What types of filling materials are used for cavities? What are the advantages and disadvantages?

 There are 3 materials that are commonly used as direct dental fillings .

1. amalgam

People used to call it "lead filling". Not completely wrong. But amalgam is actually a mixture of metal with liquid mercury. The metals used are silver, tin, and copper. Mercury for dentistry in Indonesia has not received a distribution permit (due to environmental waste considerations) so that this material is practically no longer used. Dentists who still use it are definitely using the old stock they still have.

Pros:

• Strong
• If done well, it is more resistant to secondary caries

Disadvantages:

• Requires a lot of teeth grinding because it attaches to the teeth in a "sitting" way (hence requires a lot of grinding because the rest of the dental tissue needs to be formed first)
• In the long term, there is a risk of cracking because the stress is high
• Causes black marks on the surface of the teeth attached to amalgam
• Not for the front teeth. I wouldn't say "unaesthetic" because a well carved, shaped and polished amalgam can look really good (only the dark color matters)

2. Glass Ionomer Cement / Glass Ionomer Cement

Maybe you remember that after a tooth filling you were told "wait 1 hour then you can eat". Well, this material is used. Why? Because just like amalgam, GIC takes time to harden (setting). This material is a mixture of silica glass, alumina, calcium fluoride, aluminum fluoride, sodium fluoride, aluminum phosphate with an acidic polymer liquid.

If you pay attention, many of the ingredients contain fluoride. This is the first advantage. GIC material can protect teeth from caries and stimulate dentin growth. The second advantage is that because it is chemically attached and contains fluoride, not all of the dentin tissue that has become soft due to the caries process needs to be removed so that more tooth tissue remains.

The drawback is that it is not strong enough to withstand the pressure so it cannot be used on teeth that are subjected to a large chewing load. (Note that I didn't write "large patch size").

3. Composite resin

This is the most popular material today. Often referred to as a "laser patch". Even though the process has nothing to do with the use of lasers. Composite resin consists of a matrix and a filler. Just imagine that I make a box or tube with many supporting frames (matrix), then fill it with sand (filler). This filler material is silica glass such as GIC. The composition varies depending on what kind of composite character you want to make.

Pros:

• VERY AESTHETIC. There are so many color variations so that they can be shaped exactly like real teeth
• Because it just hardens through the activation of radiation (the blue light, you know), the duration of action is longer (so it can be shaped as good as possible). Should be much tidier than the first 2 ingredients. (Pure GIC and amalgam have an average duration of action of only 2 minutes before the material hardens).
• Strong enough, especially composite resin that has been mixed with fiber. Its strength can be equivalent to amalgam.
• Requires minimal gear grinding like GIC because it adheres to the mechanical system

Disadvantages:

• Very sensitive to technique. To produce a good and durable patch requires operator skill and good quality tools. If these 2 factors cannot be met, it is better to use the first 2 ingredients.
• Can cause hypersensitivity if the technique is wrong and the condition of the tooth cavity is close to the nerve.
• Vulnerable to secondary caries if the technique is wrong (marginal leakage occurs aka edge leakage).
• Does not stimulate new tissue growth because the composite is plastic.
• If not polished properly, it is very easy to absorb the color (thus changing the color of the patch) and the patch will look ugly.
• Experiencing shrinkage (shrinkage). When irradiated, the composite resin material will experience shrinkage (shrink). This shrinkage occurs immediately and will be clearly visible at the boundary of the filling with the teeth. To prevent this from happening, again to do with the technique and quality of the filling material.

Clinical appearance of shrinkage composite resin. Note that there is a clear gap between the filling material and the natural teeth. This is tantamount to giving a toll road to bacteria

In addition to the 3 main ingredients above, the material manufacturers also innovate to make a mixture of the three ingredients. There are mixtures of GIC-amalgam, GIC with resin mixtures, composite resins containing fluoride.

Are the results any better? According to my experience and knowledge, no. Because the weaknesses in each finished material appear in the product. The advantages are also insignificant compared to using the materials individually.

In addition to the 3 common ingredients, there is also a bioactive material to replace dentin , which contains calcium silicate. This material is very good as a substitute for dentin because as you read, it contains calcium, the main building block of teeth (the amount of calcium minerals is more than phosphate and fluoride as teeth-forming minerals). This material is quite expensive so not all doctors or clinics have it. Because of this price reason too, this material is not popular with dentists (except conservation dentists).

Materials such as metals (cobalt chromium, titanium), gold, porcelain, glass ceramic, alumina, zirconia are more commonly used as filling materials (better called restorative materials) indirectly — fabricated outside the mouth, in a dental laboratory or chairside .

So keep in mind that no single material is superior to other materials. They all have their own pluses and minuses. Operators need to know the case at hand and use the best materials possible. Using a combination of several ingredients for complex cases will yield much better results.