I have been informed by Dr. Starkey and his staff of the different options regarding fillings and inlays and onlays.
I understand when Dr. Starkey uses the term inlay or onlay he is referring to a ceramic material that is cut from a block of synthetic gem stone known as zirconium or a different hard material. I understand that the lab fabricated restoration is harder than composite or silver filling material. Further ceramic material has no metal in it and it is tooth colored. It is meant to last for 10 years to decades. I understand that an onlay is a lab fabricated restoration that covers some or all of the chewing surface of a back tooth so the tooth is less like to break and that an onlay is more conservative than a crown. A crown covers the whole tooth while an onlay covers just the upper half of a tooth.
Ceramic inlays and onlays are superior to composite and silver fillings according to Dr. Starkey because of hardness and precise fit.
The advantages of silver fillings are their cost and that they can be done in one visit. The problems with silver fillings are partly cosmetic and partly that they are metal and have mercury in them and some people do not want or like metal or mercury amalgam in their teeth. Dr. Starkey does NOT believe me that silver amalgam is dangerous. Dr. Starkey is okay with silver fillings. It is my decision.
The bigger the filling the higher the risk of failure of the filling or of the tooth breaking. A dentist drill causes cracks in teeth, biting on fillings and inlays causes cracks in teeth.
Any type of restoration can cause a tooth to go bad. That is to say the nerve can die or the tooth can abscess. A root canaled back tooth usually needs coverage of the whole tooth because root canaled teeth get dry and break. That is a risk.
I understand that if I choose composite fillings I must have excellent hygiene and that I should not be a tooth grinder. If I am a tooth grinder Dr. Starkey advised me to have an appliance to protect my teeth and restorations from wear or cracking.
If I have a diet high in sugar as in drinking pop or eating candy I am more susceptable to cavities. I understand that my hygiene needs to be excellent if I elect composite or ceramic inlays and onlays. That is because cavities can form under or around dental work and I must remove the plaque daily to prevent bacteria and acids from breaking down teeth. I also realize I must see the dentist or hygienist for regular cleanings to help prevent new decays or redecays or if there is a problem Dr. Starkey can find the problem sooner and fix it before the problem gets more expensive.
I understand that sometimes it is not rational to save a tooth. There may be so much decay that a filling or a crown will not stay in place.
I have read the advantages an disadvantages of fillings and inlays/onlays and all my questions have been answered. I understand that for decayed prone patients composites and expensive inlays onlays may not be in my best interest.
I choose to have the following types of restorations
on the following teeth. I understand there can be no guarantees in dentistry and that while perfection is a worthy goal it is not possible.
Fillings and Ceramic inlays and onlays
Informed consent below
Types of Fillings Benefits/Advantages Risks/Disadvantages Long Term Fee Range
Silver and Mercury
aka Silver Amalgam Corrosion creates good seal Metalic Long lasting 10-20 years 137-525
Bacterial Static Not cosmetic Average Home Care 525 complex
Good for Cavity prone Contains Mercury which is controversial 525 for crown
Cannot fit on edges of teeth Not to be used in front teeth fillings where a filling
Complex filling subs for crown Must cut down more tooth structure
Less expensive than crown A very challenging procedure for complex fill
Requires 2nd app. to polish filling or it stains
Composite Can bond to edges of teeth Bonding on edges tends to fail Life 3 years bonding edges 137-525 It is difficult to place a composite filling 5 years composite crowns
below gum especially if bleeding gums 10 years other types of fillings
Looks natural! Large comp can pick up bad odor Excellent home care required
Metal Free from bacteria infiltration Avoid or reduce Tea esp.
no metalic taste or shock Bacteria get under fillings Reduce coffee
Seal can leak, technique sensitive Drink through straw
Softer than ceramic or porcelain NOT advisable for patient with hard bite May need night time appliance.
so will not wear down opposing teeth NOT advisable to cavity prone
Composite fillings can bond to other NOT for patients who drink a lot of pop
other composites so sometimes Or have a high acid diet ( sugary mostly)
a small false tooth can be bonded Takes time and effort polishing to get lustre It is difficult
to fill a small gap Sensitivity!!! We use tooth desensitizing agent but for some
like front tooth that is missing patients it still doesn't work. When it is a problem it is usually
so you don't have to wear a back tooth. The composite will have to be removed and a
a flipper or cut down teeth silver filling placed or a crown
Composites set up hard right away The Doctor needs a dry field in order to have long term success
so you can chew on them sooner with composite. A dry field means the use of a rubber dam
& dont have to be as cautious as (see photo) and an agent that dries the patient's mouth. That is
you do with silver amalgam the advantage of IV sedation. We can use a short acting drying agent in the IV.
Sometimes composites can be lab fabricated and the result is a longer lasting higher quality restoration
Glass Cement Mixed w Silver
Sticks to tooth better It is a long term temporary or provisional restoration
than regular amalgam It needs to be polished.
No mercury, less sensitive The filling looks black almost.
Seals better than composite
more cost effective for caries control
Good for large defects
good for small fillings Soft so wear down fast
especially children more for cavities on side of teeth
take less time to prepare & fill Considered more as a temporary
Ceramic Restoration Or "filling" Long lasting All things being equal this is the optimum 20 years plus 575 to 1100
It is not really a filling tooth colored restoration. It is NOT really a filling in that Good home care fee varies w size
But is placed in a filling No odor will be picked up the fillings are machined out of FLOSS!! shade
prepared hole Will NOT stain like composites synthetic gem material-zirconium usually. LOW acid diet and location
very hard material the biggest negative is cost meaning little to no pop
rarely ever breaks The hard material can wear opposing enamel regular professional cleanings
non metalic if patient is a tooth grinder
In my opinion it has the best of composite a night time appliance might be needed to protect opposing teeth
and best of amalgam and not the negatives NOT advisable if patient has gum disease out of control
NOT advisable if decay prone
Cavit These are non metalic and non composite Temporary fillings designed to last a week to six months No Charge to 89
Eugenol Base It signals other dentists that a temporary filling was intended
other Used in filling hole in tooth from root canal tx. They are temporary
There are several types of Fillings and in order for Dr. Starkey to proceed with any dental restorative work we need your Informed Consent. That means you are entitled and must know the benefits and risks of the different treatment options. And all your questions must be answered to your satisfaction. The photo above shows well done silver amalgams that would give years of service. The patient did not want silver so the silver fillings were replaced with composite. It is the patient's choice. We usually leave functional silver fillings alone unless there is an obvious cosmetic problem when patient smiles or the patient requests silver mercury fillings removed. The problem of replacing perfectly functional silver amalgam fillings with composite or ceramic is that mercury particles are released in the process and can be inhaled or swallowed. When removing old filling and decayed tooth structure we utilize a rubber dam to protect the airway and it is not enough to cover the nose with a shield due to location so we use a nasal hood and then a screen over the hood.
Master, College of Conscious Sedation American Dental Society of Anesthesiology
Informed Consent for Fillings, inlays, and Onlays
Advanced Systemic Health Care through the Mouth
All your dental treatment needs met in one location
Michael A. Starkey, DDS MS and The Team
There are advantages and disadvantages to various kinds of restorations assuming that it is rational to fill your tooth and not extract it. There are three main types used in dentistry today and it is important that you understand your options so you can make choices that are optimum and based on your own best interest:
Pain? Dental Emergency?!