The Other White Crown
It is a common myth that silver amalgam fillings last forever. They are very durable but are not indestructible. There are several reasons why a silver filling can fail. Fillings have to endure an incredible amount of biting force and over time, they become worn and turn black, and their edges wear away. Moisture and temperature changes can also cause the filling to expand and contract. This expansion can create a wedging effect in the tooth, which can fracture or break off tooth structure. The expansion can also lift the surface of the filling slightly creating a gap where the filling meets the tooth and allow bacteria into the tooth.
Jamie had begun to have sensitivity when flossing in her lower right molar, which had a large silver amalgam filling. Dr. Adler diagnosed recurrent decay in the tooth and recommended that an inlay be placed.
An inlay is similar to a filling and lies in between the cusps of the tooth. They are custom-made to fit the prepared cavity and are then cemented into place. An onlay is a more extensive reconstruction that replaces one or more cusps of a tooth. Onlays are indicated in situations where a substantial reconstruction is required. However, more of the tooth structure can be conserved compared to the placement of a crown. To repair damage to the tooth’s biting surface, rather than using a simple filling, or a crown, Dr. Adler will often use an inlay, or an onlay. Inlays and onlays are made from porcelain because of its strength and ability to match the natural color of the tooth.
Dr. Adler prepared Jamie’s tooth by removing the old amalgam filling and the underlying decay. He then painted a reflective powder over the prepared tooth. Using a special camera, he took an accurate picture of the tooth which was then displayed on a computer screen, where he designed the inlay. Then CEREC took over and automatically fabricated and shaped the restoration. CEREC is an acronym for Chairside Economical Restoration of Esthetic Ceramics. With CEREC there was no need for us to make an impression and send it to a lab. The inlay was then permanently bonded to Jamie’s tooth. The whole process took about an hour and Jamie was able to leave with a beautiful and healthy white tooth verses the discolored and decayed one that she came in with.