1. The dentist will determine method for pain and fear control. This may require a local anesthetic.
2. The dentist will discuss with patient the type of material that will be used.
3. The decay is removed painlessly, there will be lots of water to flush out the decay. The nurse will use a suction so that patient will feel comfortable at all times.
4. For deep fillings, a lining may be placed.
5. Generally, after the filling is in, your dentist will finish and polish it.
6. Additional steps are required for tooth-colored fillings. The material is placed in layers. A special light that "cures" or hardens each layer is applied. At end of the multilayering process, the dentist will shape and polish the final restoration. For this type of filling, moisture control is very important for good bonding.

1. Tooth-Coloured Restorations - TCR

• Composites
  • Advantages of composites: Aesthetics; Bonding to tooth structure; Tooth-sparing preparation (sometimes less tooth structure needs to be removed compared with amalgam fillings when removing decay and preparing for the filling.)
  • Disadvantages of composites: Lack of durability (wear out sooner than amalgam fillings); Increased treatment time; Expense (composite fillings can cost up to twice the cost of amalgam fillings.)
• Ceramics
  • Advantages of ceramics: more resistant to staining; Generally lasts 10 to15 years.
  • Disadvantages of ceramics: more abrasive
• Glass ionomer

  This filling is most commonly used for fillings at the gum line and for fillings in young children (drilling is still required)

  • Advantages of Glass ionomer: release fluoride, which can help protect the tooth from further decay.
  • Disadvantages of Glass ionomer: weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts five years or less with costs comparable to composite resin.

2. Silver Amalgams - AR

• Advantages of silver fillings:Durability; Strength, Less expensive than composite fillings
• Disadvantages of silver fillings: Poor aesthetics; Discoloration.

3. Cast Metal Fillings

Precious metals (Gold, Palladium); Non Precious metals (Titanium, Nickel Chromium)

• Advantages of cast fillings:Durability -- Strength
• Disadvantages of cast fillings: Expense -- more than other materials; Additional office visits; Aesthetics -- most patients dislike metal "colored" fillings and prefer fillings that match the rest of the tooth.

The location and extent of the decay, cost of filling material, your insurance coverage, and your dentist's recommendation assist in determining the type of filling best for you.

Over the past several years, concerns have been raised about silver-colored fillings, otherwise called amalgam fillings. Because these fillings contain the toxic substance mercury, some people think they are responsible for causing a number of diseases, including autism, Alzheimer’s disease and multiple sclerosis.

The American Dental Association (ADA), the FDA, and numerous public health agencies say there's no proof that dental fillings cause harm to consumers.

Although amalgams do contain mercury, when they are mixed with other metals, such as silver, copper, tin, and zinc, they form a stable alloy that dentists have used for more than 100 years to fill and preserve hundreds of millions of decayed teeth.

A dental crown may be needed in the following situations:

• To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
• To restore an already broken tooth or a tooth that has been severely worn down
• To cover and support a tooth with a large filling when there isn't a lot of tooth left
• To hold a dental bridgein place
• To cover mis-shapened or severely discolored teeth
• To cover a dental implant
• To make a cosmetic modification

For children, a crown may be used on primary (baby) teeth in order to:

• Save a tooth that has been so damaged by decay that it can't support a filling.
• Protect the teeth of a child at high risk for tooth decay, especially when a child has difficulty keeping up with daily oral hygiene.

In such cases, the dentist is likely to recommend a stainless steel crown.

Permanent crowns can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal, all resin, or all ceramic.

• Stainless steelcrowns are prefabricated crowns that are used on permanent teeth primarily as a temporary measure. For children, a stainless steel crown is commonly used to fit over a primary tooth that's been prepared to fit it.
• Metalsused in crowns include gold alloy, other alloys (for example, palladium), or a base-metal alloy (for example, nickel chromium).
• Porcelain-fused-to-metaldental crowns can be color matched to your adjacent teeth (unlike the metallic crowns).
• All-resindental crowns are less expensive than other crown types. However, they wear down RAPIDLY over time and are more prone fractures than porcelain-fused-to-metal crowns.
• All-ceramic or all-porcelaindental crowns provide better natural color match than any other crown type and may be more suitable for people with metal allergies.
• Temporary versus permanent.Temporary crowns can be made in your dentist's office, They are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by a lab.
• Zirconia or milled crownwhich are digitally constructed (CAD/CAM) either in an office that has the software and hardware to produce them or in a dental lab. Dental offices that have the software and hardware have the ability to produce a crown in one visit with no need for a temporary. These crowns require no impression.