What is the difference between anterior and posterior fillings

This patient had four amalgam fillings that needed to be replaced because they were breaking down at the margins or where the teeth and the fillings meet.

The old amalgam was removed under a rubber dam to keep the teeth dry and isolated and keep the patient from swallowing any of the old filling material. No one except the patient and us will ever know there was once a cavity in these teeth. Fillings are a great choice for small to medium sized restorations. However, crowns are recommended as the restoration with the best long term prognosis for teeth that have lost a large portion of their structure.

This photo taken before treatment, the tooth on the bottom of the screen was the tooth that was filled with a composite filling. For the tooth just above that, a crown was chosen in order to give the patient the best long term solution.

This picture shows the same teeth after treatment. Again, the tooth at the bottom has been treated with a composite filling, and the tooth above that has a crown. While we discuss here anterior fillings front teeth , where composite as a direct filling material is preferable, bear in mind that composites can also be used for back, posterior teeth.

Composite is clearly one of the most important developments made in dentistry since amalgam was discovered in the s. Adhesive dentistry is discussed in Chapter V. But — while the use of composite materials for direct anterior restorations is unquestioned, the use for back teeth is questionable because of the relative lifetimes of the alternatives. In the last Section we looked at the restoration of posterior teeth by DIRECT methods — both at the preparation of the tooth, and the filling of this prepared tooth with silver-amalgam.

Now we will study the direct restoration of anterior teeth — those in the front of the mouth, where the visibility is maximized. The anterior teeth that can be restored well by DIRECT techniques are minimally involved with decay or fracture, and do not necessarily need crowns. I will illustrate the use of composite resin materials and methods for this direct restoration of anterior teeth, as I illustrated the use of amalgam in the previous section. Some discussion of the difference between these two materials may be found in the Introduction to this Section.

In Chapter V. THIS subject is of landmark importance in dentistry, because the availability of TWO materials to do similar tasks, and the dentists response to the choices that needed to be made, has altered the field of dentistry, perhaps irrevocably.

Here we address the decay on the proximal surface touching adjacent teeth of the anterior teeth. Actually, decay is progressing, typically, in both adjacent teeth near the edge of the contact closest to the gumline. As discussed in the section on X-rays, these carious lesions decay will generally be visible in the radiographs, but are more easily seen by direct observation in the mouth. This visible inspection is done by shining a strong light on the facial surface of the tooth and looking from the lingual direction in a mirror.

This transillumination will allow the dentist to see THROUGH the tooth, visualizing the DEJ dentinoenamel junction within the tooth, AND, typically, a gray shadow in the enamel that can be seen to extend from the surface near the adjacent tooth toward the dentin. Anything less deep than this, stopping within the enamel, may NOT need to be restored. When I worked regularly with candidates for patient-based clinical exams I evaluated thousands of class III lesions in patients.

In one instance I recall my students suggesting the patient use fluoride gel to keep the lesion from getting too much deeper before the exam — as it was very close to the DEJ at that point.

If it penetrated into the dentin it would get very much larger quickly. When he saw the patient again after a few months the lesion could not be found! Generally, by transillumination, we can SEE clearly when the lesion has entered the dentin, as the COLOR of the lesion changes from gray to brown, and it spreads along the DEJ in all directions, as the dentin is softer and more susceptible to damage from decay than is enamel.

AND, when we see this pattern of decay on one tooth, we often find a matching lesion on the adjacent tooth. The facial extent of the lesion is important esthetically. Most often, when we find a lesion that penetrates to the DEJ, it also extends out onto the facial surface to some extent, as surface decalcification.

There are two pictures above that show this graphically. Talking to someone that has a class III lesion, we often observe whitish or brown staining, as a sign that decalcification is present on the surface in the facial embrasure. When the dentist DRIES the tooth with a stream of air, this decalcification becomes very much more obvious. When the tooth is restored, we must include this area. Having identified by X-rays or visible inspection that there is a class III lesion, we need to remove the decayed area and prepare the tooth for the restorative material, in this case composite resin.

Since the lesion can be seen visibly through the enamel while working, the dentist knows exactly where to penetrate the tooth. A drawing of a typical, conservative, class III preparation is shown below, as seen in the mirror from the lingual side.

Note that the margin of the preparation closest to the incisal edge is just touching the adjacent tooth, and that the margin closer to the gunline gingiva is minimally into the open space below the contact. Also note that the facial margin, into the conversationally visible area of the tooth, extends onto the facial surface enough so that there is clearance space between the facial margin and the adjacent tooth. We discussed that for silver-amalgam the preparation must be done so that the angle of amalgam at the margin is as close as possible to 90 degrees, so that the amalgam will be strong enough there to resist chipping away.

For composite, we deliberately make the angle of the preparation at the margin small — not worrying for this material that it might chip away. The distinction of the last paragraph should be elaborated upon somewhat. Why not? This is crucial. Adhesion between composite resin and enamel depends upon exposure of these rod ends! You can see that if the margin were bevelled it would cut across these ends and allows good adhesion. Now, the details of adhesion we need not get into in depth here although visit Chapter V.

Leaking margins produces staining and eventually recurrent decay at that margin. If the preparation is NOT bevelled wherever possible, there will be premature leakage, discoloration, and the need to replace the restoration especially if the discoloration is visible conversationally. If the truth be known, most dentists do NOT bevel their composite preparations. AND, most dentists come out of dental school thinking that since the composite resin is bonded to the tooth structure, leaving undermined enamel see the last section is OK.

They are SO wrong, on both counts! If a composite preparation is NOT bevelled at the margins, there will be leakage because the adhesion is compromised. If there is undermined enamel at that margin, the composite will bond to it, but during the curing process, when the composite shrinks, it will pull this piece of undermined enamel away from the rest, leaving a gap which is susceptible to recurrent decay. To save time at the expense of the patient?

And, it just might have something to do with the fact that the composite resin restorations will need to be replaced far sooner than they should! However the preparation is done, we need to fill it with composite resin. This matrix is made of mylar and is transparent. We also wedge, as in the class II amalgam case, for the same reasons. Then we prepare the tooth for bonding by etching the enamel and dentin too with phosphoric acid, a weak acid which is quite safe to use on teeth.

Then we apply a coating of adhesive or bonding agent, which is actually just the resin without filler particles more on the details of the composite material in Chapter V.

To this layer, which is well bonded to the tooth preparation, especially at the bevelled margins, we add layers of the composite resin, with embedded particles of filler which increases strength, improves its response to changing temperatures, increases opacity to match tooth structure better, and provides more resistance to wearing out. This line of direct CG composites has 22 shades to offer the best possible aesthetic result. These tones are divided into :. We have provided this quick example of KM on how to select shades according to the restoration required.

Explore all of the products related to Anterior Composites that we offer. Another type of composite is Posterior. As its name suggests, it is used for restorations in the back of the mouth , where the priorities to be taken into account are: high physical strength , low wear rate and, unlike previous composites, aesthetics is not the priority , however, many brands nowadays are improving their formula to get even more natural results.

Kuraray has an excellent range of posterior composites including Clearfil Majesty, which is one of the best rated by our customers. Its main characteristics are:. Clearfil Majesty colour guide.

Another composite that is highly rated by our customers is Kulzer's Venus Bulk Fill , which is a low-shrinkage fluid composite for creating later restorations with bulk filling technique. The advantage of this composite is its practicality , as it does not require complex and time-consuming techniques using 2 mm layers.

Venus Bulk Fill is also easy and quick to apply to baby teeth. A second layer of a composite is not necessary, which saves time and makes it ideal for pediatric treatment.

Explore the latest composites on our website! This type of composite must combine the resistance and strength of posterior composites with the aesthetics and tone range of anterior composites. By choosing universal composites, the dentist is able to simplify its stock , perform a faster job , since he does not need to switch from one composite to another, and all this without reducing the quality of your restorations.

If the dentist needs to perform restorations that require excellent aesthetics, he or she can choose between the two:. In addition, Filtek Supreme XTE 's authentic nano technology wears at a similar rate to the surrounding resin matrix , maintaining a smooth and shiny surface.

The composite also has high physical properties and high wear resistance , making it ideal for later restorations. Restoration created using three tones A3D, A3.