Tooth colored Fillings

Due to improvement in material science, tooth colored fillings are more lasting and esthetic.

Factors affecting its longevity

Size- the larger the restoration, the chance of breakage and redo is higher

Margins of the restoration- the longer the boundary of the restoration and the deeper it is into the gums, the more risk of breakdown and leakage due to caries

Occlusal load- the heavier the bite and especially in night grinders, the greater the incidence of breakdown of the filling

Lifestyle-Heavy smoking, wine , coffee and lots of colored drinks eg cola inevitably will result in faster staining of these tooth colored fillings

*These can be alleviated by

crowning large restorations to reduce fracture

extraction would be recommended for deep lesions where maintenance is not possible- option of denture, bridge or implant ( may be discussed with the dentist as to which is most suitable)

Rinsing out colored beverages may delay staining and regular prophylaxis of teeth.

Types of restorations:

1.  Composite resin or tooth colored ones are available in many shades and strength. High impact ones may cost more.

2. Inlays and onlays- there are indirect fillings made in the laboratory from impressions of the preparations taken in the mouth. They rarely break as they are fabricated as a piece to be cemented over the cavity prep. Also anatomical grooves have been carved into them to simulate real teeth. They almost never stain.

3 Crowning- the capping of tooth with zirconia or alloy (for back teeth where the tooth is vertically challenged)

Veneers- is a porcelain facing that is cemented over usually front teeth that are badly discolored. It has the advantage of being more conservative as there is less tooth reduction and negates the need for temporary fillings.

*The  trusty silver amalgam is in declining use but still have its indications. Will update this when MOH issues further notice.


Silver amalgam though have been used for more than a century has been controversial due to the presence of mercury. In any case, amalgam is not aesthetic and the margins creep with time resulting in leakage and decay. Filling replaced with a high impact tooth colour composite resin has more marginal seal due to the use of dental bond.


Crowns and Bridges (Prosthodontics)

crown is a cap that is built over a tooth that is non vital and brittle following root canal treatment or heavily restored to strengthen it and prevent fracture.

bridge is a series of crowns joined together.

Conventionally, the PFM of porcelain bonded to metal crown is fabricated. Nowadays, the zirconia crown that is more esthetic and stronger is the preferred choice. As the metal is no longer used, the amount of tooth reduction required is less.

If the supporting teeth of the bridge are undamaged, it is best not to do a bridge as it is more conservative and go for the implant/implant crowns that are independent of other teeth. However, cost is higher and result takes longer for completion.

Maintenance of crowns and bridges

1 Regular check up / scaling & polishing by the dentist every six months

2 The patient should floss regularly and brush the crown margins gently.

3 Hard food like ice, crab shells should not be cracked with natural or crowned teeth.


Indications for crowning

Heavily restored tooth due to possibility of fracture

Satisfactorily done root canal treated tooth usually darken with time. see circled tooth.

A bridge is a good indication where both supporting teeth are heavily filled so crowning them will strengthen the teeth.