Metal fillings have been a constant for the past 150 years but concerns about mercury release raised eyebrows globally. Technically, it consists of metals like silver, copper, tin, mercury, palladium, zinc and indium. Mercury is a well-known neurotoxin having adverse effects like anxiety, depression, tremors, paralysis, insomnia, impaired hearing and vision, developmental defects during foetal growth etc.
Under normal circumstances, a very small amount of mercury vapor is released due to the wear and tear of amalgam and has been considered safe by reputed organizations like American Dental Association or U.S. Food and Drug Administration. On the contrary, individual countries like Denmark, Sweden, and Norway have restricted the use due to the known toxicity of mercury. European Union is contemplating a ban by 2030.
DISADVANTAGES OF SILVER AMALGAM FILLING:
Compromised aesthetic appearance owing to dark colour
Transmits temperature changes and lead to occasional sensitivity
Silver fillings inevitably result in a grayish hue on surrounding healthy tooth structure
The metal expands and contracts significantly more than other materials leading to microfractures in the tooth over time
Amalgam fillings cannot be repaired and must be replaced if any problem occurs
Silver fillings demand specific box formation inside the tooth for proper retention and longevity. This mean removal of additional healthy tooth structure just to accommodate the metal filling
DEFECTIVE SILVER FILLINGS
We recommend replacing metal fillings when we spot margin gaps, leakage, decay underneath existing filling, fracture, roughness or chipping, excessive filling on gum tissue (overhang) or cracks in teeth. We also suggest replacing them for esthetic reasons if they are visible in your smile zone. If there are no signs of failure in old silver fillings, they are best left untouched.
DEFECTIVE SILVER FILLINGS
BETTER ALTERNATIVES TO SILVER FILLING:
COMPOSITE RESTORATION: Composite is a white colored filling material which enables shade matching thereby mimicking natural tooth structure. With improvements in material sciences, the bond to the tooth has significantly improved resulting in long lasting restorations. Only decayed portion of the tooth has to be removed for composite thereby preserving healthy tooth structure. It can be easily repaired as new composite can stick to both the tooth and old composite filling. It is most suitable for small to medium sized cavities.
Coloured Composite Filling
FIG: REPLACING METAL FILLING WITH TOOTH COLORED COMPOSITE FILLING
EMAX INLAY/ONLAY: Emax is the most esthetic material available in Dentistry. Large sized cavities of post Root canal Treatment RCT restorations are best done with Emax inlay or onlay. Due to the solid bond with the tooth owing to special cements, it reinforces the remaining tooth structure imparting great strength and functionality.
REPLACING SILVER AMALGAM FILLING WITH E-MAX INLAY AND ONLAY
FIG: REPLACING SILVER AMALGAM FILLING WITH E-MAX INLAY AND ONLAY
To conclude, in our humble opinion, strong and sturdy silver amalgam fillings with no signs of fracture or leakage are best left alone. However, we certainly do not advise repairing old metal fillings or getting new ones as dentistry has certainly progressed towards saving your natural tooth as much as possible. Specialists at Dental Panache, Gurgaon dental clinic, are trained at minimally invasive Dentistry. We do not use silver amalgam in our practice owing to inherent risks involved both for the patient and practitioner.