Restorative – Dr Phoebe Tsang

Fillings:

Two types of fillings: silver (metal) or white (plastics).

Fillings are used to fill in holes after tooth decay is removed. Fillings are only used when the cavities are small.

Silver (Amalgam) Fillings:

Pros:	Cons:
Durable, can withstand high chewing load	Weaken tooth during decay removal
Resistance to saliva contamination	Concern with leakage of metal in mouth
Easy and quick to apply
Affordable

Comments of the American Dental Association before the Dental Products Panel of the Medical Devices Advisory Committee Food and Drug Administration US Department of Health and Human Services, Dec 2020 (Download PDF)

Canadian Dental Association position for Amalgam (Download PDF)

Tooth Colour (composite) fillings:

Pros:	Cons:
Esthetic, natural look	Not compatible with high caries risk and acidic mouth environment
Less temperature (hot/cold) sensitive	Less durable than silver fillings depending on chewing force
Less tooth removal needed before placing filling	Prone to recurrent decay / staining
	Insurance may not cover, especially on baby teeth

Silver caps (Stainless Steel Crowns)

When the damage on the tooth is large and the remaining tooth structure needs reinforcement, a stainless steel crown is used to fit over a tooth above the gum line. A crown seals the tooth and augments the tooth integrity. It keeps the tooth from breaking and getting cavities again. The dentist is able to shape the existing tooth to make room for the crown and be able to place the crown on in the one appointment. Unlike an adult crown, a child’s crown is considered a basic restoration and can be achieved in one appointment without taking impression or extra lab processing. It is usually covered by most insurance plans.

Stainless Steel Crowns (Silver)	Zirconia Crowns (White)
Durable and strong	Esthetics
Can be placed with minimal tooth removal	Require more tooth removal before placement
Adaptive to existing bite	Harder to adjust to existing bite
High success rate

Why do we put crowns on baby teeth? Can the tooth be filled?

To stop future decay on the same or adjacent tooth
To prevent fracture of the tooth which has large cavities
To preserve correct spacing between the teeth in order for the permanent teeth to grow properly

When a cavity is very large, a crown (stainless steel crown or tooth coloured stainless steel crown) is a more appropriate choice than a filling. This is an example of an extensive filling failing. Part of the tooth fractured and bacteria leaked inside the tooth from the crack. Unfortunately this tooth has to be extracted.

Tooth Colour Composite Crowns for front teeth:

Tooth shaped coverings are cemented to the tooth to restore its original shape and function when teeth that are too heavily decayed or traumatized. Depending on the extent of the decay, this may not be a viable option. When it is feasible, these esthetics caps cover the entire tooth which can prevent future decay and fracture. The procedure can be done in one visit. However, this material is brittle and can be prone to fracture if your child has a heavy bite (eg. Grinding or toys in the mouth). It is also prone to staining if oral hygiene is hard to maintain.

Before Restoration

After tooth-coloured composite crowns

Pulpotomy

Pulpotomy (P) is a procedure to restore and save a baby’s teeth which its nerve has been invaded by untreated tooth decay. This procedure tries to save the teeth so extraction of the tooth can be prevented. After the treatment the teeth are covered with a stainless steel crown to prevent contamination from bacteria or loss of the medicine inside the tooth.

A Zirconium crown can be placed instead of a stainless steel crown. It is a preformed, white crown that provides excellent esthetics but only works well in selective restorative cases. If you are interested, please ask us for more information.