filling therapy

What is a filling ?

If a tooth is diseased with caries, a filling (colloquially "filling") is necessary. The diseased tooth substance is completely removed (excavated) and a cavity (cavity-free hole) is prepared.

This defect is then filled with a suitable filling material.

The choice of filling material depends on the size and position of the cavity and on aesthetic requirements.

Filling types and filling materials

In general, filling therapy is differentiated according to the type of filling and its processing technique and according to the filling materials

When it comes to the types of fillings, a distinction is made between how the filling is processed and how it is placed in the tooth.

• the classic amalgam
• Dental cement (glass ionomer cement) as an alternative to amalgam
• good plastics (composite)
• high-quality ceramic inlay (insert filling)
• high-quality gold inlay (insert filling)

The plastic filling

Plastic fillings are soft filling materials that can be inserted (stuffed) directly into the tooth and processed (modeled) in the mouth. These include :

• the classic amalgam
• Dental cements (glass ionomer cement) as an amalgam alternative
• Plastics (Composite and Compomer)

The insert filling (inlay)

The high-quality filling (inlay) is made individually with the help of computer technology (Cerec) or in a dental laboratory. This finished and dimensionally stable filling is then glued into the tooth.

A distinction is made depending on the material

• ceramic inlay
• gold inlay

In order to achieve the best possible fit of an inlay, this treatment requires several treatment steps, regardless of the material, and is very complex and precise.

The durability of the inlays is therefore higher than that of plastic fillings.

Why is a filling necessary?

The natural tooth crown (the part of the tooth that is visible in the mouth) is a hard tooth substance and consists of two layers:

the tooth enamel and the underlying tooth bone (dentin).

Beneath the dentin lies the dental pulp (the nerve).

If tooth decay attacks these tooth substances and progresses further, not only noticeable cavities develop, but root inflammation and abscesses can also occur and thus endanger the entire tooth.

Fillings thus replace the missing tooth substance and serve as a protective barrier between the oral cavity (with many bacteria) and the healthy, normally bacteria-free tooth pulp (tooth nerve).

In addition, fillings ensure a smooth tooth surface and thus reduce the dirt niche and thus the surface area for tooth decay.

In addition, the tooth-colored fillings restore the overall aesthetic appearance of the tooth.

healthy tooth

caries and its consequences

Tooth decay is a disease of the teeth caused by the metabolic products of bacteria.

The bacteria contained in plaque convert the sugar from food into an acid, which then attacks the tooth structure and dissolves (demineralizes) it over time.

Initial caries (initial stage)

In this initial stage, the bacterial acid demineralizes the tooth.

This is expressed by a white spot on the smooth surface of the tooth, the so-called "white spot". In the further course, the white spot often turns brownish "brown spot" due to the pigment deposits from the food.

In this phase there is still no palpable damage or depression on the tooth and therefore no pain.

The initial caries does not necessarily have to be treated. Regular check-ups with prophylaxis and professional tooth cleaning (PZR), fluoride products (gels, tablets) and nutritional advice are usually sufficient.

Fissure caries and interdental caries

Caries often begins in places that are difficult to reach with a toothbrush and are therefore usually not cleaned thoroughly and sufficiently.

"Fissure caries" develops in the furrows, grooves and pits of the teeth or between adjacent teeth "approximal caries".

Depending on the depth of the fissure caries, a decision must be made between extended sealing and filling therapy, just as with approximal caries. Classical filling therapy is opposed to microinvasive caries infiltration.

Enamel caries and dentine caries

In the case of "enamel caries", the top layer of the tooth (enamel) is damaged by an initial depression. If caries spreads deeper, the tooth bone (dentine) is also damaged "dentine caries".

In this 2nd and 3rd phase, caries is first noticed by those affected: sensitive reactions, pulling and toothache to hot, cold or sweet things.

These are the noticeable signs of a decayed tooth.

Since the dentin is much softer than the enamel, the bacteria spread more quickly and affect other areas of the tooth. The spread is now not only in depth but also in width and thus hollows out the tooth from the inside. This often breaks off suddenly when chewing.

Deep caries (Caries profunda)

If the caries is left untreated, it penetrates deeper into the dentine and causes caries profunda (deep caries).

At this stage, the nerve (pulp) is not yet affected.

So that this is not irritated during the filling therapy, a layer of a special lining is placed before the actual filling. On the one hand, this prevents direct contact between the nerve and the filling material and, on the other hand, another additional protective layer of dentine (tertiary dentine) is formed over time.

Penetrating caries (Caries penetrans)

In this phase, caries has completely penetrated the dentine layer and has reached the pulp, i.e. the nerves. This becomes inflamed and leads to severe toothache (typical night pain).

A root canal treatment with subsequent filling or crown is now the therapy.

If left untreated, the inflammation can spread further into the jaw, which can lead to an abscess and, in extreme cases, the diseased tooth must be removed.

Please attend your six-monthly check-ups so that we can identify and treat the early stages of caries early.

Early treatment prevents the spread of tooth decay. This not only avoids unnecessary pain and further tooth damage, but also unnecessary financial costs.

At the latest at the first signs of tooth decay (sensitivity to cold, hot, sweet, aching pain) you must go to the dentist's office immediately.

Which filling is right for me?

Deciding on a specific filling therapy is not always easy for the patient concerned.

The following factors should be taken into account:

• which tooth is affected?
• How big / small is the carious defect?
• Which processing technique and type of filling is preferred?
• what aesthetic standards do you have?

With the help of our expert advice and information, this decision will be made a little easier for you.

This page is not intended as a substitute for advice, it is only intended to provide an overview of the most important factors of the various filling therapies that you should consider when making your decision.

Further details on the individual fillings and their techniques can be found under the respective therapies.

Amalgam GIZ Compo Composit Gold inlay Ceramic inlay Color /

aesthetics

silver matt/

light yellow

tooth colortooth colorgoldtooth colorwhich teeth? SZMZ

PV

car

SZ

MZ

car

car

SZ

SZSZDurability7-8 J2 J4-6 J5-8 J10-15 J8-10 JExpenditure****************Costs**************** *KK benefit 100%100%100% in the amount of one

A-fill

in the amount of one

A-fill

in height

one

A-fill

legend and explanation

A-Fllg = amalgam filling

compo = compomer

FZ = front tooth

MZ = milk tooth

PV = Temporary filling

SZ = posterior tooth

KK = health insurance

1) Note on durability

Statements about the durability of a filling are only statistically possible.

In addition to the filling material, the position and size of the filling also determine the durability in individual cases. Dental care behavior also has a major influence on lifespan. With good oral hygiene and regular check-ups, the fillings can last longer than average.

2) Note on effort/costs

* small amount

** normally

*** more than average

**** high

***** very high

3) Note on KK benefit

100% = health insurance benefit, no additional payment necessary

A-Fllg = health insurance only pays the comparable value of an amalgam filling,

additional payment necessary

You have further questions?

Call us on +49 30 7908430 or use our directly Contact form.

Amalgam - the classic or poison?

Amalgam is a mixture of mercury, silver, tin and zinc and is the oldest and most commonly used filling material in dentistry worldwide.

For many years, experts have been arguing whether amalgam fillings are dangerous to health or not.

In Germany, too, there have always been discussions about the harmlessness of amalgam to health.

Although according to the latest international scientific findings - amalgam is harmless - the use of this filling material has been banned for some patient groups in Germany for several years:

- for children up to 16 years

- for pregnant women and nursing mothers

- for patients with kidney and liver diseases

The filler is suspected of being responsible for over 100 different side effects, such as headaches, nausea, immune deficiency and insomnia.

Only the deposit of tiny mercury particles in the brain, kidneys, lungs, liver and intestines can be detected.

The European Union wants to reduce the use of amalgam fillings in the long term due to the mercury and the associated environmental problems. From July 1, 2018, amalgam should only be used in children and in pregnant and breastfeeding women in absolute exceptions.

In 2020 it should then be checked whether from 2030 under certain circumstances

amalgam fillings can be completely dispensed with.
Source : KZBV (National Association of Statutory Health Insurance Dentists)

Even the suspicion that amalgam can have a toxic effect is reason enough for us not to use amalgam.

That is why we offer suitable alternatives for everyone, all of which do not burden the body, hold up well and are aesthetically more attractive.

We remove old amalgam fillings using modern methods in such a way that no mercury particles can get into the body (see p.amalgam restoration)

Our practice has been doing without amalgam processing for 20 years!

Amalgam is inexpensive and is fully covered by health insurance companies. Alternatives are paid partially or not at all (filling flat rate).

In children up to 16, pregnant women, nursing mothers and in patients with kidney or liver problemssimple plasticFillings accepted.

GIZ (Glass Ionomer Cement)

We offer glass ionomer cement filling as a free alternative to amalgam

• free amalgam alternative
• dull yellowish color
• well tolerated
• only conditionally durable
• suitable as a temporary measure
• hardens automatically after a few minutes
• for children
• for pregnant women
• no co-payment

compomer filling

Compomer is a combination ofcomposite (plastic)andglass ionomer cement.

Today's compomers are not approved for large and extensive fillings in the side tooth area!

• tooth colored
• well tolerated
• only conditionally durable
• hardens after 30 sec. by a special blue light
• for milk teeth
• for visible tooth neck area
• suitable as a temporary measure
• no co-payment

The plastic filling (composite)

Today's composite is a tooth-colored filling material and consists of 80% plastic and 20% fine glass particles (nanoparticles). Due to the improved properties of the composite, it is similar to ceramics, but is one of the plastics.

• tooth colored
• well tolerated
• relatively long shelf life
• hardens with a special blue light
• for front teeth
• for posterior teeth
• no additional payment for simple composites in the front tooth
• no additional payment for simple composites in the posterior tooth only if amalgam is prohibited
• Additional payment for side teeth and multi-layer filling in the front tooth

There are several methods and techniques for gluing the composite into the tooth for the plastic filling. A distinction is made here:

> the single-layer plastic filling

> the multi-layer plastic filling

> the multicolor layered plastic filling

All plastic fillings are bonded to the tooth substance using the acid etching technique.

The Acid Etch Technique (SÄT)

With the acid-etching technique, a stable connection can be made between the plastic filling material and the tooth substance.

The tooth structure is etched with an acid. The etched areas are now coated with an adhesion promoter (primer) and then with an adhesive (bonding) and cured with a special blue light (polymerization lamp).

The treated surface now offers increased support for the filling material.

The single-layer plastic filling

After the SÄT, the soft composite is filled into the tooth in one layer and cured with a special blue light (polymerization lamp) for 30 seconds.

• for small enamel defects in the front tooth area
• for small enamel defects in the posterior region
• as a standard filling in the front tooth area (limited aesthetics)
• as a standard filling in the side tooth area (restricted aesthetics) when amalgam is prohibited
• for tooth neck fillings

The multi-layer plastic filling

In the case of large caries damage, another method is necessary and differs from the simple plastic filling in one essential point:

- the composite is applied in several individual layers

- each layer is individually cured with blue light

Why a multi-layered filling?

During light-curing, the composite shrinks and forms very small marginal gaps between the tooth and the filling material. The micro columns can close againCarieslead (secondary caries).

The less material is used per layer and the more individual layers are placed in the filling and individually cured, the smaller the risk of shrinkage.

This multi-layered plastic filling is very complex and time-consuming. An additional payment is therefore required.

The multicolor - layered filling

This method combines the multi-layer technique with a multi-color technique.

Not only individual composite layers are laid, but also with several different color intensities.

The multi-color technique gives the tooth a natural, individual tooth color and is optimally matched to the remaining teeth.

The excellent aesthetics of this method is very complex and time-consuming and is particularly suitable for the front tooth area.

For the best possible results, it would be advantageous to place these fillings in the first half of the day (because of the natural refraction and scattering of light)!

A co-payment is required

What does the checkout pay?

Statutory health insurance companies do not always cover all costs.

Here you get an overview of what the health insurance benefits are and in which cases you may have to pay something extra.

Front teeth (visible area)

Statutory health insurance only pays for the simple (single-layer plastic filling) in the visible front tooth area.

In the case of multi-layer and multi-color fillings, health insurance only reimburses the cost of a single-layer filling.

With these very complex techniques you have to reckon with an additional payment!

The statutory health insurance does not cover the replacement of intact fillings on request or because of the aesthetics and this is a private service.

Posterior teeth (not visible area)

Irrespective of the type of filling material and method, those with statutory health insurance receive an allowance equivalent to one amalgam filling.

Our practice offers the glass ionomer cement filling as a health insurance service to the amalgam alternative.

Exceptions :

For patients who are not allowed to receive amalgam care for medical reasons, the health insurance pays for a single-layer plastic filling.

This regulation applies to the following patients:

- Children up to 16 years of age

- Pregnant and lactating women

- People allergic to mercury

- Patients with kidney and liver damage

It is essential to present an allergy test or a medical certificate to the health insurance company and to the dentist.

In the case of multi-layer plastic fillings and inlays (insert fillings) you have to add an additional payment!

The statutory health insurance does not cover the exchange of intact fillings on request or because of the aesthetics and this is a private service!

Private patients should check with their insurance company and submit a cost estimate.