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Indirect dental restorations are custom made fillings placed into teeth by your dentist.  Indirect restorations are made according to the doctor's prescription by a dental laboratory technician working in a dental laboratory.

Fine quality dental laboratory technicians are specially trained professional craftsmen who devote their careers to making all sorts of indirect dental restorations (inlays, onlays, crowns, bridgework, partial dentures, and complete dentures) according to the doctor's detailed prescription.  The best dental laboratory technicians are skilled artisans who contribute a talent for sculpture in miniature, an artist's eye for color, a knowledge of jaw mechanics and proper bite, and an advanced knowledge of dental materials to patient care.  Dental laboratory technicians are an important part of the team of dental office professionals who work together to bring patients the benefits of modern dentistry.  Our office only works with the finest dental laboratory technicians to enhance the beauty and durability of our indirect restorations.

Dental laboratory technicians work with high precision models of both the treated and untreated  tooth or teeth.  The models are made from incredibly accurate impressions taken in the mouth by the doctor and dental assistant.  Indirect dental restorations generally require two separate treatment appointments to complete.

During the first appointment the following steps are completed:

bulletNumbing the area of treatment, so care will be pain free.
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Removing decayed or weakened hard tooth structure (enamel and dentin) and preparation of the cavity.

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Special impressions which make precise duplication of the shape of the treated tooth and cavity.  This duplication process allows a dental technician to make the indirect restoration (according to the doctor's prescription) in the dental laboratory.

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placement of a temporary restoration.

At the second appointment the following steps are completed:

bulletnumbing the area of treatment, so care will be pain free.
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removal of the temporary restoration.

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placement of the final restoration.

Selecting the appropriate direct restoration to meet the needs of the patient and the individual tooth depends on a large variety of factors.  Each material has different physical properties, and different advantages and disadvantages as a result.

The weight of scientific evidence is that all of these materials are safe and effective for their intended use when properly placed in the appropriate clinical situation.

 Dental Insurance may provide coverage for the least expensive material than can be used, whether or not it is the best material recommended by the dentist after discussing this with the patient.  Patients, in consultation with their dentist, should be free to choose the most appropriate among them for their particular needs, and individual desires.

Crowns ("caps") and Fixed Partial Dentures ("bridgework") are restorations that are placed over one or more teeth after they are suitably reshaped.  Crowns and Fixed Bridgework may be made out of the same materials that are used for indirect fillings.

The following chart illustrates some common considerations your dentist takes into account when determining which material is best for a particular tooth needing an indirect restoration. The list is by no means complete.

Comparison of Indirect Restorative Dental Materials

FACTORS

COMPOSITES
(Indirect)

ALL-PORCELAIN
(ceramic)

PORCELAIN Fused to METAL

GOLD ALLOYS
(high noble)

BASE METAL ALLOYS
(non-noble)

General Description A mixture of tiny glass filler particles and acrylic resin that forms a solid tooth-colored restoration.  Laboratory processing increases strength compared to direct composites cured in the mouth.  Porcelain, ceramic or glass-like fillings and crowns.  Porcelain is fused to an underlying metal structure to provide strength to a filling, crown or bridge. Alloy of gold, copper and other metals resulting in a strong, effective filling, crown or bridge. Alloys of non-noble metals with silver appearance resulting in high strength crowns and bridges.
Principal Uses Esthetic dental fillings and veneers Esthetic and Strong dental fillings, inlays, onlays, crowns & veneers. Inlays, onlays, crowns and fixed bridges Inlays, onlays, crowns & fixed bridges.  Crowns, fixed bridges & partial dentures. 
Leakage and Recurrent Decay Leakage low when properly bonded to underlying tooth; recurrent decay depends on maintenance of the tooth-material bond. Leakage very low if properly bonded to underlying tooth structure.  Recurrent decay depends on maintenance of the tooth-material bond. The commonly used methods used for placement provide a good seal against leakage.  The incidence of recurrent decay is similar to other restorative procedures. 
Durability Fair to Good in small-to-moderate size restorations, if not subject to biting forces. Excellent durability, very strong yet able to withstand biting forces well. Very strong and durable. Very strong and durable, but lower quality alloys may have poor corrosion resistance.
Dentist's Cavity Preparation Considerations Strength depends on adequate composite resin thickness, requires moderate tooth reduction during preparation (1 to 2 mm). Strength depends on adequate porcelain thickness, requires more tooth reduction during preparation.  Usually more conservative than a crown & may eliminate need to crown a tooth. Including both porcelain and metal creates a stronger restoration than porcelain alone; more tooth reduction is required (1.5 to 2 mm). The relative high strength of metals in thin sections requires the least amount of healthy tooth structure removal.
Clinical Considerations These are multiple step procedures requiring highly accurate clinical and laboratory processing. Some restorations require at least two visits, others require multiple appointments.
Resistance to Wear Moderately resistant, but less so than silver amalgam alloy. Highly resistant to wear. Inferior grades of porcelain can rapidly wear opposing teeth in some situations. Highly resistant to wear, but porcelain can rapidly wear opposing teeth in some situations Resistant to wear and gentle to opposing teeth. Resistant to wear and gentle to opposing teeth.
Resistance to Fracture Moderate resistance to fracture in high-load restorations, some what better than direct composite restorations. Excellent strength if properly bonded to underlying tooth structure. Fracture is uncommon. Excellent resistance to fracture. Highly resistant to fracture.
Biocompatibility Reasonably well tolerated. Material may release estrogen-like chemicals, but clinical significance is unknown. Very well tolerated. Very well tolerated if high quality noble metal used. Low quality base metals may can cause allergic reactions. Very well tolerated. Well tolerated, but some patients may show allergenic sensitivity to base metals.
Post-Placement Sensitivity

           Sensitivity, if present, is usually not material specific.

Occurrence of sensitivity highly dependent on ability to adequately bond the restoration to the underlying tooth. Sensitivity is rare when proper placement of quality materials is done.  Low thermal conductivity reduces the likelihood of discomfort from hot and cold.  High thermal conductivity may result in early post-placement discomfort from hot and cold. 
Esthetics Mimics natural tooth color and translucency, but can be subject to staining and discoloration over time. Excellent esthetics, color and translucency which can very closely match natural tooth appearance. Excellent Esthetics, color & translucency. Porcelain can very closely match natural tooth appearance, but metal may diminish translucency if placement not well done. Metal colors do not mimic natural tooth coloration or translucency.
Relative Cost to Patient Moderate; actual cost of fillings depends on size and technique. Generally requires at least two office visits and laboratory services. Higher; requires at least two office visits and laboratory services. Higher; requires at least two office visits and laboratory services. Higher; requires at least two office visits and laboratory services.
Average Number of Visits To Complete Two or more visits for indirect inlays, onlays,  veneers and crowns. Minimum of two; matching esthetics of teeth may require more visits. Minimum of two; matching esthetics of  teeth may require more visits. Minimum of two

Comparison of Restorative Dental Materials Reference List

1. US Public Health Service. "Dental Amalgam: A Scientific Review and Recommended Public Health Service Strategy for Research, Education and Regulation." January 1993 (Section on Dental Materials for Restoring Posterior Teeth.)

2. US Public Health Service. "Dental Amalgam: A Scientific Review and Recommended Public Health Service Strategy for Research, Education and Regulation." January 1993 (Table 2: Selected Characteristics of Posterior Restorative Materials.)

3. American Dental Association, Council on Dental Materials, Instruments and Equipment. "Choosing Intracoronal Restorative Materials." JADA 1994; 125:102-3.

4. American Dental Association, Council on Scientific Affairs; Council on Dental Benefit Programs. "Statement on Posterior Resin-Based Composites." JADA 1998; 129:1627-8.

5. Douglass CW. "Future Needs for Dental Restorative Materials." Adv Dent Res 1992; 6:4-6.

6. Reich E. "Risks and Benefits of Direct Restorative Materials as Alternatives to Amalgam." Dental Amalgam and Alternative Direct Restorative Materials, Oral Health, Division of Noncommunicable Diseases, World Health Organization, Geneva 1997; 1-15.

7. American Dental Association, Division of Communications. "Answers to Your Questions About Silver Fillings." 2000.

8. American Dental Association, Division of Communications. "Dental Materials." 1993.

9. US Public Health Service, "Update Statement by the U.S. Public Health Service on the Safety of Dental Amalgam." Annex A and Appendix B, 1995 & 2001.

10. Burgess JO, Norling BK, Rawls HR, Ong JL. "Directly Placed Esthetic Restorative Materials - The Continuum." Compendium 1996; 17:731-748.

11. US Food and Drug Administration, "Consumer Update: Dental Amalgams February 2002." http://www.fda.gov./cdrh/consumer/amalgams.html, February 8, 2002.

12. Mackert, J.R., Berglund, A. "Mercury Exposure from Dental Amalgam Fillings: Absorbed Dose and the Potential for Adverse Health Effects." Ctir Rev Oral Biol Med 1997; 8:410-436.

13. Smith, C.T., Gold as a Historic Standard and its Role for the Future, Operative Dentistry 2001;Suppliment 6:105-110.

14. Peutzfeldt, A., Indirect Resin and Ceramic Systems, Operative Dentistry 2001:Suppliment 6:153-176.

NOTE: The information in this chart is provided to help dentists discuss the attributes of commonly used dental restorative materials with their patients.  The chart is a simple overview of the subject based on the current dental literature.  It is not intended to be comprehensive.  The attributes of a particular restorative material will vary from case to case depending on a number of factors. Chart above modified from a chart published by the American Dental Association, 2002.

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David J. Fox, D.M.D., P.C.

Quality Dentistry for Discerning Adults ®

Telephone: (215) 481-0441

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