Help: Crowns, Fillings and Amalgam 
Author Message
 Help: Crowns, Fillings and Amalgam

Dear dentists,

Despite reasonable dental hygiene I have a mouthful of huge amalgam
fillings - or should I rather call them amalgam-tooth replacements.  One of
these fillings (a molar) had to be removed recently, I have a temporary
filling right now.  The best strategy to safe the tooth seems a crown.  More
crowns are likely to follow in the next few years.
I have been following SMD for the past few weeks and I have learned a fair
bit.  But I am still puzzled about a few things and would appreciate any
comments of the dental community on the following questions before I go
ahead with the treatment:

- I want to replace my amalgam fillings one by one as treatment becomes
necessary.  This limits the crown material to porcelain (galvanic element
with metal crown).  What is the best filling material for a tooth to be
crowned (e.g. is amalgam safe in this case, durability, conductivity)?

- Can onlays be an alternative to crowns?  How much of the tooth must be
left to fit an onlay?  Are there any advantages over crowns at all?  Are
there any other alternatives to crowns or do I have to put up with the fact
that I am getting old :-( ?

- What is the best filling material for large cavities?  If I understand
right, composites -unlike amalgam- bond to the tooth.  Does this mean a
reduced occurrence of caries under a 'white' filling due to a better seal?

Thanks a lot for your help.

Martina



Fri, 01 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam

Quote:
> - What is the best filling material for large cavities?  If I understand
> right, composites -unlike amalgam- bond to the tooth.  Does this mean a
> reduced occurrence of caries under a 'white' filling due to a better seal?

Actually, amalgams can be bonded to teeth.

As for the best filling material... that depends.  Porcelain onlays can be
good replacements for large amalgams that go bad.  If something a little
more is needed, either a porcelain/gold crown or an all porcelain crown
(like Procera) can be made.

Composites resin materials are good if the amalgam is small and amalgam
itself is also not a bad replacement material if you don't mind the darker
color.

I still love placing gold onlays and crowns, when possible, and they are the
restoration of choice in my own mouth as my old amalgams "come due".



Fri, 01 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam
Never ever let someone place a cap over an existing amalgam.

arie



Quote:
>Dear dentists,

>Despite reasonable dental hygiene I have a mouthful of huge amalgam
>fillings - or should I rather call them amalgam-tooth replacements.  One of
>these fillings (a molar) had to be removed recently, I have a temporary
>filling right now.  The best strategy to safe the tooth seems a crown.  More
>crowns are likely to follow in the next few years.
>I have been following SMD for the past few weeks and I have learned a fair
>bit.  But I am still puzzled about a few things and would appreciate any
>comments of the dental community on the following questions before I go
>ahead with the treatment:

>- I want to replace my amalgam fillings one by one as treatment becomes
>necessary.  This limits the crown material to porcelain (galvanic element
>with metal crown).  What is the best filling material for a tooth to be
>crowned (e.g. is amalgam safe in this case, durability, conductivity)?

>- Can onlays be an alternative to crowns?  How much of the tooth must be
>left to fit an onlay?  Are there any advantages over crowns at all?  Are
>there any other alternatives to crowns or do I have to put up with the fact
>that I am getting old :-( ?

>- What is the best filling material for large cavities?  If I understand
>right, composites -unlike amalgam- bond to the tooth.  Does this mean a
>reduced occurrence of caries under a 'white' filling due to a better seal?

>Thanks a lot for your help.

>Martina



Fri, 01 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam

|Never ever let someone place a cap over an existing amalgam.

Why?

Dr. G.

|
|arie
|
|


|
|>Dear dentists,
|>
|>Despite reasonable dental hygiene I have a mouthful of huge amalgam
|>fillings - or should I rather call them amalgam-tooth replacements.  One of
|>these fillings (a molar) had to be removed recently, I have a temporary
|>filling right now.  The best strategy to safe the tooth seems a crown.  More
|>crowns are likely to follow in the next few years.
|>I have been following SMD for the past few weeks and I have learned a fair
|>bit.  But I am still puzzled about a few things and would appreciate any
|>comments of the dental community on the following questions before I go
|>ahead with the treatment:
|>
|>- I want to replace my amalgam fillings one by one as treatment becomes
|>necessary.  This limits the crown material to porcelain (galvanic element
|>with metal crown).  What is the best filling material for a tooth to be
|>crowned (e.g. is amalgam safe in this case, durability, conductivity)?
|>
|>- Can onlays be an alternative to crowns?  How much of the tooth must be
|>left to fit an onlay?  Are there any advantages over crowns at all?  Are
|>there any other alternatives to crowns or do I have to put up with the fact
|>that I am getting old :-( ?
|>
|>- What is the best filling material for large cavities?  If I understand
|>right, composites -unlike amalgam- bond to the tooth.  Does this mean a
|>reduced occurrence of caries under a 'white' filling due to a better seal?
|>
|>Thanks a lot for your help.
|>
|>Martina
|>
|>
|>



Fri, 01 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam

Quote:

> Never ever let someone place a cap over an existing amalgam.

Whats your justification for such a hard-line stance?


Sat, 02 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam

Quote:

>Never ever let someone place a cap over an existing amalgam.

Especially if the guy is not a dentist!
Quote:
>arie


>>Dear dentists,

>>Despite reasonable dental hygiene I have a mouthful of huge amalgam
>>fillings - or should I rather call them amalgam-tooth replacements.  One of
>>these fillings (a molar) had to be removed recently, I have a temporary
>>filling right now.  The best strategy to safe the tooth seems a crown.  More
>>crowns are likely to follow in the next few years.
>>I have been following SMD for the past few weeks and I have learned a fair
>>bit.  But I am still puzzled about a few things and would appreciate any
>>comments of the dental community on the following questions before I go
>>ahead with the treatment:

>>- I want to replace my amalgam fillings one by one as treatment becomes
>>necessary.  This limits the crown material to porcelain (galvanic element
>>with metal crown).  What is the best filling material for a tooth to be
>>crowned (e.g. is amalgam safe in this case, durability, conductivity)?

>>- Can onlays be an alternative to crowns?  How much of the tooth must be
>>left to fit an onlay?  Are there any advantages over crowns at all?  Are
>>there any other alternatives to crowns or do I have to put up with the fact
>>that I am getting old :-( ?

>>- What is the best filling material for large cavities?  If I understand
>>right, composites -unlike amalgam- bond to the tooth.  Does this mean a
>>reduced occurrence of caries under a 'white' filling due to a better seal?

>>Thanks a lot for your help.

>>Martina



Sat, 02 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam
Hi Dr G,

Quote:

>|Never ever let someone place a cap over an existing amalgam.
>Why?

According to a witness statement made by Scandinavias most
distinguished Professor of Prosthodontics, who had been reviewing
all the existing litterature on this, in an state insurance court a few
years ago the electro galvanic phenomenon dissolve the cement
between the tooth an crown over time.

Hans Lennros DDS



Sat, 02 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam
Hi Dr. G,

Quote:

>>|Never ever let someone place a cap over an existing >>amalgam.
>Why?

You have probably witnessed the
electro galvanic phenomenon   while
removing an old crown.  Next time
you redo a crown, observe the color
of the amalgam core under the restoration.  
Or if a crown with improper retention
comes off,  note the the core.  If the
amalgam is dark black (tarnish and
corrosion), or if the cement is missing
only in the integlio surface where the
crown/core interfaced -you are probably
witnessing electrolytic corrosion.

Beside with lack tooth volume to achieve
adequate mechanical retention on
most tooth stumps wouldn't a bonded
composite make more sense.

From the other Dr. G.

Stan Goloskov



Sat, 02 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam
"Beside with lack tooth volume to achieve
adequate mechanical retention on
most tooth stumps wouldn't a bonded
composite make more sense. "

Absolutely! Excellent point! I think the use of dissimilar metals together
in the mouth has not been studied as much as it should.   Also when I remove
large older amalgams before doing a new composite build up about 80% of them
show recurrent decay. Amalgams leak like sieves after several years and I
believe that the mercury kills a lot of the bacteria and arrests a lot of
the decay. In my dental school notes that is listed as an advantage.Lord
knows what it has done to our brains....I have removed so much of it
recently....that....that....that....what's my name?



Sat, 02 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam
Hi Stan,

Quote:

>Beside with lack tooth volume to achieve adequate mechanical retention
>on most tooth stumps wouldn't a bonded  composite make more sense.

Definately!  Provided the dentist has some sense. And some technical skills.

Hans
PS Just making the reflexion that one of those, without the other one, is
     nothing worth ....



Sun, 03 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam
Dear Martina:

In my opinion porcelain (ceramics) is the best restorative material available
today to replace the missing tooth structure. That's what I would have placed in
my mouth if I needed some prosthetic work done on my teeth.

When we talk about restoration, we must fully understand what the word means. To
restore something implies bringing it back to it's original condition. Metal
restorations(be it gold or any other metal or alloys) and amalgam bring the
tooth back to it's original shape and form. By that you can say that these
materials restore the form and the function, but not the appearance (esthetics).
Porcelain is the only material that "FULLY" restores the tooth to it's original
condition. The only drawback is cost. Porcelain is probably one of the most
expensive restorative materials in dentistry. You must first question your
dentist about porcelain. In terms of strength, porcelain is a very strong
material and can certainly be used in posterior teeth with a fairly good
longevity. There are also some new, stronger ceramics that offer the option to
eliminate the metal structure underneath the porcelain. One such system (just to
name one of many) is the Empress ceramic restorative system manufactured by the
swiss company Ivoclar and associated in the United States to the American
Company Williams (read Williams/Ivoclar). Studies and research show very good
results for this material in terms of strength.
Amalgam remains a widely used dental restorative material and is one of the
least expensive and easiest materials to work with. Another option is Composite
Resin. Where one can be used, so can the other. These two materials are
restricted to cavities that are not to big in size. There must remain enough
tooth structure. Usually a good rule of thumb is that amalgam/composite should
not be used if the cavity preparation is 1/3 the width of the tooth measured
from the buccal side (cheek side) to the lingual side. One very important
restriction is the fact that both "must" never cover the cusps (the tips) of any
tooth.
Despite all the discussion we all have been exposed to in this discussion group,
amalgam is today a very controversial issue. I will not attempt to debate on the
merits or the disadvantages of amalgam as a dental restorative material. My
personal feelings are that anything this controversial and that simply raises
the question on safety, is not safe enough for my patients. These are people
that rely on me and trust their health and their lives to me and to my
professional decisions. I prefer not to risk.
Composites are good alternatives. In fact they are at least as good as amalgam
if used right and by a professional that knows how to use them. If the cavity is
small enough it can be used quite successfully and with very good esthetic
results. The new adhesives used in dentistry today to bond the composite to the
tooth structure have the property to strengthen the tooth that was weakened by
the portion lost due to the carious lesion and the preparation done by the
dentist. Composites, however, require a much greater level of expertise on the
part of the dentist. When I do a bonded restoration I "always" use {*filter*} dam
isolation. This is some type of{*filter*}curtain that isolates the tooth the
dentist is working on from the rest of the {*filter*}environment and it's inherent
humidity/moisture level. It's very important not to have saliva or moisture
contamination of the tooth while the bonded restoration is being done.
For any type of restoration to last, however, it is very important for the
patient to follow an {*filter*}hygiene protocol. Think of your dental treatment as a
form of partnership between you and your dentist. The dentist must do his part
which is related to the quality of the work he will do to restore your
dentition. But no matter how good this work is, it will not last very long if
you do not take {*filter*}hygiene seriously. Remember that that point where the
restorative material meets the tooth structure is the weak link in the chain and
it must be kept clean by proper tooth brushing, "flossing" and the use of home
fluoride and/or antiseptic solutions.

Good luck and keep smiling !

Quote:

> Dear dentists,

> Despite reasonable dental hygiene I have a mouthful of huge amalgam
> fillings - or should I rather call them amalgam-tooth replacements.  One of
> these fillings (a molar) had to be removed recently, I have a temporary
> filling right now.  The best strategy to safe the tooth seems a crown.  More
> crowns are likely to follow in the next few years.
> I have been following SMD for the past few weeks and I have learned a fair
> bit.  But I am still puzzled about a few things and would appreciate any
> comments of the dental community on the following questions before I go
> ahead with the treatment:

> - I want to replace my amalgam fillings one by one as treatment becomes
> necessary.  This limits the crown material to porcelain (galvanic element
> with metal crown).  What is the best filling material for a tooth to be
> crowned (e.g. is amalgam safe in this case, durability, conductivity)?

> - Can onlays be an alternative to crowns?  How much of the tooth must be
> left to fit an onlay?  Are there any advantages over crowns at all?  Are
> there any other alternatives to crowns or do I have to put up with the fact
> that I am getting old :-( ?

> - What is the best filling material for large cavities?  If I understand
> right, composites -unlike amalgam- bond to the tooth.  Does this mean a
> reduced occurrence of caries under a 'white' filling due to a better seal?

> Thanks a lot for your help.

> Martina



Mon, 04 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam

Quote:

>Dear all,
>Firstly, I thank everybody for his contribution to 'Crowns, Fillings and
>Amalgam'.
>I have been watching the discussion unfold on my screen with one laughing
>and one crying eye.  On the one hand I am learning a lot (maybe I should
>consider going into the dental business myself :) ), on the other hand l
>still cannot make up my mind what to do with my 'provisional' which is
>cracked now and probably doesn't make it much longer.  I know that my
>problems are only minor compared to those some people report about to this
>group.  Nevertheless I would be grateful if you could spare another moment
>to answer some more questions.

>Beside with lack tooth volume to achieve
>adequate mechanical retention on
>most tooth stumps wouldn't a bonded
>composite make more sense.

>Absolutely! Excellent point!

>Definitely!  Provided the dentist has some sense. And some technical skills.

>Usually a good rule of thumb is that amalgam/composite should not be used if
>the cavity preparation is 1/3 the width of the tooth measured from the
>buccal side (cheek side) to the lingual side.

>As for the best filling material... that depends.  Porcelain onlays can be
>good replacements for large amalgams that go bad.  If something a little
>more is needed, either a porcelain/gold crown or an all porcelain crown
>(like Procera) can be made.
>1) It seems to me that the large filling/crown question is almost as
>controversial as the amalgam issue...
>Any idea what happens after another filling or two when literally no tooth
>is left any more?  Root canals and implants into stumps?

Standard care is root c{*filter*}therapy, post, build-up (core) and crown.
This can be done is the stump is flush with the gum, or even a bit
below, but the dentist should be a master of inserting good posts.
.

Quote:
>2) If the retention of a crown on a tooth with a large filling is a problem,
>do I understand right that there is no filling material available that bonds
>to crown cement?

crown cement is what?

Filling material can be bonded to tooth structure with varying
results. There are various improved bonding substances which work or
do not work depending on the tooth and the dentist.

Quote:
>3) I got very little information on onlays, their advantages and
>disadvantages and whether they can be considered a real alternative to
>crowns.  In fact, the first time I read about them was in this group.  I
>never heard of them during numerous visits to dentists in Germany, England
>and Ireland.

Where there is some solid tooth structure, it may be advantageous to
use an onlay. To install a crown, the tooth must be tapered. Sometimes
this removes that good tooth structure which might have held the
restoration.

Additionally, an onlay leaves the natural contour of the tooth as
opposed to an artificial metal - porcelain contour. Depends on the
tooth.

Cheers,

Joel

--

- Show quoted text -

Quote:
>I am looking forward to your comments.
>Thanks again.
>Martina



Mon, 04 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam

Dear all,

Firstly, I thank everybody for his contribution to 'Crowns, Fillings and
Amalgam'.
I have been watching the discussion unfold on my screen with one laughing
and one crying eye.  On the one hand I am learning a lot (maybe I should
consider going into the dental business myself :) ), on the other hand l
still cannot make up my mind what to do with my 'provisional' which is
cracked now and probably doesn't make it much longer.  I know that my
problems are only minor compared to those some people report about to this
group.  Nevertheless I would be grateful if you could spare another moment
to answer some more questions.

Beside with lack tooth volume to achieve
adequate mechanical retention on
most tooth stumps wouldn't a bonded
composite make more sense.

Absolutely! Excellent point!

Definitely!  Provided the dentist has some sense. And some technical skills.

Usually a good rule of thumb is that amalgam/composite should not be used if
the cavity preparation is 1/3 the width of the tooth measured from the
buccal side (cheek side) to the lingual side.

As for the best filling material... that depends.  Porcelain onlays can be
good replacements for large amalgams that go bad.  If something a little
more is needed, either a porcelain/gold crown or an all porcelain crown
(like Procera) can be made.

1) It seems to me that the large filling/crown question is almost as
controversial as the amalgam issue...
Any idea what happens after another filling or two when literally no tooth
is left any more?  Root canals and implants into stumps?

2) If the retention of a crown on a tooth with a large filling is a problem,
do I understand right that there is no filling material available that bonds
to crown cement?

3) I got very little information on onlays, their advantages and
disadvantages and whether they can be considered a real alternative to
crowns.  In fact, the first time I read about them was in this group.  I
never heard of them during numerous visits to dentists in Germany, England
and Ireland.

I am looking forward to your comments.
Thanks again.

Martina



Tue, 05 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam

Quote:
>One very important
>restriction is the fact that both "must" never cover the cusps (the tips) of
>any
>tooth.

I had a hairline fracture on the outside of my bottow left molar and have had
the feeling of this that she might have put too much white composite (?)
filling on that hairline crack and up to the tip too much ...is this what you
are refferring to when you said that.?  What is this was done to me...what
would happen next then?  Am curious...thx


Tue, 05 Mar 2002 03:00:00 GMT
 Help: Crowns, Fillings and Amalgam
Hi Joel,

Quote:

>To install a crown, the tooth must be tapered. Sometimes
>this removes that good tooth structure which might have
>held the restoration.

Correction:

Putting a tooth through a pencil sharpener ALWAYS removes
that good tooth structure which might have held the restoration.

Hans Lennros DDS



Tue, 05 Mar 2002 03:00:00 GMT
 
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