Selecting Materials Used for Tooth Restorations

This information is provided to help you make decisions about selection of materials as tooth restorations in your mouth. Many types of metals are used in dentistry for the replacement and rehabilitation of oral structures. Most of these metals are considered to be inert when placed in the body, while others have been criticized as potential toxins or allergens. Plastics and ceramics are used commonly as tooth restoratives, and these have not been shown to have adverse biologic responses. The following information will help you to make decisions about the type of tooth restorations you prefer to be placed in your mouth:

RESTORATION OF MISSING PARTS OF SINGLE TEETH (FILLINGS):
Silver amalgam has been used for about 160 years for tooth restoration. This alloy contains silver, tin, copper, zinc, and about 50 percent mercury. It has been a highly successful, but unsightly material. Use of mercury in the body has been criticized since its inception, but amalgam use is still supported strongly by the American Dental Association and other health groups worldwide. A few people in the overall population may be allergic to the elements in silver amalgam. However, you have several other options for restorations (fillings).

YOUR CHOICES FOR RESTORATION OF MISSING PARTS OF SINGLE TEETH (FILLINGS):

  1. Silver amalgam. Average longevity about 15 years, silver colored, low-moderate initial cost. Best used in smallto medium-sized restorations of posterior teeth (premolars and molars).
  2. Gold inlays and onlays. Average longevity 20 years to life, gold colored, moderate to high initial cost. May be used in most locations where metal is not displayed to an objectionable level.
  3. Resin (plastic) – direct (one-day appointment placement). Average longevity 10-15 years, tooth colored, moderate cost. Best used in small-to medium-sized restorations for any teeth. Considered at this time to be comparable to silver amalgam’s service potential.
  4. Resin (plastic) – indirect (two-appointment placement). Average longevity (expected) 10-15 years, tooth colored, moderate to high initial cost. Best used in medium to large restorations for posterior teeth (premolars and molars).
  5. Ceramic – indirect (two-appointment placement). Average longevity 10-15 years, tooth colored, moderate to high initial cost. Best used in moderate to large restorations for any teeth.

CROWNS OR FIXED PROSTHESES (BRIDGES) Gold alloys have been used for many years for the construction of crowns or fixed prostheses. Gold alloys provide excellent, strong, long-lasting service. Other alloys are used as well. Three major types of alloys are now available:

  1. High-noble metal. Mostly gold, but also palladium, silver, and occasionally platinum, zinc, and copper.
    >Noble metal. Mostly palladium, but also silver, gold, and other trace metals.
  2. Base metal. Mostly nickel, but also chrome or cobalt and other base materials.

All of the above alloys are used either as the sole constituent of a crown or as a thimble on which porcelain is fired (baked). Most people have no biologic response to any of these categories of metals, but some people, especially females, have adverse tissue responses to base metals. If you know of allergies you have to metals, please tell us. We usually use noble or high-noble metals. The cost of these is somewhat higher than base metals. Fixed prostheses are strongest when metal is used with or without porcelain on it; but, in certain limited situations, all-ceramic or polymer fixed prostheses may be used as described below.

YOUR CHOICES FOR CROWNS (CAPS) OR FIXED PROSTHESES (BRIDGES):

  1. Metal alone. High-noble, noble, or base metal. Average longevity 20 years to life, gold or “silver” color, moderate to high initial cost. May be used in any area where metal display is not objectionable.
  2. Porcelain fused-to-metal. Average longevity 10-20 years, tooth colored, moderate to high initial cost. May be used in any area where extreme biting stress is not present, and patient does not have severe tooth grinding habit.
  3. All-Ceramic. These restorations are constructed from ceramic alone. Average longevity is 10-plus years, moderate to high initial cost. All-ceramic fixed prostheses may be used in some clinical situations. These materials are being improved constantly.
  4. Polymer (plastic). These restorations may be used for single crowns or bridges. Average longevity is several years. Success has been reported up to 5 years.

We will inform you about the best type of tooth restoration for your mouth, and we welcome your questions. Thanks for helping us to make these important decisions.

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