As a profession, so many fillings are placed every year that we, as dentists, have nearly become numb to the fact that patients usually don’t know what is in their filling with the exception of “it’s white” or “it’s silver”. We are going to review the two most commonly placed in-office restorations in dentistry: Silver Amalgam and Composite Resin fillings.

What is a Silver Amalgam Filling?

For roughly a century and a half, silver amalgam fillings have succeeded as durable, long-lasting, inexpensive, and effective restorations for decayed or broken teeth. Over the past several decades, silver fillings have fallen out of favor with many doctors and patients largely due to relatively poor esthetics and material content. Modern silver fillings are composed of elemental mercury, silver, tin, copper, indium, and zinc. The material comes in pre-packaged capsules with the mixture of “powdered” silver, tin, copper, indium and zinc in one side and the mercury on the other. Once mixed, the mercury bonds with the other metals creating a metallic putty which hardens within minutes of being placed in the cavity. Several hours later, the restoration reaches its full hardness and strength, and can be expected to provide a serviceable life of around 7-10 years, with many lasting 20 years or longer. Failure often occurs in the form of fracture of the tooth or filling, recurrent decay, and breakdown of the restoration’s seal with the tooth. It is generally accepted that mercury vapors, both during placement and during the lifetime of the restoration, are released form the materials.

When a patient would prefer a silver amalgam restoration or asks specifically for the material, we still provide the material as an option in my practice. Over the past several years, I’ve noticed a significant transition in patient desires, as well as my own, for tooth colored restorations. A few years back I had a discussion with a patient who would not consider any material other than tooth colored composites because of concerns over the mercury and metals of silver fillings.

What is a Composite Filling?

The patient and I had a discussion on materials and reviewed that composite resin tooth colored fillings are still a synthetic replacement for lost tooth structure composed of different sized fillers and monomers which cure with a light to form the solid matrix that is the filling. A properly prepared and cured restored composite resin should be free of the dreaded Bisphenol-A (BPA) we hear and read about regularly, but BPA is still a precursor to several of the materials which may leave trace residual amounts in the matrix. As composite resins break down from the rigors of the oral environment, it is possible (according to the American Dental Association) that the monomer in the restoration may release small amounts of BPA as salivary enzymes break down the resin.

How do we overcome this? Several products have evolved to eliminate monomers which could contain or break down to release BPA. In our practice, we feature two different composite materials for our every-day fillings and we decide which to use based on location and shade requirements. We also provide sealants for children and teens with BPA free sealing materials which also release fluoride to prevent cavities. We will use an alternative composite resin to seal teeth if a parent would prefer this option. When we consider what to use as a restorative material, we strive to select optimal filling materials, as well as bonding agents which will result in a functional, esthetic, durable, and failure resistant solution! If you don’t live in Southern Oregon and can’t stop by White Dental Studio, make sure to find a dentist in your area that will thoroughly discuss your options with you!

More questions? Please leave us a comment and we’ll get back to ya!

Dr. Brandon White, DDS