White Filling

Introduction

A composite filling is a tooth-colored plastic and glass mixture used to restore decayed teeth. These fillings can also be used for cosmetic improvements of the smile by changing the color of the teeth or reshaping the disfigured teeth.

Following preparation, the dentist places the composite in layers. This is done by using a light specialized to harden each layer. When the process is finished, the composite is shaped to fit the tooth. The dentist then polishes the composite to prevent staining and early wear to increase its longevity. Although cost may vary, the composites can cost up to two times the price of a silver filling.

Main advantage of the composites is their aesthetics. The dentists can blend shades to create a color nearly identical to that of the actual tooth. Composites bond to the tooth to support the remaining tooth structure, which helps to prevent breakage and insulate the tooth from excessive temperature changes.

Main advantage of the composites is their aesthetics. The dentists can blend shades to create a color nearly identical to that of the actual tooth.

Post-operative sensitivity is a common problem in patients after receiving a composite. Also, the shade of the composite can change slightly in case if the patient drinks tea, coffee or other staining foods. If the patient is particularly concerned about the tooth color, the dentist can put a clear plastic coating over the composite to prevent the color from changing. Composites tend to wear out sooner than silver fillings in larger cavities. But they hold up well in small cavities.

Procedure:

• Need of Anesthesia: Usually, no anesthesia is required for the placement of composite restoration. However, in case if a badly decayed tooth needs to be restored by composite, patient may experience pain while preparing cavity and removing decayed tooth structure. In such cases, anesthesia may be required to numb the tooth.

• Cavity Preparation: The decayed portion of tooth is removed and tooth is given proper shape by doing minimal reduction of tooth structure. If composite filling is being done for cosmetic improvement then also minimal amount of tooth structure requires to be reduced to provide space for composite restoration.

• Cleaning of Tooth: Composite does not bond to the tooth structure properly if any debris or plaque is presenton its surface. Therefore, the tooth surface is cleaned properly and polished to make the surface receptive.

• Shade Selection: Composite is available in various shades. A shade is selected matching to the color of tooth to be restored.

• Isolation of Tooth: Tooth to be restored is isolated using cotton rolls or rubber dam. This is an essential step in composite restoration as any contact of the tooth with oral fluids while placement of filling can affect the bonding mechanism and composite may not adhere to the tooth properly.

• Etching the Tooth Surface: Both enamel and dentin of the tooth is etched using 30-40% phosphoric acid. Phosphoric acid is available in the form of a gel. Etchant is applied on the tooth surface for 15 seconds then it is washed away using water spray. After this, tooth is dried with air. Enamel shows a frosted appearance on drying. If frosted appearance of enamel is not observed then process of etching needs to be repeated again.

• Application of Bonding Agent: A liquid bonding agent is applied on the etched tooth surface using a brush or applicator. Bonding agent is then cured using a special light source for 10-20 seconds.

• Placement of Composite: Composite material is placed and cured in increments as only 2 mm layer of material can be material in one application. Each increment of composite is cured for about 40 seconds after shaping it properly. Composite is available in two varieties:

• Putty like material available in tubes which is taken out and filled in the tooth using a hand instrument. It is then shaped according to the form of tooth.

• Flowable composite is available in syringes which can be applied directly on the tooth surface by pushing it out of the syringe. Then it is shaped and cured/hardened using curing light.

• Shaping the Restoration: Composite is filled slightly in excess and then it is shaped using cutting instruments such as burs or diamond points to give the filling a proper contour.

• Checking Bite: After placing the composite, cotton rolls or rubber dam placed for isolation of tooth are removed and patient is asked to bring the opposite teeth together to check the presence of any high point on the surface of filling. If high point is found, a carbon paper like articulating paper is used to mark it and it is removed.

• Finishing and Polishing: Completed composite restoration is finished and polished using fine burs to give it a smooth surface.