The best filling is no filling at all. After that, the smaller the restoration, the more tooth structure is conserved and the longer the restoration will last. Again, prevention is the key. Early detection of hygiene or occlusal problems through regular exams and cleanings will keep you on track to a healthy, life long smile.
There are a number of reasons to need restorative dentistry. These include caries (decay or cavities), fracture due to injury or due to increase occlusal stresses placed on natural or previously restored teeth, defects of tooth formation or due to cosmetic concerns. Nowadays due to the increasing public awareness of dental health there is a general trend towards fewer new carious lesions. With early and regular preventative care, new cavities can be held to a minimum or completely prevented. Unfortunately, once a tooth has been restored, the restoration generally needs to be replaced or updated for various reasons. The rate at which they need to be replaced primarily depends on the size of the previous restoration (smaller restorations last longer), type of material used and host factors such as oral hygiene and occlusal forces.
Sometimes due to the extent of decay or fracture a stronger restoration is needed. When the piece of the tooth that is missing gets to be proportionally larger than the remaining tooth structure, we look to lab processed restorations. The basic lab processed restorations generally used are onlays or crowns. These restorations generally require two visits. The first visit is used to clean up the tooth, which may include placing a foundation filling called a build-up. The tooth is then shaped in a specific way to allow proper fitting of the onlay or crown. When the preparation is done, an impression is made so that a duplicate of the tooth can be sent to a lab on which the permanent restoration is made. At the end of the first appointment, a temporary is made so that you can leave the office with an intact tooth. The permanent restoration generally gets back to the office within two to three weeks, at which time a second appointment can be made to finish the treatment. The second visit entails removing the temporary and then cementing or bonding the permanent restoration to the tooth.
Restorative dentistry is primarily focused on returning an individual tooth back to a state that most closely resembles its original integrity of strength and function. It is an exciting time in dentistry because most materials nowadays allow us to bring back the esthetic qualities of the tooth as well. Gone are the days of routine silver fillings. Today's white (bonded) fillings allow us to restore teeth in ways that make the restoration virtually undetectable. The bonding science behind these restorations may also bring back some of the strength of the tooth by "gluing" it back together, rather than just plugging a hole in the tooth and requiring the tooth to hold the filling in (basic principal of silver filling).