Tooth filling with cement
introduction
Tooth decay is common and almost everyone has had a decayed tooth. Either in the front or on the large molars - tooth decay attacks the hard tooth substances and breaks them down.
So it succeeds bacteria, to penetrate further and further into the tooth. To remove the tooth decay and thus to protect the tooth from further damage, only going to the dentist will help. There the caries is removed and a hole remains that cannot be left as it is.
A filling is needed to close the hole. Stand for different materials to choose from, such as amalgam, composite or a filling with a special cement.
But what exactly is it and how does the cement filling differ from the others?
What filling materials are there?
The classic and best-known filling is an amalgam filling. The silver amalgam consists of mercury, tin, copper and silver. Due to its properties, it is easily deformable and expands after being introduced into the cavity, so that it can completely seal the hole and no substances can penetrate from the outside.
Where there is great chewing force, such as on the large molars, it is still the method of choice. Amalgam fillings have come under fire in recent years due to the fear that the mercury they contain could be harmful to health. However, the dose is so small that this is not the case.
The newest means that are used are the so-called Composites. A composite consists of 80% silica salt and 20% plastic. The big advantage is that it is tooth-colored and can therefore also be used optimally for fillings in the anterior region. There is also the option of using a special color technique to optimally adapt the plastic to the rest of the tooth color in the dentition. Composites are long-lasting and retain their shape, so that they can also be used in the anterior region as well as in the posterior region.
A mixture of a composite and a glass ionomer cement is called a compomer. However, these still require some research and further investigations, because the agents currently available on the market are only suitable for fillings in the tooth neck area, on milk teeth or for a transitional period. A filling on chewed surfaces is currently not possible.
Gold hammer fillings with a thin gold foil in the hole "knocked in“Are rarely used. The filling would be clearly visible, but has a good durability.
Another way to fill a tooth is to use cement.
Read more about this:
- Material of a tooth filling
- Temporary filling
Glass ionomer cement
If one would like to fill a tooth, one does not simply speak of a "cement", rather it is called more closely than Glass ionomer cement (GIZ for short). In this way you can avoid the confusion, since the “cements” used in dentistry are otherwise used Attachment of a crown be used.
You can distinguish between 3 basic types of cement:
- Filling cements, like that just mentioned Glass ionomer cement
- Retention cements with which a denture, such as a crown or a temporary, is attached to the tooth either permanently or provisionally
- Underfill cements, e.g. for fissure sealing
Before taking a closer look at glass ionomer cement, one must consider the properties that such a cement has to offer. It has to be biocompatible, not too thick and easy to process. Furthermore, it must hold well, let light through, resist high pressure and tensile forces and be able to be loaded quickly. Not every cement can 100% meet all these requirements.
The glass ionomer cement used for filling therapy is used for salivary, temporary filling, such as in a dental emergency service is used when you don't have time for a more elaborate filling. So it is not used for permanent filling, but is given to the tooth for a certain period of time.
The full name for a glass ionomer cement is: Glass-polyalkenoate cement and consists of a powder and a liquid that are mixed together. The liquid consists of 48% polyacrylic itaconitic acid copolymer, 5% tartaric acid and 47% water. The powdery component consists of 100% aluminum silicate glass with Fluorides and Calcium. This also addresses a specialty of this type of cement, because there are fluoride and Calcium from.
After it's brought in, there is fluoridewhat is also present in toothpaste, for example, in small amounts on the tooth. This is intended to counteract renewed tooth decay on the edges of the filling. In addition, possible bacteria are killed and the enamel is strengthened.
If the two components are mixed together shortly before they are introduced, a chemical setting reaction occurs. The acid contained in the liquid attacks the glass parts and metal ions are released. These free metal ions can now migrate, so that the atoms are rearranged. A gel-like mass is created, which sets and then hardens in the further course. If the dentist now fills the existing hole with this mass, it adheres to the untreated enamel and dentin through a chemical bond between the polyacrylic acid and the calcium of the tooth enamel. Thus, the attachment is given for a certain time.
Properties of the glass ionomer cement
As mentioned above, this mineral cement is only intended for temporary filling therapy and is otherwise used more for the attachment of dentures. In addition to the temporary filling, it can also be used to treat carious defects in milk teeth. Smaller defects on the tooth neck can also be treated with it, but must be checked at regular intervals for their durability.
A provisional filling makes sense as soon as a definitive filling is not yet indicated. This would be the case if a tooth decay was already dangerously close to the tooth nerve and it is not yet certain whether the nerve might have been damaged. A definitive filling should not be selected for a critical tooth, as it is more complex and expensive and you have done all the work for free if it turns out that the nerve has to be removed or even the whole tooth has to be extracted.
It can also be used after a root canal treatment until the therapy is successful. In all of these cases, temporary care makes more sense for the time being in order to save unnecessary costs and effort. In terms of color, it shows a matt, light surface after curing. However, the color does not quite match the natural tooth color and is therefore recognizable as a filling.
disadvantage
The reason why a filling with a cement cannot be counted as a long-term supply is that it can become brittle more quickly and has less resistance to abrasion. It wears out faster and can break more easily with high chewing forces.
There is also the disadvantage that it absorbs water, which also leads to cracks. Due to its matt color, it does not meet very high aesthetic standards. Temporary fillings can remain in the tooth for 6 months to a maximum of a year, but should be replaced after the year at the latest, or replaced with another, higher quality.
costs
Glass ionomer cements can collect plus points in terms of financial aspects. They are part of the standard care of the statutory health insurances, also in the posterior area, and are therefore free of additional payments. For the time being, there are no further costs for the patient. It should be noted, however, that these fillings do not have a long shelf life and must be renewed at certain time intervals, which requires regular appointments with the dentist.
Furthermore, a little more of the tooth substance has to be removed with each new filling process, so that healthy tooth substance is lost in small amounts with each treatment. That is why it is advisable to have a permanent supply, such as with one Compositeto think about. However, this is associated with costs for the patient in the posterior region, as it is not a standard care provided by the health insurance company. A Composite filling is only adopted if it is in the visible area. On the posterior teeth, the difference to the amalgam filling must be paid, which would otherwise be the standard care of the health insurance company. However, if there is amalgam intolerance, the health insurance company will cover the composite costs in the posterior region.
Shelf life of cement fillings
The guarantee for dental care is 2 years. A cement filling should not be expected to last longer. Cement is actually not a definitive (= final) filling material. It is often used as an underfilling, under an amalgam filling or as a building-up filling in order to later restore the tooth with a crown.
Dental cements solidify by mixing a powder with a liquid. This powder consists of calcium, aluminum, silicates and glass, minerals that are not very stable. Cements are therefore very porous compared to amalgam or plastics. Over time, the minerals wash out of the cement. On the one hand, the filling lacks stability and hardness. On the other hand, the tooth is more susceptible to tooth decay due to the lack of mineral release. The advantage of cements with small particles is that they fit very well. The disadvantage, however, is that it is less strong and less resistant to abrasion. If you choose a coarse-grained cement, it is harder, but it does not fit into the filling cavity.
Ceramic filling as an alternative
In addition to the alternatives mentioned, such as amalgam or composite, filling with ceramic can also be made. In this case one does not speak of a filling, but of a ceramic inlay, as it can also be used from gold.
Ceramic has the advantage that it is extremely resilient and has a tooth-like color, so that you can often not tell the difference between tooth and inlay. The ceramic powder is mixed and pressed into a mold, which corresponds to the hole to be filled later. When the dentist holds the finished ceramic inlay in his hand, he only has to glue it into the tooth. Even larger defects on the tooth can be repaired with it. Modern ceramics have a long shelf life and can be gently inserted into the tooth. Since glass ionomer cements are only a temporary solution and have some disadvantages, a restoration with ceramic is the better choice, especially in the posterior region, as the ceramic can absorb the great chewing force. The manufacturing process is more complex and the costs, which have to be paid privately, are therefore quite high. Depending on the extent of the destroyed tooth substance, costs between 400 and 700 € can arise.
Read more on the topic: Tooth filling with ceramic
Gold filling as an alternative
Another alternative is an inlay or an inlay made of gold. This is not pure gold, as it would be much too soft, but a gold alloy with other, more stable metals. Here, too, the inlay must be made beforehand in the laboratory and is then cemented in by the dentist with relative dryness. Gold has the advantage that it can be made very precisely and precisely and thus perfectly fills the given space. It can withstand heavy loads and still does a good job even after 15 years. The disadvantage, however, is the color and the time-consuming manufacturing process, which incurs private costs in the range between € 400 and € 650.
Find out more here: The gold inlay
Pain after filling the teeth with cement
Basically, there may be pain after a filling is placed. These are independent of the material that is introduced into the cavity. The tooth is irritated by the grinding tools and the cold water during the treatment. Depending on how deep the caries is, a lot of protective dentin material is removed so that little protection remains over the pulp, the tooth chamber. The dental nerve is also strongly irritated, which causes pain after the treatment as soon as the anesthetic injection wears off.
With cements in particular, irritation occurs because the liquid in the 2-component cement, among other things Tartaric acid and Polycarboxylic acids contains. Therefore the cement has a relatively low pH value. When fresh, it continuously releases acid to the tooth, causing pain in the area of this tooth.
Summary
Dental cements can be used not only to fix a crown, but also to fill teeth. This temporary filling is paid for by the health insurance company, but has to be renewed regularly due to its lower stability, so that longer use is not recommended.
Alternatives are found in fillings made of composite or inlays made of ceramic or metal.
