White FillingsHow many times have you examined your old metal fillings in the mirror, wondering what can be done to make them look better?  Have you also questioned your dentist about the options he has to offer in this instance?

Your old amalgam fillings  have been placed in your teeth probably a long time ago by your childhood dentist when you were in your early teens.  Some of them are very big indeed, others are still functioning quite good even though they show multiple cracks and abrasions.

At an early age our adult teeth have not yet reached their later strength.  The development of our teeth is such that their final strength requires a long period of mineralization.  Therefore, teenagers’ teeth are more susceptible to fast developing decay.  In other cases the natural development can be disturbed by different diseases or events, leading to insufficient closing of fissures (the deep depressions in our tooth structures).  In particular cases, the absence of fluoridated water during the developmental stage of teeth will contribute to the fragility of their structure facilitating decay and cracking of the superstructure.

The placement of large and sometimes very deep amalgam or metal fillings dating from this early age was never a choice but a strict necessity.  Your dentist had simply no other possibility to repair and save your teeth.  Now, decades later, those not very attractive metal structures look like they do not belong anymore in someone’s mouth; who would like a more attractive and natural aesthetic?

In our practice, several times a week we are inevitably confronted with the justifiable desire of new patients for replacement of the old metal fillings with the new, modern, white, non-metallic materials.  On the other hand and with the same regularity we examine new patients who have already replaced many if not all of their metal fillings with white ones.

From the patient perspective the replacement with the natural color filling material is absolutely desirable and totally justifiable aesthetically.  By simply comparing the before and after pictures side by side the aesthetic improvement is dramatic enough such that replacement is unquestionable.  With closer analysis and critical observation however, some restrictions and limitations for the recommendation of total replacement of old metal fillings with new white ones must be discussed.

When confronting your dentist on your next visit with the replacement question, it would be of eminent importance to analyze together with the dentist the “pros” and “cons” – the advantages and disadvantages of each individual tooth retreatment.

Some simple and basic guidelines when observed can protect your teeth from future disasters.  One of these such limitations would be presented by the size of the old amalgam filling.  If your tooth was initially excavated to a high degree and your old filling represents more than 60% of your original tooth volume – a new filling will definitely be larger – the tooth walls will become much thinner and consequently your tooth will break or crumble under normal chewing pressure.  The new filling will look much better but will not last .  When the tooth splits or cracks, chances are quite high you will lose the tooth altogether; a split tooth cannot be repaired.

Another restriction hint will come from the necessary radiograph picture (x-ray) taken before such treatment.  If your old filling shows a relative extension towards the nerve chamber of your tooth and at the same time secondary decay has been detected – your dentist will need to excavate even deeper towards the nerve to clean the new cavity prior to filling.  This increased proximity to the nerve as well as reduced structural resistance is of course detrimental to the tooth and undesirable.

There are many other circumstances rendering the replacement non-advisable.  The close observation of the old metal fillings and the analysis of the present tooth condition will determine the ideal course of treatment and the alternative if the  metal to white change cannot be made.
The most conservative advice if the old filling is not visible with a large smile or if it still performs without absolute need for replacement would be to avoid the replacement at all – to check and recheck each filling at every three month hygiene appointment and monitor the integrity of each tooth.

If the structural condition of the tooth is becoming a questionable preoccupation, the alternative treatment after the initial repair / replacement, is a regular crown which is the safest, longest lasting and most reasonable alternative.
Talk to your dentist … do not simply demand replacement with white fillings at any cost.  His experience and guidance can save the life of your tooth and secure the proper, long-lasting functionality of the mouth.

If in doubt, a second opinion could also provide you with the professional and experience-based treatment alternatives, meant to offer your teeth the best, least traumatic treatment.

© 2011 All Rights Reserved, Dr Florian Braich DDS PhD