Silver fillings have been used in dentistry since 1826. They consist of mercury, silver, copper, tin, and other trace metals. Together these metals mix to form an alloy which is commonly known as a silver filling. The use of mercury in the fillings has resulted in widespread safety concerns and a history full of controversy. Despite the bad reputation, silver fillings continue to be placed because of the high survival rate, low cost, and the relative ease with which the filling can be provided compared to more expensive alternatives.
In addition to health and safety concerns from mercury, silver fillings fail to adequately restore the natural properties and strength of teeth. As a result, teeth with silver fillings face damaging long-term complications such as fractures, cracks, and root canals. Many of these old fillings are treated with crowns which can be avoided by a more natural, biomimetic treatment approach.
Biomimetic dentistry completely eliminates the use of silver fillings, in favor of white fillings or ceramic restorations that mimic the properties of natural teeth and protect teeth from long-term complications.
This article will cover the following:
- The problems with silver fillings
- Replacement options and recommendations for silver fillings
- The benefits of Biomimetic Dentistry for silver tooth replacement
THE PROBLEM WITH SILVER FILLINGS
Silver fillings have serious health and safety concerns, contain toxic mercury, and fail to adequately mimic the properties and structure of natural teeth. Teeth restored with silver fillings do not regain the strength and function of normal teeth and this leads to problems and complications. Metal and silver fillings are NOT ideal substitutes for replacing tooth structure.
Silver Fillings Release Mercury
The fact is that mercury vapor is released from silver fillings, and scientists agree that mercury absorbed in high enough doses will cause health problems.
The published science indicates the amount of mercury released from silver fillings is below the FDA accepted daily intake of .4 micrograms per kilogram of body weight. The World Health Organization states that: “No controlled studies have been published demonstrating systemic adverse effects from amalgam restorations [silver fillings].” In turn, the American Dental Association supports the use of dental amalgam as a safe, affordable, and durable material. The FDA concludes “that there is insufficient evidence to support an association between exposure to mercury from dental amalgams and adverse health effects in humans.”
In my opinion, it is nearly impossible to predict how much mercury exposure from silver fillings is “safe”, but it is common sense that minimizing or eliminating this exposure is ideal. Mercury is extremely toxic and should be avoided as much as possible. There is strong evidence supporting the use of alternative mercury-free treatment options that can perform better and restore teeth more naturally. These alternative options include white fillings and ceramic restorations which are similar to natural tooth structure and eliminate unnecessary exposure to mercury.
Silver Fillings Are Not Ideal
Silver fillings have been used since 1826, but they do not meet any of the ideal properties for filling materials. They have been popular because they can be placed relatively quickly and they are usually cheaper to provide. However, the treatment cost can be misleading because complications from silver fillings often end up costing significantly more long-term than restoring teeth with a biomimetic approach. Fortunately, advancements in dental materials and techniques have completely eliminated the need for silver fillings.
Ideal Properties for Filling Materials:
- Possible to form a strong seal to prevent leakage, cavities, and decay
- Mimics natural tooth structure (Enamel, Dentin, DEJ)
- Restores the strength and function of the tooth back to normal
Structural Integrity of Teeth Restored with Silver Fillings
Silver fillings are extremely stiff and they do not reconnect the tooth back together because there is no adhesion between the silver filling and your tooth. As a result, teeth restored with silver fillings are much weaker than intact teeth and experience more complications. Also, the placement of silver fillings requires shaving and removal of healthy portions of teeth as part of the technique and material requirements, leading to further weakening of the tooth. These shortcomings make teeth restored with silver fillings very likely to develop cracks and experience other complications including sensitivity, pain, gaps around the edges, cavities, root canals, fractures and a higher chance of extraction.
Silver Teeth Needing Replacement
Silver fillings cause teeth to develop cracks
REPLACING SILVER FILLINGS – TREATMENT OPTIONS
The ideal silver tooth replacement option depends on the size of the existing silver filling and the amount of healthy remaining tooth structure. Healthy tooth structure includes portions of teeth which are free of cavity, cracks, and fractures.
The goal when replacing silver fillings is to restore the structure, function, and strength of the tooth with more natural materials and provide a long-term seal to resist complications (leakage, cavities, cracks, root canals, etc). Dentistry is technique sensitive and operator dependent. This means the success rate of any procedure will be primarily dependent on the dentist providing the treatment. It’s very important to understand that dental restorations are not “products” which are similar in performance and quality, but rather “services” which are completely dependent on the dentist providing the treatment. Some of the common silver tooth replacement options are summarized below.
Silver tooth replacement options include:
- White filling (also known as composite filling)
- Ceramic inlay or Ceramic onlay
- Crown (usually the last resort)
Changing Silver Fillings to White Fillings
When the existing silver filling is small, and there is a large amount of healthy remaining tooth structure (no cavity, crack, fracture), then a white filling will be the best option. The white filling is made of a composite material (also known as a composite filling) which comes in a variety of options and brands with different properties. Ideally, the filling material used will have properties that are similar to tooth structure (stiffness, flexibility, strength). However, there are many different materials and many ways to place the fillings, with some materials and protocols designed for speed and simplicity while other protocols are optimized for performance and longevity of the filling. With the best approach, placement takes significantly longer but the tooth will benefit the greatest. However, many white fillings are completed quickly with simplified techniques that perform poorly with little to no improvement over silver fillings.
Do NOT Replace Your Old Silver Fillings With Crowns
White fillings can not adequately restore teeth which are more structurally compromised, but a crown is almost completely avoidable when replacing silver fillings. A crown involves removing (shaving or drilling) substantial amounts of healthy tooth structure which increases the chance of complications and increases the risk of root canals further. Ceramic inlays and onlays are treatment options which are ideal when the size of the existing silver filling is larger with less healthy remaining tooth structure. Ceramic inlays and onlays conserve significantly more tooth structure than crowns, and restore the structure, function, and strength of the teeth when provided with a biomimetic approach. This combination minimizes damaging complications and maximizes long term success compared to crowns.
SILVER TOOTH REPLACEMENT WITH A BIOMIMETIC DENTIST
Biomimetic means to “mimic” or imitate “nature”. Biomimetic dentistry is the practice of dentistry dedicated to restoring the structure, strength, and function of teeth back to that of natural intact teeth (i.e. normal). Biomimetic dentistry uses the materials, protocols, and techniques which are scientifically proven to best restore the properties of natural teeth. Biomimetic dentistry can be provided for any type of restoration, but the goal is to select the technique which conserves the maximum amount of healthy natural tooth structure and regains the strength of natural teeth. All biomimetic restorations have a significantly different set of requirements and application techniques than standard techniques used for fillings, inlays, onlays, and crowns. This is a very important distinction because white fillings, ceramic inlays, and ceramic onlays are usually NOT provided with the biomimetic approach.
It is the specific materials, application technique, and manner in which the restoration is completed which makes the restoration biomimetic. The biomimetic restoration provides the best long-term performance and protection of teeth and minimizes the risk of complications.
Normal White Filling VS Biomimetic Composite Filling
Its hard to believe, but white fillings can actually perform worse than silver fillings and I see this every day. White fillings rely on adhesion to seal the interface between the tooth and filling. Many white fillings have little to no adhesion due to the materials and application technique. This makes them extremely susceptible to leakage and cavities. When a white filling is placed, a light is used to make the filling turn solid and during this transition, there is shrinkage of the material. When this shrinkage is not controlled, there will be large gaps and leakage which gives these white fillings the reputation of being short-lived and very susceptible to new cavities. This is especially true when the entire filling is placed all at once instead of using smaller layers to build the tooth back up gradually. There are many reasons reason these types of problems exist including the training and expertise of the dentist, as well as the practice and patient economics. Many dentists must limit treatment time and therefore quality in order to provide these restorations for insurance prices. It takes a lot of time to do a biomimetic white filling, and unfortunately many practices can’t dedicate this time at a cost patients are willing to spend. This gives rise to drastically different levels of quality and performance.
With the biomimetic approach, the shrinkage of the material can be controlled and the adhesion to tooth structure can approach the same strength that layers of the tooth are naturally joined together (enamel and dentin bond strength). This allows for incredible treatment possibilities which eliminate the need to provide silver fillings or shave healthy teeth for crowns. Biomimetic composite fillings minimize the chance of major complications and have the best long-term performance which outlasts silver fillings. Additionally, the biomimetically restored tooth regains the strength of the weakened tooth back to natural levels comparable to a normal tooth.
Advantages of Biomimetic Composite Fillings:
- Natural appearance – can blend seamlessly with the natural tooth.
- Strongly sealed margins- less plaque accumulation and opportunity for leakage and cavities.
- Conservative- only the damaged portions of the tooth are remvoed while healthy portions can be entirely preserved.
- Easily repaired- any chips can easily be repaired without replacing the entire restorations.
- Restores the strength and function of the tooth to normal levels, preventing cracks and fractures
Biomimetic Composite Filling (center tooth) done by Dr. Matt Nejad
Expertise in Biomimetic Dentistry
I have been practicing and teaching biomimetic dentistry since 2010. Since then, I have helped thousands of patients with biomimetic dentistry and educated thousands of dentists on the techniques and science of the biomimetic approach. My practice welcome patients from around the world who are seeking the highest quality biomimetic dentistry available.
Silver Filling Frequently Asked Questions
Can I change my silver fillings to white?
Yes, silver fillings can be replaced to white fillings but other options such as an inlay or an onlay may be more suitable. The ideal restoration depends on the clinical condition of your tooth, with the goal being to conservatively restore the strength of your tooth and provide a more natural material that does not contain mercury.
How much does it cost to replace silver fillings for white?
The cost for white fillings varies greatly because there is no “standard” for the quality of the white filling. A filling is not a product, but rather a service and the cost is largely dependent on the quality of the restoration and the expertise of the dentist. A small white filling can be performed very quickly with low quality and cost as low as $50. This type of white filling is most common in HMO or PPO insurance offices where the fee is set by insurance companies. In this setting, the time spent on the filling and quality of the restoration are compromised to make the treatment possible. On the other hand, a large white filling can cost as high as $1500 when it is provided with optimal quality and this type of filling takes significantly longer (1-2 hours) to make.
For more information regarding silver fillings please visit: http://www.ada.org/1741.aspx