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When it comes to repairing worn, damaged or decayed teeth, you and your dentist have choices. There are many different kinds of restorations, or ways to fix a tooth. The kind of restoration used depends on many things, including:

• your oral and general health

• the materials used in the restoration

• where and how the restoration is placed

• the chewing load that the tooth will have to bear

• the cost of the restoration

• the number of dental visits needed to restore the tooth.

With so many things to think about, how do you make a decision? Talk to your dentist to find the best option for your smile.

Common Materials for Crowns, Inlays and OnlaysPorcelainThis glasslike material can be used by itself in restorations, or bonded to another material for extra strength.

• All-porcelain restorations have a color and translucency that look like natural tooth enamel. However, they can crack under pressure, so they may not be the best option for teeth in the back of the mouth.

• Porcelain fused to metal is stronger than porcelain alone. More of the existing tooth must be removed to make room for this type of restoration.

• Porcelain fused to zirconia is very strong and durable. It can be matched to the exact color of your teeth. This type of material may be more expensive than all-porcelain or porcelain-fused- to-metal restorations.

Metal AlloysFor large restorations such as crowns, metals are often used. They are very strong and resist cracking and wear. They can also be highly resistant to corrosion and tarnishing. Since metal alloys have a dark color, they do not look like natural teeth.

• Gold alloys contain gold, copper and other metals. Less of the natural tooth may need to be removed than with some other restorations. They may cost more than other restorative options.

• Base metal alloys look like silver. They are used in crowns, fixed bridges and partial dentures.

CompositesComposites are not only used in direct fillings. They can also be made into crowns, inlays and onlays in a lab. Indirect composites are tooth colored but can become discolored over time. They are not as strong or durable as porcelain or metal restorations.

By working closely with your dentist, you can have your best possible smile. Thanks to advances in technology, there are more ways than ever to have a pleasing, natural-looking smile. Talk to your dentist to see which one is right for you!

Choices for Restoring Your Smile

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A few states require that specific information be provided to patients concerning various types of restorative materials. This brochure is not intended to fulfill those requirements, but to provide information of a more general nature.

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Prevention, the Food and Drug Administration and the World Health Organization.

Composite Fillings:• are a mixture of glass or

quartz filler in resin • are tooth-colored and

long lasting • are sometimes called

composites or filled resins• allow the dentist to remove

less of the tooth when the dentist prepares it for the filling. As a result, the filling may be smaller than an amalgam filling.

Composite fillings may cost more than amalgam fillings. They may take longer to place in the tooth. Composite fillings may discolor over time. Ionomers:

• are tooth-colored materials made of a mix of acrylic acids and fine glass powders

• can release a small amount of fluoride that may help patients who are at high risk for decay

• allow the dentist to remove less of the tooth as the dentist prepares it for the filling. As a result, the filling may be smaller than an amalgam filling.

An important thing to consider with ionomers is that they may crack more easily than other filling materials. Ionomers work best when they are placed in areas where there is not heavy chewing pressure. Ionomers may be very close to your natural tooth color, but do not have the translucent look of real tooth enamel. Their cost is similar to composites, but ionomers cost more than amalgam.

Direct RestorationsFillings are used to repair a tooth damaged by decay. With direct restorations, the dentist puts the filling material right into the tooth. When you get a filling, the dentist first removes the decayed part of the tooth. Then the dentist cleans the area and fills the cavity. Most of the time, this happens during a single visit.

After some dental fillings are placed, patients may be sensitive to hot or cold for a short time. In rare cases, patients may have an allergic reaction in that area to some ingredients in dental filling materials. It is important to talk to your dentist if you are concerned.

Common Dental Filling Materials

Dental Amalgam:• is a stable alloy made of about 43 percent

to 54 percent mercury with other metals, including silver, copper and tin

• has been used for fillings for over 150 years• is very long lasting• works well under pressure, so it is good for

teeth in the back of the mouth, where chewing pressure is greatest

• is relatively inexpensive compared to other materials

Amalgam fillings are silver-colored and do not look as natural as a tooth-colored filling, especially when the restoration is near the front of the mouth. Also, the dentist may need to remove a larger part of the tooth to place an amalgam filling compared to other kinds of fillings.

Recently, there has been some concern about the mercury used in amalgam. However, the amount of mercury released from amalgam fillings is well below established safety limits. Major U.S. and international science and health organizations have agreed that dental amalgam is safe to use for fillings. These groups include the National Institutes of Health, the U.S. Public Health Service, the Centers for Disease Control and

Inlays and OnlaysAn inlay is a special kind of filling that may be used to repair the chewing surfaces of a back tooth like a molar, premolar or bicuspid. It fits into the contours of the tooth, between the cusps (points) of the biting surface. The inlay restores the space that remains after the dentist removes the decay or old filling.

An onlay is like an inlay, but it is bigger and covers some or all chewing surfaces of the tooth. It may provide more coverage for a tooth that has lost much of its biting surface when decay damages the surface between teeth. Your dentist may recommend an onlay based on how damaged the tooth is.

During the first visit, the dentist prepares the tooth by removing the old filling or decay. The tooth is then shaped for the restoration. Next, the dentist makes an impression of the tooth, the opposing teeth and the bite. The dentist then makes a model. From that model, the inlay or onlay is made in a dental lab. A temporary filling protects the tooth until the next visit, when it is removed.

During the second visit, the permanent inlay or onlay is checked for fit before the dentist cements it to the tooth. The dentist then adjusts the inlay or onlay for comfort and gives it a final polish.

Indirect RestorationsInstead of being made directly in the tooth, indirect restorations are made in a lab and then placed on the tooth. Indirect restorations include crowns, inlays and onlays.

Typically, indirect restorations require two or more visits to place. During the first visit, the dentist prepares the tooth and makes an impression of the area to be restored. The impression is sent to a dental lab. The lab then makes the dental restoration. At the next appointment, the dentist cements the restoration into the prepared cavity and adjusts it as needed.

The cost of indirect restorations is generally higher due to the number and length of visits required, and the extra cost of having the restoration made in a dental lab. As with direct restorations, talk to your dentist about possible allergic reactions to certain dental materials.

CrownsA crown is an indirect restoration that covers or “caps” a tooth to restore it to its normal size, shape and function. It covers the entire chewing surface and sides of the tooth. It usually requires two dental visits to complete a crown.

During the first visit, the dentist prepares the tooth by removing the outer portion so the crown can fit over it. If additional tooth structure is needed to support the crown, the dentist may build up the core of the tooth.

An impression is made to provide an exact model of the prepared tooth. Your dentist or a lab technician then uses the model to develop the shape and size of the crown.

A temporary cap is placed on the tooth until the final crown is made. When the crown is ready, your dentist places it and adjusts it for your comfort. When you and your dentist like how the crown looks and feels, your dentist will cement the crown into place.

Inlay Onlay

Tooth with an amalgam filling

Ionomer filling

Composite filling

When people think of repairing teeth, fillings usually come to mind first. But there are also other types of restorations, such as crowns. The two main ways of making a restoration are called direct and indirect restorations. And there are different materials to choose from, each with different benefits.

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