Dental services

Tooth fillings

Structure/parts of the tooth

Enamel constitutes the outer layer of teeth above the gumline; enamel is the hardest tissue in the human body. The layer under enamel is dentin, which surrounds the innermost part of the tooth, pulp. Pulp is in fact the collection of blood-vessels and nerves; the blood vessels nurture the teeth and the nerves transmit the signs of various impacts towards the nervous centre. These nerves are responsible for tooth-aches. If the enamel damages (because of caries or the injury of the tooth), the pulp, which is less resistant to pain stimuli, becomes accessible for the outside world, through the minute canals in the dentin, and the tooth responds with tooth-ache.
The teeth are "sitting" in the toothridge of the lower mandible (mandibula) and the upper mandible (maxilla). The connections between the bones and the teeth are provided by several tiny ligaments and fibres.

This is how caries develops

Bacteria feed on carbon-hydrates and produce acids, which attack the enamel. Caries occurs when enamel gradually loses its mineral content as a result of its exposure to acids, becomes thinner and porous, breaks and collapses. If the cavity is not filled, bacteria reach the alveola, which causes inflammation and severe pain. And if this inflammation is not treated, either, bacteria may even get into the bloodstream, which may first damage the jaw-bones and later the whole body.
The health and resistance of enamel depends on five factors: the presence of pellicle or carbon-hydrates, food remaining in the mouth, the frequency of meals and the lack of protective factors.

What is a tooth filling?

By filling the cavity in the teeth it is possible to restore the original state and shape of the carious tooth. The dentist first removes the carious parts of the tooth, cleans the concerned areas and then fills the cleaned cavity with the filling material, thus preventing the further spread of caries.

What material are fillings made of?

The materials and procedures applied by dentists and dental technicians have changed and developed tremendously during the past decades. Therefore the composition and characteristics of filling materials have also changed significantly.
Modern, tooth-coloured or white fillings are made of composite material and inlays are made of gold, porcelain and composite. Previously, amalgam, an alloy including mercury, was often used but today it is very rarely applied due to its mercury content and aesthetics.

Amalgam

Amalgam is the alloy of metal filings of 75% silver and 25% other metals, as well as mercury. It was widely used earlier as it is relatively cheap, simpler and faster to make than aesthetic fillings, it is durable and has a long lifetime.
Its advantages are that is not attractive, it conducts heat and electricity and, according to some opinion, it is toxic due to its mercury content, which is why many are reluctant to use it. It does not fit the tooth perfectly, so the bacteria may settle in the microscopic gaps between the tooth and the filling, causing the development of caries (under the filling).
It is obvious that one of the ingredients of amalgam fillings is mercury, and mercury is indeed a toxic metal, but its "seeping" or "evaporation" is not proved or the evidence is not indisputable. Still, if this comforts the patient, it is worth changing them for aesthetic fillings or inlays.

Biological (or, in other words, bio-) dentistry

Biological dentistry does not apply amalgam fillings. If the patient decides to have his old amalgam fillings for aesthetic ones, then it is well worth conducting a detoxication course after the dental treatment. Selenium helps clear the body from heavy metals.

Aesthetic, tooth-coloured fillings (white fillings, composite fillings)

Esztétikus, fogszínű tömések

Here we can list materials that are called composite, compomer or glass-ionomer type materials. They are generally produced from glass particles, synthetic resin and adhesives. Dentists in today's modern surgeries almost exclusively use such fillings - for frontal teeth and molars alike. As the colour and appearance of these materials is almost completely identical to those of the teeth, it is easy to reproduce the shape and colour of the original teeth so the aesthetic value is perfect in most cases. These are plastic filling materials, which means that they are placed in the teeth in the form of a paste and they later solidify in the prepared cavity in some way.
Depending on the adhesive mechanism, there are two types of composites; one harden as a result of some kind of catalyst in a chemical way, while the other, more common solution is based on photo-polymerisation. In the latter case the filling material is lit using special blue light, as a result of which it solidifies and hardens. The resulting filling can be burdened and used right away.
The favourable mechanical features and unique chemical structure of these filling materials have made it possible to develop a new filling technique. Contrary to the previous method, when the cavity is prepared, a minimal amount of healthy tooth tissue needs to be removed so that the filling will have the appropriate stability.

Ceramics, composite or gold fillings (inlay, onlay, overlay)

Inlay is a type of fillings, prepared by the dental technician according to an imprint. It can excellently fill the missing tooth tissue even in case the crown of the tooth cannot be restored through filling, while it also offers a more advantageous solution when it comes to changing the old, large fillings. We can achieve a more natural effect with it than by applying an "everyday" filling, prepared in the mouth. The tooth-coloured inlay restores the anatomic shape of the tooth, as well as its physical characteristics, chewing ability and function. As it is prepared outside the mouth in laboratory conditions, its physical features are better than those of the traditional fillings: it does not discolour and it is more resistant to wear and tear (although porcelain may crack, due to its natural rigidity). Tooth-coloured inlay is a very durable and aesthetic filling type; the lifetime of well-prepared inlays may be several times longer than that of traditional fillings.
Dentists fix inlays to the teeth using a special method of sticking (with cement).
When applying inlay, the cavity is not prepared in the traditional way because the filling made in the laboratory has to fit in its place later, so it is important that the walls of the cavity should converge by a few degrees, towards the bottom of the cavity.
The material may be composite, ceramics and metal, the latter being gold, metal ceramics and gold ceramics.
Inlay is altogether a better solution that the simple filling of the tooth.

Gold inlay

This is the only filling type that improves as time lapses. Its lifetime may be several decades. The explanation is simple: using the filling of high gold content (which is therefore relatively soft), i.e. chewing with it, we push the edges of the filling more and more against the edge of the tooth, thus the filling fits the cavity tighter and tighter and prevents the development of secondary caries.
If the patient has aesthetic problems with the colour of gold, a porcelain cover may be placed over the gold. This can be solved in two ways. If the whole visible surface receives a porcelain cover, then the result will be aesthetically perfect but this way we lose the advantage of the excellent sealing the gold provides. If, however, gold remains as a narrow line, sealing the edges, the porcelain cover will form an island in the middle. In this case porcelain often breaks due to its natural rigidity, which means that the eventual result is worse, aesthetically.

Why is gold the best?

Because gold does not oxidise or shrink and this is the only metal that does not react with oxygen and sulphur even at high temperatures. Gold is the most tolerable metal for the living organism (it is completely bio-compatible) and its material has no harmful effects whatsoever; allergic reactions can also be prevented by applying it.

Filling without drilling

This method is quite popular because it is noiseless and, most importantly, painless.
During the treatment the dentist places a gel into the carious tooth, which then softens the damaged part in a way that the active chloride, generated in the gel, selectively softens the demineralised dentin, while it does no harm to the healthy tissue. The process takes 30 seconds, which may be repeated if necessary, after removing the softened material.
This method is recommended in cases when it is necessary to remove the caries in a tactful, safe and preferably painless way, for example in case of root caries or when treating the teeth of children and anxious adults.
The material softened by the gel is removed using manual tools, which generally causes no significant inconvenience, even without local anaesthesia.

Sealing the tooth grooves

This is a process, which is mainly applied to children's molars. If you can see dark discolouring on the surface of the molars and it their grooves as you look into the mouth of your child but the teeth are not yet decayed, it is worth considering this treatment as it is fast, completely painless, requires no drilling, there is no loss of tooth material and, last but not least, it is cheaper than a filling.
The occlusal (chewing) surface of molars is rather bumpy and groovy. Food remains may get trapped in these grooves and the accumulating bacteria may ignite caries in the tooth.
The purpose of groove sealing is to fill the tooth surface susceptible to caries (the grooves) with a solid protective layer containing fluoride, a protective cover (liquid composite), thus preventing the development of caries. During groove sealing the dentist applies a thin liquid on the occlusal surface of the strongly grooved teeth, which then spreads in the grooves and hardens. It remains durable for years but it needs to be checked frequently; children may wear it for a long time but from time to time the dentist needs to supplement or change it to make sure no caries has developed underneath.

The process of groove sealing

First of all the dentist thoroughly cleans the teeth using a fluorine-free polishing paste or sand polisher. (This is called conservative groove sealing.) Then he dries the surface with blast air and applies a coloured liquid on it. This is cleaned off after a few minutes, washed down with water and dried again. The liquid groove sealing material is now applied on the tooth, sealing the smallest grooves. If the material is photosetting (hardens if exposed to light), it is lit for about half a minute. After hardening, it takes about 1-2 minutes till the material hardens completely. The coloured liquid is an acid that makes the surface of the enamel a bit coarser so that the groove sealing material can attach to it more effectively. And what happens if the acid is applied where it is not needed? Nothing. The fluorine in the saliva and the toothpaste shortly returns back into the coarsened enamel surface and its original condition is restored.
The completed groove sealing effectively protects the tooth from caries for 2-3 years and continuously emits fluorine, which strengthens and protects the teeth. Bacteria cannot multiply in a fluorine environment of a certain concentration; therefore one of the main advantages of groove sealing materials is their ability to release fluorine.
The method of groove sealing can also be applied on the healthy molars of adults - in a slightly modified variation.

Micro-invasive technology

Micro-invasive technology is a special preventive procedure. In essence, only the parts of the tooth affected by caries are removed, using especially thin microdrills. Therefore, in contrast to traditional methods, the healthy tooth tissue does not need to be sacrificed at all.
According to the old approach, these tiny groove caries were allowed to grow and the dentist intervened only much later when the destruction was more serious. Using the revolutionary micro-invasive drills, the smallest caries and discoloured grooves can be eliminated painlessly and fast, even without any form of anaesthetics. The thus revealed tiny, narrow system of cavities is filled up with special liquid composite filling material, which enters the finest, narrowest gaps due to the capillary activity. As a result, the process of developing caries is stopped. Its further advantage is that it is cheap, fast and several "fillings" of this type can be applied at one sit.

Root treatment, root filling

If the caries has spread so deep that the infection reaches the dental pulp, the inflammation of the blood vessels and nerves in the pulp becomes almost unbearable, resulting in a pulsating pain that mainly occurs at night. (The pulsating pain is caused by the inflammation of the nerves and the tensive pain is a result of the generated gases and the pus produced by the bacteria.) If the tooth receives a powerful blow, the dental pulp may decay without any symptoms. This is often only discovered when an X-ray is made (if some lesion is visible on the root tip or if the dead tooth discolours.) Root treatment may also become necessary if the tooth crown is damaged to the extent that the fracture reaches the nerve channel.

To make root treatment painless...

If the patient arrives having a serious pain, the first task is to treat him with analgesic drugs. In case of root treatment it is practical to apply strong anaesthetics that have a four times more intensive effect than the traditional Lidocain. If the tooth is in the estate of acute inflammation, it is still possible that complete anaesthetisation is not possible. In this case a special gel should be placed on the nerve so that the nerve will die painlessly before the next treatment, when the process can be truly painless.
The tooth is closed using antiseptic, sedative medicine - several times, if necessary - to promote recovery. The final root filling is placed in the tooth only after this.

Root treatment instead of tooth replacement

It is easiest to extract a dead or aching tooth but let us not forget that the removed tooth will then have to be replaced in some way. If this does not happen, the tooth opposite the removed one will grow out of the denture more and more, the neighbouring teeth lean into the empty space and if several teeth are missing, the remaining ones may be overburdened. As a result, we can lose several teeth in the near future. What is more, the problem may even spread to the mandibular joint. Therefore, if possible, do not have your teeth extracted; let's save the tooth applying root treatment instead!