General dental practitioner Andre Vella Bonnici questions whether the days of silver fillings are numbered? Thanks to innovations in dentistry, the future is looking whiter.

One of the first associations most of us make when we hear the word dentist is fillings. Most of us have them, some more than others, depending on how rigorous and vigorous our diet and hygiene was and is.

The solution to restoring broken teeth in an aesthetically pleasing way was found in ceramic technology

The thought of them makes most of us cringe – especially the annoying sound of the drill used to prepare the teeth to allow the placement of the filling material.

Dental fillings are used to replace a part of a tooth which has chipped or broken off from trauma or decay. They are essential in eliminating any possible pain, which may be caused by the loss of tooth structure, and are also vital in restoring the functionality the tooth once had.

For over 100 years, amalgam has been the filling material of choice. It is a mercury/tin alloy, most commonly known as the silver filling, and has survived for so long because of its low cost, ease of use in difficult clinical situations and its longevity.

A lot has been said about dental amalgam fillings over the past few years. Much controversy lingers on from its early days when it was first introduced. But the criticism did not stifle the reputation of the material, which without doubt, has been the most widely used direct restorative in dentistry.

Over the past two decades, much research has been dedicated towards measuring the real effects of amalgam. The end result of these studies has been positive as regards the safety of the material. Critics, however, often link the mercury content to potential neurotoxicity and to allergic reactions, but no statistically significant link was found in the reported cases. An association was made in a few cases of oral lichenoid plaque lesions, an autoimmune condition characterised by white lesions in the mouth – a far cry from what the critics claim.

Unfortunately, some perspectives are still skewed by emotional and political views, which detract from the toxicological evidence produced.

Even though still a reliant and safe material, the popularity of dental amalgam is on the downside as more people request the more aesthetically pleasing white fillings, which are made of a composite resin. The long-term survival rate of this relatively young material, when compared to amalgam, has improved considerably with the advancement of dental technology, with long-term survival rates being quoted as equal or close to those of amalgam.

The main problem arises when the size of the filling required becomes very large. In these clinical situations, the white composite filling does not perform as well as the trustworthy amalgam filling.

The solution to restoring large, broken teeth in an aesthetically pleasing way was found with the development in ceramic technology and the adhesives used to attach them to the tooth. Ceramic inlays, or onlays, are constructed to replace the missing tooth structure and offer good long-term survival rates for strength and resistance, thus restoring the tooth back to function and also giving it back its natural appearance.

Thanks to these innovations, the future is looking brighter – or whiter – for dentistry, with a move towards more aesthetically pleasing restorations, offering adequate performance and reliability to replace the stalwart that is amalgam. These advances also meet the demands of any dissident critics about the validity and safety of the good old silver filling, which has served us so well.

andrevellabonnici@hotmail.com