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.

Patient Signature__________________________________Date___________________


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

Colored composites                                               

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:

  1. Silver Amalgam/Miracle Mix (which has silver in it)- Silver most cost effective and best for patients that have lots of cavities, is decay prone, has high acid diet such as from pop and candy, who has difficulty maintaining good home care, and who does not come to dentist as a matter of routine for professional check ups and cleanings, and finally it is the most affordable for those with limited income.
  2. Composite- This is used for areas in the mouth where patients don't want silver to show when smiling or because they don't want silver mercury fillings. The fee is similar to silver fillings it is affordable compared to porcelain and ceramics. However except for the front teeth composites are not advisable for patients who have a high cavity index, have trouble keeping their teeth clean, smoke, drink great quantities of dark beverages like tea and cola and coffee, not advisable for patients that do not like going to have their teeth cleaned and checked regularly and have a high acid diet. Composite fillings do not last as long as silver fillings and they get decay under them easier than silver. I advise composite only for front teeth where silver would show when patient smiles or where silver will not stick.
  3. Ceramic inlay/onlay- This is the ideal restoration. It has the strength of silver, it has the esthetics of composites, it lasts for many years. It is the longest lasting of the three types of restorations most used today. But this restoration is ideal only for those who have excellent home care and are not decay prone and do not have bleeding gums or gum disease and who will take the time to have their teeth cleaned professionally as often as required. They are also the patients that really want to invest in themselves and have the nicest healthiest mouth possible. Finally it is a matter of being able to afford such dentistry.  Sometimes it is best for patients to get silver fillings first and as their home care improves and the prognoses improve then ceramic inlays and onlays would be an excellent next step. The photo to the left shows silver amalgams that were replaced with porcelain or ceramic. Composite would have not have been a good solution because the there is too much tooth surface to cover.

Informed Consent  for Fillings, inlays, and Onlays

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.

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Michael A. Starkey, DDS MS and The Team

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