The Many Options for Fillings

There are many types of fillings to repair your chipped, broken, or decayed tooth

Filling Types, Advantages and Disadvantages

Fillings are used to repair cracks in a tooth, decayed teeth, and worn enamel. Amalgam (silver-colored) and composite resin (tooth-colored) fillings are the most common restorative materials known to patients. Did you know there are other filling materials available? Your dentist will determine which filling material is the best selection to restore your tooth after an exam, reviewing the extent of repair needed on the tooth, cost, and insurance benefit.

Each filling material has its own advantages and disadvantages:

• Amalgam Fillings
  • Advantages - amalgam fillings are inexpensive and very durable. Amalgam can also withstand harsh chewing forces. The procedure can usually be completed in one office visit.
  • Disadvantages - amalgam fillings are silver-colored, so do not match the natural color of the tooth; they can even stain teeth to a grayish color. Preparation requires large removal of damaged tooth structure in order to place an amalgam filling.
• Composite Filling
  • Advantages - composite material provides a wide spectrum of colors that match natural tooth color and blend in with adjacent teeth. Composite can repair small chips and decay without removing a large amount of natural tooth structure. The procedure can usually be completed in one office visit.
  • Disadvantages - composites can cost twice the amount of amalgam fillings and generally do not last as long. Composites can chip easily when located on the chewing surfaces of the front tooth. One can expect to sit longer in the dental chair for composite procedure in comparison to amalgam.
• Glass Ionomer
  • Advantages - glass ionomer can help protect the tooth as this material releases fluoride. The material is typically used for baby teeth with small cavities and to repair decay underneath the gum line.
  • Disadvantages - glass ionomer is weaker than composite and amalgam materials and generally does not last as long. The cost of glass ionomer is comparable to a composite filling.
• Cast Gold Fillings
  • Advantages - gold fillings are stronger and more durable than amalgam, composite, or glass ionomer.
  • Disadvantages - the procedure requires two appointments, since gold fillings are an indirect filling. This means that an impression has to be taken at the first appointment, then the patient must return to the dental office for a second appointment to have the filling custom fit. Some patients may dislike the metal shade in comparison to a natural tooth shade. Gold is also costlier than direct filling materials (amalgam, composite, glass ionomers).
• Porcelain or Ceramic Fillings
  • Advantages - porcelain or ceramic fillings are aesthetically pleasing and can be custom stained to match the natural tooth and adjacent teeth. The materials are stronger than composite and amalgam, but aren't as strong as gold.
  • Disadvantages - porcelain or ceramic fillings are also indirect fillings, so they require multiple visits to the dental office, and may cost as much as the gold fillings.

How Are Direct Fillings Different from Indirect Fillings?

Direct fillings involve a single visit, where the dentist numbs, prepares the tooth, fills and polishes the tooth on the same day appointment. Examples of direct fillings are amalgam and composite fillings.

Indirect fillings are the most durable and long lasting, however, they involve two separate office appointments:

• During the first appointment, the dentist prepares the tooth, selects the custom shade, and takes an impression. The impression is then sent to a lab where the filling is custom made.
• During the second appointment, the custom filling is inserted, bonded, adjusted, and polished.

Indirect fillings are stronger and last longer than most other types of fillings, however, they also tend to be the most expensive.

Insurance and Co-Pay for Fillings

Your dentist will recommend which filling material is the best option to restore the tooth based on the amount of tooth structure loss, extent of decay, cost, and the strength of filling material needed (especially for those who grind their teeth). Fillings are categorized under Minor Restorative Services in your benefit booklet; be sure to review the benefit booklet for co-pay, deductibles, frequency, and limitations for fillings. A pre-estimate is recommended for porcelain and cast gold (indirect) fillings to provide a better understanding of out-of-pocket charges.