A Metal-Free Mouth

Next week, my dad and I will be heading back to Las Vegas for another course at the Las Vegas Institute for Advanced Dental Studies (LVI). This particular course, entitled "Advanced Adhesive Aesthetic Dentistry," is taught by Dr. Ron Jackson who is world-reknowned as an expert in the field of bonded densistry. This is another live-patient class, meaning we get to take a patient with us and do the dental work there in Las Vegas. It is also another installment of LVI's Core Curriculum which, once completed, grants Fellowship status and makes the graduating dentist eligible for Mastership - LVI's highest honor. In this particular class, we will be replacing old amalgam fillings with new, strong, highly aesthetic composite fillings and ceramic onlays.

It's been over 10 years since Dr. Max placed his last silver amalgam filling. Not only are they unsightly and an outdated material that has been around as long as dentistry itself, but silver fillings have a number of disadvantages that make them a poor choice for filling teeth:

*Silver amalgam fillings leak. Unlike composite or ceramic, which is actually bonded to the tooth structure, amalgam is simply wedged into place. As it expands and corrodes, little discrepancies occur between the margin of the filling and the tooth. Microleakage begins to occur and over time leads to more decay underneath the filling.


*Silver amalgam fillings weaken the tooth. Because silver amalgam is a metal alloy, it can expand over time. These minute changes flex the enamel and microfractures start to appear. These microfractures can be likened to a "star" (small ding) in a windshield - over time the star grows and grows until the windshield breaks. The same thing happens to tooth enamel. Essentially, the amalgam filling acts like a wedge, flexing the tooth sometimes to the point of fracture. Depending on how the tooth fractures, it usually necessitates an onlay, crown, or sometimes even extraction if the fracture extends down into the root.

*Silver amalgam contains 50% mercury by weight. Mercury vapor is released from these fillings every time you chew, as well as when they are placed and removed from teeth. Several countries, including Sweden and France, have implemented a precautionary principle advising pregnant women against having silver amalgam fillings placed in their mouths. This year, the FDA reclassified dental amalgam as Schedule II substance, meaning it is now subject to special controls.

Today's dental materials, such as composite and ceramic, offer a much more effective, aesthetic alternative to silver amalgam. These materials are actually bonded to the tooth, making the tooth stronger. If done properly, microleakage is dramatically reduced and usually avoided altogether. You can also have much more conservative dentistry done with these materials, saving healthy tooth structure and only removing what is decayed. This is in stark contrast to silver amalgam, which requires a large amount of enamel and dentin be removed in order to hold the alloy in place.


And with our CEREC machine, we are able to make these ceramic onlays in one visit - no second injection or second visit to have it bonded in place. Ask us about the benefits of bonded dentistry at your next visit!