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How are White Fillings Placed?

amalgam replacement

Everybody likes beautiful white teeth.

Did you ever wonder how a white composite filling is placed?

What is involved in replacing a silver mercury/amalgam filling?

Well, here is a quick step by step outline demonstrating the placement of a white filling.

ISOLATION:

We need to isolate the tooth with or without a rubber shield. Below you can see how some of the fillings are isolated. In some of the teeth the silver mercury or decay has already been removed. We use a clamp to separate the teeth so a tight contact can be achieved in the final restoration.

Step 2 isolation rubber dam

EVALUATION:

fractured tooth

We then use high powered magnification and strong lights to look for fractures in the tooth. More often than not a silver mercury filling/amalgam results in the tooth being fractured. If fractures are present, as seen above, then a white filling cannot be placed, but rather a full cuspal coverage restoration such as a crown is needed.

 

FILLING:

white filling placementFilling

Proper filling of the cavity is key to avoid post-operative sensitivity. The white filling material has to be placed in a dry, clean environment and layered in no more than 2mm increments. This is where most errors take place! Meticulous handling of the materials is essential.

FINISHING:

finished white filling

Once the restoration has been placed and hardened with a strong LED like light it needs to be polished and adjusted. If the filling hits the opposing tooth even a little bit too much then it can kill the tooth! So, proper adjustment is critical. Once the filling has been adjusted correctly it needs to be polished to a high gloss.

I hope this helps everyone understand the basic principles of a white filling. Of course there are many more details and variables, but that is for the dentist to understand 🙂

Keep smiling,

Dr. Chris

 

posted in Blog, Cosmetic Dentistry, General Dentistry

4 thoughts on “How are White Fillings Placed?

  1. Flemming

    Hi Dr. Chris
    Five years ago, I had leakages at amalgam fillings in two of my back molars. My dentist took out the fillings, cleaned the recurring decay that were under the fillings away, and made two white fillings. Until now, I have been happy with my white fillings, but now the dentist says these two fillings need to be redone/replaced already after five years. After having lots of decay as child and teen, I am now taking good care of me teeth and have not had any new decay for more than 20 years. Therefore, I am surprised that the white fillings are so short lasting – compared to my 30+ years old amalgams. Is that normal they last so short? What is the reason they need to be redone/replaced? What can I do to make the white fillings last longer?

  2. Dr. Chris

    Fillings fail for many reasons and it is impossible to tell why without more information. Your dentist needs to be able to give you the exact reason and more importantly “why” it happened. If it is decay then is it due to diet (soda, sugar, etc) or heartburn acid or wear. Regardless, 5 years is pretty short and I would question it as well. Find out exactly why and what the supporting reasons are and let me know!

  3. Flemming

    Hi Dr Chris
    Thanks for your comment. I went to the clinic again and had a kind of second opinion on my two white fillings form another dentist at the clinic. The one is worn down – it is a very large filling covering one corner and most of the chewing surface. The dentist said I seemed to be too large to take the chewing pressure on the back molar teeth and he suggested to have a crown placed instead. The other one has new decay. Since I don’t have much sugar in my diet and no other new decay for many years, his explanation was that it was due to shrinkage when the filling was done 5 years age, which had formed a slight gap between tooth and filling, in which the new decay had formed. Does those explanations seem reasonably?

  4. Dr. Chris

    Well, you don’t cover cusps with white filling material, it’s not strong enough not designed for that. So, bad decision on that dentist a while ago. Should have been an “onlay” or worst case crown. Many dentists don’t know how to do onlays anymore…sad.
    Secondly, if there was shrinkage when filling was placed then it was probably bulk filled, or in increments of 2mm or more. Also bad decision. You need a dentist that not only n owns what to make but how to do it correctly. In other words, not a clinic 🙂

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