There is a difference between dental restorations being functional and being esthetically functional.
Thirty-some years ago, the emphasis was on function, since there were no time-proven and predictable esthetic materials available. Dentists relied on silver amalgam fillings even in the front of the mouth if they could possibly get away with it.
This was because the tooth-colored fillings of the time did not adhere to the tooth very well and would wash out within a relatively short period of time.
Other than that, gold was the best material of choice. Dental gold alloys were somewhat softer. This allowed for minimal wear during chewing on the opposing teeth and for the margins to be sealed in the best way possible.
The two biggest ways dental restorations fail are moisture leakage at the margins and succumbing to bite force. Gold was considered superior in quality and esthetics over silver amalgam.
If you questioned 1,000 patients who were given a choice between esthetic vs. just functional restorations, all but a few would choose materials most resembling that of tooth structure. The great news is that due to chemical and mechanical research over the years, modern-day materials can be both functional and esthetic.
The biggest advancement was the ability to bond predictably to a tooth. Bonded restorations are used in almost every restoration placed today. White fillings, crowns and veneers are the most-used esthetic restorations that rely on the ability to bond to the tooth.
Not only does this allow for beautifully restored teeth, it also preserves tooth structure because mechanical retention is not needed. Mechanical retention used to "lock" the restoration in place requires considerably more tooth removal, thus weakening the tooth. That is why many patients have experienced broken tooth cusps around old amalgam fillings.
Another aspect of tooth bonding is the ability to light cure the restoration as opposed to placing and waiting for the material to "set." This is now taken for granted.
The ability to position and sculpt a restoration, curing it with a light when ready, is what makes porcelain veneers and white filling materials possible. Combine this with an imaging and milling tool, like Cerec, and restorations can be manufactured in the office and placed in one visit.
Making esthetic and functional restorations is exciting for both the operator and patient. Everyone benefits from teeth that are restored to look like natural teeth.
Like all technology, dentistry has advanced a long way since the silver filling.
James G. Jenkins, D.M.D. is the owner of Bluffton Dental Care in Bluffton.