the Procedure | Cosmetic Fillings |
Advantages of cosmetic fillings
| Applications of cosmetic fillings | Disadvantages of Composite Fillings |
Proper Technique |
and Health at the Center for Dental Excellence
You will have both health and beauty at the Center for Dental
Excellence. Dr. Prus applies the most advanced home care techniques
to ensure your dental health and preserve your beautiful smile. CDE
provides all the contemporary cosmetic services both on site and by
referral to a team of equally dedicated and inspiring specialists
who complement our services for our patients. Whatever cosmetic
service you ask for, you can get it at CDE.
BONDING IS A PROCEDURE by which restorations
are retained to a tooth by micro-mechanical adhesion. Tooth
structure is made porous on the surface so a plastic resin can lock
onto the surface of the tooth. It is very much like bonding Formica
onto a wood counter top.
Composite (tooth colored) fillings, are resin (plastic)
based. They are composed of 1) a flowable resin base and
2) are filled with fine granular quartz or silicate particles
(think of sand in cement) to give it structure, color,
luminescence, and transparency. All these are mixed to match the
visual characteristics of your teeth.
If the fillings are small with a significant amount of tooth
structure surrounding it, the wear on the filling will be reduced.
They should mostly be used in locations where there are no strong
chewing and grinding forces. Large plastic restorations on molars
normally do not hold up well (many fail within 5-10 years).
If enamel, the hardest substance in the body wears down
prematurely in your mouth, so will plastic fillings, only
Advantages of cosmetic fillings over silver
- Bonding can be applied with/to any material.
The most commonly bonded materials are tooth colored resin fillings
(composites) and ceramic
porcelains. There are a wide variety of
manufacturers and colors for each. Metals (e.g. gold) can also be
- Bonding creates a good marginal seal which KEEPS
BACTERIA OUT of the tooth and away from the pulp which
causes decay and sensitivity. (fig. 3)
DECAY and micro-leakage can be
identified at its earliest stages
as a brown stain at the margin, because bonded tooth colored
materials are similar to the tooth in appearance . Many times
these can be easily repaired.(fig. 4,5)
- Bonded fillings can STRENGTHEN A
WEAKENED TOOTH, reducing the chance of tooth
- They are relatively easy to place in one
- They have many different textures and colors
to make them wear better and look more natural.
- They are relatively inexpensive compared to
- They are routinely used in minor tooth repair and
cosmetic needs for any tooth.
Applications of cosmetic
- Repair decayed, broken, cracked, or chipped teeth (fig.
- Replace old, unattractive dental treatments (fig. 10,11)
- Change the size, shape, and alignment of certain teeth (fig.
- Lighten or brighten the color of teeth (fig. 8,9;
- Replace missing teeth ( fixed, bonded bridgework)
- Fill in unattractive spaces between teeth (fig. 14, 15)
Disadvantages of Composite
- They usually WEAR FASTER than porcelain or metal (also amalgam)
- Large composite fillings are softer than enamel and on molars
they will wear quickly requiring change on a regular basis. This
wear causes the bite to become out of balance. This imbalance can
harm the jaw joint (Temporal-Mandibular Joint: TMJ). When the jaw
is out of balance, muscles become affected and can be painful (fig.
- They cannot be chewed on aggressively (steak bones, hard nuts,
non-food items-finger nails, etc) or they will break (fig.
- They can stain if enough strongly colored foods and liquids are
in contact with them (fig. 10)
Proper technique and shaping of bonded
Critical for proper function, comfort and durability.
Bonded fillings must have the shape, color and surface
characterization of the natural teeth to
Contacts between teeth must be kept tight to
prevent food from lodging in between the teeth and damaging the
gums. This causes inflammation, bone loss, damaging the support
structure of the tooth.
Biting surfaces must be shaped properly so they
do not interfere with proper movement of the jaw.
Improperly shaped fillings will decay, wear
faster, break or cause damage to the tooth structure.
Well Sealed Composite filling Fig. 3
Leaking Composite Filling Fig. 4
Marginal breakdown at early stage Fig. 5
Dr. Prus has been involved with dental bonding since the
1980s. When bonding was new to dentistry, he was
involved in developing some of the protocols for bonding
porcelain inlays, veneers and crowns. Because of his
clinical and research experience in cosmetic dentistry, he has
developed a complete understanding of the techniques that work best
for his patients. As a result Dr. Prus creates restorations that
are not only beautiful but also last many years into the
Before Fig. 6
After Fig. 7
Before Fig. 8
After Fig. 9
Cosmetic bonding front four teeth-conservative prep and less
Before Fig. 10
After Fig. 11
New Nano-hybrid restoration
Before Fig. 12
'Frozen in position'
After Fig. 13
-lengthen, lighten, characterize
Natural gap between front teeth
Space closed by carefully match
bonded filling Fig. 15
Leaking composite fillings
on bicuspid teeth
Open contact between teeth allowed food trap & decay
Fillings replaced with
new longer lasting nano-hybrid
composite to increase durability and aesthetics
Excessive molar composite wear
(Bruxing/Grinding) Fig. 18
Lab Processed onlays-no wear at 3
Anterior composite & tooth
Composite Fillings and Anterior Tooth
Tooth trauma can be
mild or seriously damaging. The damaging effects can be physical
and psychological; it depends greatly onthe location of the
trauma. When front teeth are damaged the impact is the greatest as
it can adversely affect the patient's smile. Severe cases of
trauma may not be remedied by a simple filling, but may require
more advanced modes of dental care, such as crowns, implants and/or
bridges. Structural damage to the face must be assessed in
deciding a proper course of treatment.
Two severely fractured
Photo shows fracture
6mm into palatal tissue
CASE 1 (above): In the case above a young boy, just
seven years old and in possession of his adult front teeth less
than one year, seriously fractured his two front teeth on a bicycle
handle bar. After clinical exam showed the pulp (nerve) of the
tooth was not traumatically exposed (a very, very lucky boy) and
the tooth presented no pain three days after the event, a
conservative approach was chosen to preserve the health of the
tooth with composite bonding. The right tooth fractured 6mm under
the gum line. It was isolated with gingival packing and the
filling was placed on the tooth and its adjacent neighboring tooth,
which was less seriously fractured. This conservative approach
re-establishes the young boy's aesthetics, avoids the embarrassment
of a mangled smile and allows time for further evaluation of the
health of the tooth. He is presently undergoing orthodontic
treatment. The restoration is still functioning and has very
acceptable aesthetics after 3 yrs. Should additional treatment be
needed, it will be dealt with at such time.
CASE 2 (above): Not only did this teenager fracture
one front tooth and chip the other, but the fracture reached the
nerve, which then required root canal therapy. After the RCT was
finished, a reinforcing post was placed in the center and a
temporary crown was made for the right central incisor and a
composite bonded filling on the left central. In this particular
tooth the root was already showing internal damage radiographically
and its long-term vitality is questionable. The temp crown will
provide an aesthetic solution until the health of the tooth is