Silver- Mercury Amalgam Fillings:

Please note - We have chosen not to perform these in this office.

Silver fillings have been used for over 100 years in dentistry, and have improved constantly over that time. They provided an easy, economical and long lasting repair for decay. However, they are not natural looking, do not add any strength to the tooth, and release small amounts of mercury.

The amount of mercury released from fillings is only a small part of the average person's exposure, and there have been many studies regarding the health effects of this mercury release. Many have shown no harmful effects from this mercury release, but the issue is still under investigation. We do not use amalgam fillings at the Elm Tree Clinic.

It is possible to be medically tested for mercury in the body. Certain individuals are very sensitive to tiny amounts of mercury, and there is a test for this as well. If you have old amalgam fillings which are working well, and you do not have high mercury levels or sensitivity, we do not advise replacement unless requested by you. If you have fillings which need replacement we can offer the latest state-of-the-art restorations. We take special precautions to minimize our patients exposure to amalgam dust, debris and vapour while removing old fillings. Be sure to see our Office Safety and Environment section for details on how we minimize mercury exposure to our patients and staff. There is no single replacement for amalgam in all cases.

Amalgam removal with suction adapter
to minimize mercury exposure

Alternatives are: Resin Fillings; Gold, Porcelain or Resin Inlays and onlays; Full Crowns

Resin Fillings:

For small single surface fillings composite resin is the filling of choice, with better looks and strength than amalgam.

Small Amalgam Filling (Left) replaced with Composite Resin (Right)

For medium size fillings between teeth, resin can work well. They look natural, and new materials are lasting well. They are fairly quick to place too.

For larger fillings between teeth, especially on deep fillings or ones in high stress areas like molars, resins can be used but inlays or crowns are better choices. (See below)

• Resins do not seal well on fillings deep below the gumline.
• Resins will wear down more rapidly on larger fillings on molars.
• Very large resins are difficult and time-consuming to place. If the filling is very large a crown is the restoration of choice.
• Some people are sensitive to the chemicals in resins.

Inlays and Onlays:

Inlays can be made to replace medium sized fillings in almost any tooth. They can be made of gold or porcelain.

• Inlays feel very natural and smooth.
• The materials are very stable and biologically neutral.
• They are more expensive than amalgam or resin initially, but last longer so you do not need to go through the procedure as often in the future.

Please be aware that dental insurance usually covers what is cheapest, not necessarily the best, most attractive or strongest option. Insurance may not always cover inlays or crowns fully. We can provide a pre-treatment estimate for you to define your coverage.

Gold inlays:

Gold inlay fillings have been used for decades.

• The lifespan is excellent.
• They wear most like natural teeth.
• They have the best fit of all for very deep and difficult fillings. They are especially good for the very back teeth.

40 year old Gold Inlay

Porcelain Inlays:

• Porcelain inlays and onlays have a good lifespan.
• They appear very natural.
• They feel most like natural teeth too, due to their smoothness.
• They add strength to the tooth, more than resins do.
• Porcelain is very non-reactive and non-allergenic- Some highly sesitive people react least to porcelain.
• They are not ideal for very high stress areas.

	Medium sized amalgam filling (left) replaced with porcelain inlay (right)
Large Failing Amalgam	Porcelain Onlay	Onlay in place.

Full Coverage Crowns:

When a tooth is heavily filled, a full crown is needed. Crowns are much stronger and longer lasting than any type of fillings. Crowns can be made in Gold, Porcelain Fused to Metal, or All-Porcelain.

Please be aware that dental insurance usually covers what is cheapest, not necessarily the best, most attractive or strongest option. Insurance may not always cover inlays or crowns fully. We can provide a pre-treatment estimate for you to define your coverage.

• Gold crowns wear the most like natural teeth, and have the best fit. They do not look natural, but have an excellent shine. They are the best choice for very high stress situations like the very back teeth.
• Porcelain Fused to Metal crowns have a good combination of good appearance, high strength and excellent fit. We now have technology to make the edges of these almost invisible, so they blend in very well. Older types used to have a grey line at the junction.

	Very large amalgam replaced with a Porcelain Fused to Gold crown
PFM Crown before	Amalgam Removed and new core built up	PFM Crown in place

• All-Porcelain Crowns have a superb, natural appearance. They are the ideal choice for front teeth, and can work well for selected back teeth as well. They do not have the grey line at the gumline that older Porcelain-metal crowns had. These are the ideal choice for those who want metal-free restorations.They are slightly less strong than the other types, so in very high stress situations Porcelain Fused to Metal would be a better choice.

All-Porcelain Crowns before (left) and after (right)