-payment is between 30 and 150 euros, depending on the location of the dentist and the size of the filling.

If the patient decides on an inlay made of ceramic or gold, which describes a laboratory-made inlay filling, the costs are significantly higher. The dentist prepares the cavity and the dental technician creates a precisely fitting insert in the dental laboratory that fits into the hollow shape and is adhesively attached with special adhesives or cements. Inlays made of gold or ceramic are private services that are associated with higher costs due to the technical effort and the time required. The patient has to expect costs of between 200 and 1000 euros. The prices also vary greatly here. A price comparison of several dentists can be worthwhile here. With gold inlays, the current gold price, which can change daily, is decisive.

Depending on the insurance conditions, private supplementary insurance often covers the share or the cost of an inlay in full. The insured person must contact his or her supplementary insurance in advance to clarify whether the costs will be covered.

How long does a tooth filling last?

Amalgam fillings have proven themselves as a material for a filling due to their longevity of often 10 years and more, but are not desired due to the appearance and the ingredients.
Plastic fillings are not as durable as amalgam and must therefore be replaced at regular intervals.
Compomers and cements do not have a long shelf life, which is why they are rarely used (mostly only in the deciduous dentition). Cements in particular wash off quickly.
Inlays made of gold or ceramic are given by the dentist with a two-year guarantee, but are usually about as durable as amalgam fillings. Well-made inlays can last for decades without anything happening to the material or the tooth.
In general, however, the longevity of filling materials is heavily dependent on oral hygiene; if the dental care is poor, a filling can become obsolete and have to be replaced more quickly than expected.

Treatment process of a tooth filling

Placing a filling in the tooth consists of several sub-steps. It depends on the size of the defect ("hole") and which material is used.
In the case of inlays, there is also the work of the dental laboratory as well as molding and insertion.

In principle, the first thing to do is to drill (Cavity preparation) to remove all diseased material and to create the most flat base possible for the filling.
Underfilling may be necessary when you are close to the pulp
Preparation of the cavity (depending on the material)
Filling and hardening
Shaping, polishing, control

Preparation of cavities for a tooth filling

Before a tooth filling can be placed, all hard tissue that has been destroyed and softened by tooth decay has to be removed. Once this has been done, the cavity is prepared, i.e. the design of the tooth cavity for receiving the filling material.

For a long time, the guideline was " extension for prevention". This meant not only removing the carious parts, but also widening the cavity into areas that were not yet affected, but which could be prone to caries in the future. A lot of the still healthy tooth substance fell victim to this method, which is why it is being refrained from today and, on the contrary, one tries to preserve as much of the hard tooth substance as possible.

Drilling on a tooth that is still alive, i.e. that has not been treated in the root canal, is often painful, which is why local anesthesia is strongly recommended in order to make the treatment pleasant for the patient and the dentist.

Underfilling in the tooth filling

An underfill is part of every top filling. Its task is to shield the living tooth pulp, i.e. the pulp, from thermal and chemical stimuli. Zinc oxide phosphate cement is the preferred material for this use. Play a lesser role Calcium hydroxide containing pastes or zinc oxide eugenol. This underfilling is followed by the final supply with a top filling. For which different materials are available.

Parapulpular posts and fillings

If the carious process has already largely destroyed the tooth, so that a normal filling would not find a hold, the parapulpular pins can be used to create retentions to ensure that the filling material is anchored. The small pins are screwed into the dentin and can be bent so that there is enough counterforce for pulling forces. However, this only applies to vital teeth (not yet root-treated).

However, this procedure harbors numerous risks, such as the accidental opening of the pulp cavity or the rupture of the tooth in the longitudinal axis (longitudinal fracture). In the worst case, the tooth has to be extracted. A careful risk-benefit assessment should therefore have taken place before deciding on the parapulpular pen. Underfilling is a possible alternative.

Summary

In filling therapy, we have different filling materials available, depending on our needs. For the posterior area amalgam, inlay and, to a limited extent, composite. For the anterior tooth area, UV light-curing composites have become established. For every Tooth filling Underfilling is essential. Phosphate cement is the most commonly used material for this.

You can read more about this topic under "Incisor broken off'.