Durable Dental Fillings: What Material Is Best?
- The cost of dental fillings varies widely, depending on the material used.
- Each option has advantages and disadvantages as either durability, price or aesthetics may need to be compromised.
- The degree of tooth decay will also determine what kind of filling options are viable for you.
When teeth are decayed or cracked, a dentist removes the affected area and covers it with a tooth filling or restoration.
There is a wide array of materials to choose from. Here we break down the pros and cons of the most common types of fillings so you can make an informed decision when consulting with your dental care professional.
Cast gold crowns
Most cast gold fillings are actually crowns made using a mold or cast of your tooth.
A crown is essentially a prosthetic tooth that fits directly over an existing tooth, whereas a filling is when the decay is removed from the cavity and filled with the material of choice.
Gold can also be mixed with other metals to further increase their lifespan. According to Dr. Idan Snapir in Van Nuys, CA, “Inlays and onlays are a mixture of gold with other metals, such as silver and copper, to make the filling more durable.”
A cast gold crown is made in a dental lab using a mold of your tooth. It is then sent back to your dentist who then cements it in place. The exposed cavity is covered with a temporary filling until the crown is complete and can be installed.
Two visits are required for this procedure — one for the cast, and one for the final installation.
Worth its weight
These types of fillings are known for their durability as they fracture less frequently compared to less costly alternatives.
“Gold expands in heat and shrinks at different temperatures in a similar fashion to the rest of the natural tooth, which allows for the restoration to last longer and helps prevent fracturing and teeth sensitivity,” notes Dr. Chris Kammer, past president and co-founder of the American Academy for Oral Systemic Health.
As such, gold fillings maintain their integrity for years.
How much do gold crowns cost?
Gold is possibly the most expensive option out there. The average price of a gold crown on a back tooth is over $1,000 USD.
Aside from the cost, the highly reflective and visible nature of this type of filling may not appeal to many.
Also worth mentioning is a rare complication associated with gold fillings — a galvanic shock may occur when a gold cast filling is installed next to a silver amalgam filling. The interaction between the metals and saliva creates an electric current, which then produces a shock and induces a sharp pain.
Dental amalgam is composed of liquid mercury and a powdered alloy made of silver, tin and copper. Often called “silver fillings” because of their color, 50% of dental amalgam is actually elemental mercury.
The chemical properties of elemental mercury allow it to bind together the silver, copper, or tin alloy particles and form an amalgam.
Dental amalgam fillings are durable and long-lasting, so they’re less likely to break than other types of fillings. They’re also the least expensive option. At a fraction of the price of a gold crown, the average amalgam filling on a back tooth costs about $130 USD.
However, some concerns have been raised about the health impacts of mercury in amalgam fillings.
Dr. Zack Christopherson in Cheyenne, WY explains that the “argument made by proponents of amalgam is that the mercury is bound up in the amalgam and doesn’t leach into the body. Detractors claim that it is dangerous regardless.”
The World Health Organization, the FDA, and the American Dental Association maintain that, when used appropriately, dental amalgam is a safe and effective restorative material for anyone aged 6 or older.
“There is research to support both sides of the argument,” Christopherson says. “Currently, amalgam has been banned in much of Europe but is still being used in the United States.”
Another drawback of any metal filling is that they conduct heat and cold. People with gold or amalgam fillings often experience some sensitivity to hot and cold food or drinks during the first several weeks after placement of the filling.
This generally subsides, but patients with extreme sensitivities may want to consider other options.
Composite resin fillings are tooth-colored, which makes them an ideal aesthetic choice as they look natural. They’re best suited for cavities in teeth closer to the front of the mouth where they may be more visible.
The average price of a composite filling on a front tooth is $155 USD and $170 USD for a back tooth. At a higher the price point than an amalgam filling, these options do not come as cheap.
Some insurance companies refuse to cover the cost, while others only cover the amount that an amalgam filling would cost.
Versatile… but it’s complicated
Composite resin is quite versatile, and can also be used to repair chipped or broken teeth.
Christopherson adds that one benefit of composite fillings is that “They adhere to the tooth, which means less tooth structure has to be removed to keep it in place.”
A composite resin dental filling should last for approximately ten years, while its metal counterparts offer an even longer lifespan. Given the cost difference, this is something you should consider. In addition, the acrylic-type material may not stand up to the pressure of chewing as well as amalgam fillings.
Composite restorations also require several precise steps for proper installation, which can be a drawback as there are many opportunities for mistakes to occur.
“The intricate procedure entails drying the tooth (but not too much), etching with an acid, rinsing with water, drying again, placing a bonding agent, thinning it with air, curing with a UV light, then finally placing the composite resin and curing it with the light as well,” Christopherson explains. “If any one of the steps is not done correctly, the restoration will fail.”
Despite the inherent complexity involved in using this type of filling, dentists still report that it is a popular choice among patients.
Ceramic fillings are more visually pleasing. These options are white and look just like composite resin fillings. The primary material in ceramic fillings is porcelain and it can be made to match the exact color and shade of any tooth.
Another substantial advantage of ceramic fillings is that the material is very durable and can last up to 20 years. Ceramic fillings are also more resistant to stains and abrasion.
The main disadvantage is that ceramic is expensive — in fact, it can be as costly as a cast gold crown. Depending on a number of factors, such as the dentist’s experience, the dental lab being used to create the crown, the material being used and the location of the restoration, a porcelain crown can cost anywhere between $600-$2,500 USD.
Bite off what you can chew
Choosing the right type of dental filling may feel like pulling teeth. Given that you would like the installation to last a lifetime, extra diligence is definitely worth the effort.
The variety of materials available come with different price points, so rest assured that adequate restorations are accessible to you no matter what your budget.
Just make sure you consult with a dental expert to help you understand the different variables to consider before making your decision — including durability, aesthetics and tooth sensitivity.
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