To Fill Or Not To Fill…!
Tooth decay probably is amongst one of the oldest diseases known to mankind. History and remnants of various ancient civilizations suggest that man has been filling cavities long before he learnt how to fly. Accounts of some forms of tooth fillings have traced their way into the history texts of ancient civilizations of the Middle and Far-east, including China, Egypt, India and Mesopotamia. Early evidences of extracted teeth shed light on the fact that metals such as gold, silver and copper were used as filling materials before dentistry evolved as a definite science and discipline.
Over the centuries many kinds of dental materials and empirical forms of treatments have been discovered and practiced to perfection by the stalwarts of the dental practice. One often wonders what the hue and cry about filling teeth is all about. A simple procedure actually – remove the infected tooth portions and restore those portions using a biocompatible inert material which satisfies both form and function of the tooth. Sounds simple enough, but not quite. A decayed tooth is a three – dimensional problem requiring all facets of skill. Every aspect of the decay process is a dilemma itself. Decay on a particular surface on a specific tooth is to be dealt with differently from one present on a different surface located on a different tooth. Compounding further, the depth and extent of the decay greatly influences the type of filling itself. In the yester years of dental practice, the dilemma was quite different – To fill or not to fill? If the decision was to fill, then the classic solution of the Silver amalgam filling or a traditionally used metal inlay filling were the only two choices offered. No doubt the silver amalgam filling is still preferred by dentists today and used in modern day dentistry, but not without its shortcomings. The filling has a lot of un-esthetic metal display, no actual bond to the tooth, does not release fluorides, sometimes leads to discoloration of teeth and gums over a period of time. It is an acceptable choice for posterior teeth. Technological advancements have better and improved substitutes today, and the choices presented are numerous.
The cements and resins available today for the purpose of filling teeth have surpassed the abilities of the amalgam in terms of all its flaws. The Glass – Ionomer cements, the esthetically better family of Composite Resins, Compomers, Ormocers, All – Ceramic counterparts etc., are but a few which afford an actual bond with the tooth in restoring and matching the tooth form down right to the exact shade. The glass ionomer cements are cements, which chemically bond to the tooth, release fluorides and primarily were once used to restore deciduous teeth in children and non – stress bearing cavities in adults. Today with the advent of newer ionomers they are now being used in situations they were once contraindicated. The light activated composite resins also afford a definite bond to the tooth, but with a mechanism entirely different to that of the glass ionomer cements. These offer all that an ionomer offers and something more – excellent esthetics. The composite resins are no doubt the first choice when it comes to restoring a tooth where esthetics is a more important concern. But they have their own limitations. Now, there are many different generations of these so called newer resin restorative materials. Then there are the Compomers using the best of both the ionomers and composites. Ormocers, on the other hand, claim to be technically more advanced then the compomers. Each one of these has their own chemical jargon supporting their superiority over one another. All researchers justify their products to no end and with evidence. The confusion begins when the product is being chosen – all have a wide spectrum of use and indications and these indications definitely overlap each others covering all requirements needed. Like all modern day reinventions these also come with a price tag, set demands and protocols. These modern - day so called advancements are a boon when it comes to meeting the demands in terms of quality of work & results but show no mercy to their improper use and handling.
The question now, is not - To fill or not to fill? But is – To fill and with what to fill?
Then what is the ideal material to be used? Surely they all work and to a very great extent at that, then what are the standard norm? Is there such a thing as a standard norm, with so many different materials available? There is no doubt that none of these materials are perfect. But which one has the edge over the other and are we getting the best? Or, what was present before, good enough? These seem to be the million dollar questions.
Rest assured, the dentist makes these choices for you, picks the one both he and you will be comfortable with while meeting the demands set by the condition of the tooth, esthetic or functional requirements, and other factors such as longevity of the material, its primary indications for use, and the feasibility of use in that particular situation based on sound clinical experience.
Ultimately, no matter what the material and how skilled the work, the final assessment would be the patient point of view whether it has met the patient’s esthetic or functional demands, longevity, and comfort. Gone are the days when science had limited to offer, now the offers stretch the very limits and every day more improved versions of the former appear hence the race is on for better and the best.
Dr. Murali Srinivasan, MDS.
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