White fillings or porcelain: which one to choose?

Dental restorations are treatments that aim to totally or partially reconstruct the anatomy and structure of a tooth that was damaged, generally due to caries and/or fractures, in order to restore its chewing function, aesthetics, and anatomy.

This procedure consists of first removing the caries lesion of the tooth (decay) and then filling it with materials such as composite/white filling or placing a porcelain inlay, onlay or crown. This will depend on the needs and requirements of the patient, which tooth is affected, the amount of dental tissue involved, among other characteristics.

Dr Carla Placing a Filling on a Patient

Dental restorations can be direct or indirect:

Direct: In these, the filling is placed in the cavity once the decay / hole has been cleaned out and can be performed in a single appointment. There are several materials that can be used depending on the location of the tooth and the size of the lesion.

Among them is amalgam, which although it is still used today thanks to its resistance and durability properties is no longer as popular as in previous years, since dentists now prefer to opt for biocompatible materials with a low probability of generating adverse reactions in the patient and which provide as natural an appearance. Composite is a white filling material and is more conservative for the tooth. We have a page that delves into amalgam fillings removal if you are interested in finding out more on this subjuect.

Indirect: With conventional techniques, more than one appointment is required for placement because they are customized restorations that are fabricated in a prosthetic laboratory. Thanks to advances such as CEREC, which uses CAD/CAM technology, it is possible to fabricate and place the indirect restoration in a single appointment.

These types of restorations include inlays, onlays and porcelain crowns. It should be noted that inlays and onlays can also be made with composite, but are not be as strong as those made of porcelain.

The Process of Having a Tooth with Decay, Removing the Decay, then Placing a White Filling

Let's learn more about white fillings.

Composite is a moldable material that resembles the natural color of teeth. It is used to fill the cavity that remains in the tooth after removing decay, adapting and adhering to the anatomy of this space as it hardens.

How long does a filling last?

All dental restorations have an approximate lifespan, which may vary from one person to another due to factors such as oral hygiene, eating habits, whether or not the patient is a smoker and the frequency with which he/she goes to the dentist for a check-up. In relation to composites, these can last approximately 5 to 8 years, which can be more or less depending on the aforementioned factors. The size of the restoration is also important. Composite is like a plastic, and is not as strong as porcelain - so the bigger the filling, the shorter it may last if it is in composite compared to if it were made in porcelain.

It should be taken into account that with the passage of time the composite may undergo color changes, wear or leaks, and the latter favor the proliferation of bacteria that cause acids that damage the structure of the teeth, as well as the accumulation of food, which in turn can lead to the development of caries and periodontal disease.

When is a white filling not the best option?

• White composite fillings are not the best option in very extensive restorations with thin walls that require reinforcement of their structure. A ceramic inlay/onlay or a crown ma be better.

• In patients who suffer from bruxism (clenching and/or grinding of the upper and lower teeth), which can wear down the restoration and even fracture it.

In general, white fillings offer good esthetics and when they are well placed and their color is chosen correctly, they can go unnoticed. It is also a very conservative treatment since the only grinding of the tooth that is required to place them is to remove the decayed or weakened tooth. On the other hand they have some disadvantages in terms of durability, strength and esthetics compared to other treatments such as porcelain restorations.

When is it time to go to porcelain?

Porcelain restorations, whether inlays, onlays or crowns, have several advantages, among which we find:

• Excellent strength and durability properties, so there is a lower risk to fracture the restoration in relation to composite fillings.

• Excellent esthetic and optical properties, with low probability of color changes.

• Can be used in extensive restorations, where the decay lesion left little healthy tooth tissue.

• Low wear rate, which helps to reinforce the remaining tooth structure.

• They accumulate less bacterial plaque than white fillings.

• Porcelain is a biocompatible and inert ceramic.

Inlay/Onlay:

They are indicated in decayed molars and premolars that present deterioration, fracture or loss of their surface, likewise they are a good alternative to restore those teeth in which a root canal has been performed. Teeth that have been worn down from erosion are also restored well with onlays.

They are usually the best option when the affected dental area is too large to make a composite but not large enough to place a crown, in other words, there is still enough healthy tissue left.

In inlays the caries/fissure is located between the dental cusps, that is, the lesion does not compromise these cusps.

On the other hand, in onlays the caries involves the cusps or compromises a large part of the occlusal surface of the teeth (chewing surface), which makes it necessary to reinforce the remaining tooth structure.

When do I need a crown?

Dental crowns have the function of replacing the natural crown of a tooth. They can be used in the anterior teeth due to the great esthetic need of this area either in cases of extensive decay or trauma/fractures..

Also, thanks to the protection it confers to the rest of the dental structure, it is a good option in the posterior area where the force exerted when chewing food is greater.

Other indications may be:

• Rehabilitation of teeth damaged by bruxism (grinding).

• Teeth in which a root canal has been performed, since the tooth structure is weakened as it loses vitality and the access required for the root anal treatment.

• When there is a total loss of the tooth (extraction of the tooth due to caries or advanced periodontal disease) and is accompanied by a dental implant that replaces the root.

A Crown is Placed on top of a Tooth

How long does a crown last?

As with white fillings, this time varies from one person to another, but it could be said that a crown can last approximately 10 years, so they are considered a long-term treatment. Likewise, to prolong their useful life you should take care of your oral hygiene and have regular check-ups with your dentist.

What is a one visit crown?

As we said, crowns are placed in more than one appointment, since in the first one the dentist must prepare the tooth, take an impression that will be sent to the prosthetic laboratory and place a provisional crown. Subsequently, the laboratory will make the definitive crown, which will be put in place a few weeks later.

But thanks to technological innovations, it is possible to have a crown made in a single appointment, known as one visit crown. To do this, digital impressions are taken quickly and without discomfort thanks to CEREC technology, which relies on computer-aided design and computer-aided manufacturing (CAD/CAM).

This scan provides a 3D model that allows the dentist to design and modify the shape of the dental crown, and also allows them to observe and modify how it will come into contact with the antagonist tooth and adjacent teeth for a precise fit.

Once this is done, the customized one visit crown is fabricated and the crown can be cemented in the same day the tooth is prepared. Thus, this system eliminates the need for a temporary crown.

Do you think you need a restoration and are considering a porcelain one?

It is well known that porcelain restorations have a higher price than those made with composite, but if we analyze it carefully we will realize that it is a worthwhile investment for its many advantages.

Do not hesitate to go to your trusted dentist who surely has the necessary knowledge to determine which is the most appropriate treatment to solve your ailment.

Dr Carla Graneri, Dr Saul Todres and Dr Brian Hurwitz have been servicing the Morley and Noranda area and are ready to serve your smile at Dentista Dental Centre