Introduction
Choosing the type of restoration in case of a missing element of a tooth structure is not easy. While some of the types of dental fillings have stood the test of time and are used actively even nowadays (e.g., amalgam and composite types of restoration), some of the more recent, including gold or ceramic inlays and Onlays, may show better results after standing the longevity and survival tests. To understand, which choice a dentist must make to address a specific problem concerning a tooth restoration, an analysis of different types of restorations must be carried out. It should be noted that in the given research, the line between direct and indirect types of restoration has not been drawn. Therefore, both methods of direct and indirect dental cavities restoration are considered in the paper.
Hypothesis
Because of the outstanding durability of gold, such types of restorations as gold inlays and onlays should be viewed as the best method of dealing with cavities and restoring teeth. However, since amalgams and composites are much cheaper and, therefore, will be used much more often by most of the patients, it will be reasonable to promote amalgams and crowns as the most durable and long-lasting type of restoration according to the Kaplan–Meier median survival times evaluation.
Methods
To analyze the effects of several different types of restorations, a method of comparative analysis was used. Seeing how analyzing a case study would mean providing very specific results, the method for delivering a more general yet also very accurate result was used.
Literature Review
When it comes to discussing different types of restorations, most researchers seem to agree on gold inlays and onlays being the best restoration type possible. A range of researchers also stresses the fact that ceramic inlays and onlays are among the most widely used materials for filling cavities and restoring parts of teeth. For example, the study conducted by Reinhard and Manhart indicates that ceramic inlays have a rather high rate of stress-bearing (0% to 7.5%, to be particular (Reinhard and Manhart 45)). Still, the researchers admit that ceramic inlays and onlays, as well as CAD/CAM ceramic restorations, do not stand any chance in a comparison with the inlays an onlays made of more durable materials, such as noble metals, particularly, gold (Reinhard and Manhart 45).
As it has been stressed, a comparatively cheap price and a less complicated dentistry procedure of implanting amalgam restorations still attract a number of patients, therefore, making amalgam restorations by far the most popular type of cavity fillers. It is quite remarkable that the failure of amalgam restorations to stand the test of durability was discovered quite a while ago; nevertheless, amalgam still remains rather popular. The negative effects of amalgam have been studied by a variety of researchers; the latest study of its deplorable influence on not only teeth but also the human organism, in general, has revealed that amalgam triggers a variety of negative effects down to the erythematous lesion of the oral tissue (Cullough and Tyas 6) due to high rates of mercury in it. The latter may also lead to the overall hypersensitivity of the organism (Cullough and Tyas 7).
Analysis
According to the existing research, amalgam restorations are the most frequently used ones. In terms of the price/quality correlation, they are quite a reasonable choice. However, recent studies have shown that the durability of amalgam restorations leaves much to be desired. The research conducted by Lavelle in 1976 has shown that the success of an amalgam restoration hinges on the skills of the dentist; Lavelle claims that to carry out the procedure successfully, a surgeon needs truly outstanding skills (Lavelle 142). Most posterior composite restorations appear to be a complete failure, Letzel’s study claims (Letzel S16); therefore, composites must be replaced with a more suitable restoration method.
Compared to a composite restoration, which is often used as an alternative to the amalgam one, the latter, however, seems quite passable. As Opdam explains, despite their numerous problems, amalgam restorations showed better survival rates in high-risk patients (Opdam, Bronkhorst, Loomans, and Huysmans 1066).
Gold inlays and onlays, in contrast to ceramic ones, are very efficient, though just as expensive. The Kaplan–Meier median survival scale shows that gold teeth inlays have the longevity of 25 years at the very least and do not demand any additional services apart from following the basic rules of oral hygiene. The A- to B- restoration rating in gold inlays and onlays (Opdam, Bronkhorst, Loomans and Huysmans 1065) is very impressive; more to the point, the fact that both inlays and onlays have approximately the same longevity proves their efficiency.
Therefore, it can be suggested that the use of gold inlays and onlays should be promoted among both dentists and their patients. Despite their admittedly high price, gold inlays and onlays guarantee that the patient should not experience any further problems with their teeth – or, at the very least, the teeth the parts of which have been replaced by the aforementioned gold inlays and onlays – in the next few years. While addressing the problem promptly is important, and money is often the issue, it is also essential that the choice of the treatment type, i.e., the restoration used to address the problem, should not trigger further complicacies.
Results
It can be assumed that the gold inlays and onlays have the highest rate of longevity and survival rate. It should be kept in mind, though, that the conclusions regarding the longevity of onlays can be doubted after reconsideration of the technique of their application. Indeed, in contrast to the technique of applying inlays, which presupposes that the tooth cavity should be filled with the restoration material, the procedure of creating an onlay requires that a minor part of the tooth surface – a cusp – should be replaced with its gold impression. Therefore, it will be subjected to much more outside factors than an inlay will; hence, the possibility of the onlay destruction increases. Though both golden inlays and onlays are considered less prone to deterioration than the rest of restorations, it should still be borne in mind that the longevity of a restoration hinges on a range of factors outside the quality of the material. Among these factors, the food consumed by the patient, their hygiene, and the skills of the dentist should be listed. Speaking of the less efficient yet more affordable solutions for filling cavities in teeth, one must give credit to the traditional amalgam and composite fillings.
Though it has been stressed above that gold and silver inlays and onlays last much longer, amalgam and composite restorations are the most popular among both dentists and patients, since these two types of restorations are less costly and easier to implant. Though amalgams and direct composites have a considerably low rate of longevity and functionality, they are still worth evaluating as the most affordable and, therefore, the ones that are most frequently chosen as the cavity fillers by patients. Though the quality of an amalgam or a composite filler leaves much to be desired, amalgam restorations can and should be used “as an appropriate alternative to crowns” (Van Nieuwenhuysen, D’Hoore, Carvalho and Qvist 402), as the recent researches suggest. In addition, when reconsidering the choice of a restoration type, one must also remember the necessity to adopt a sustainable approach towards the restoration of the tooth. For example, it is rather unreasonable to put too much pressure on the tooth right after the surgery took place, as well as make no changes in the type of food consumed and include hard products into one’s menu.
However, by far the most important aspect of taking proper care of an amalgam or a composite includes defining the type of restoration and location of the filler. What works perfectly for front teeth may appear completely unacceptable for the back teeth despite the high price and the corresponding quality of the product. For example, the class II restorations, which presuppose that molars and/or premolars should be restored in the course of the surgery, require that a dental crown should be installed. Thus, the possibility of the patient developing coronal leakage, which is traditionally defined as the recontamination of a tooth after a root canal therapy due to the impact of oral bacteria and debris (Kantardzić, Vasiljević, Blazić and Luzanin 575), can be reduced to nearly zero. Seeing how a crown is the best means of addressing the threat of a coronal leakage at present, despite the low efficacy of a crown as a restoration method, not to mention the fact that it has very low longevity, according to the recent research, the success of restoration depends on a large variety of factors, the position of the tooth is the key one of them.
Discussion
A comparative analysis of several major studies concerning the use of different types of restorations has shown that composites trigger the least favorable consequences. Amalgam restorations are only a few notches above the composite ones. Ceramic inlays and onlays are often viewed as a reasonable choice, yet they have poor longevity rates. At present, gold inlays and onlays are viewed as the optimum choice. One should not forget, though, that the decision to use a particular type of restoration often hinges on a variety of external factors, including the type of a tooth (molar/premolar/canine, maximally central/maximally lateral, etc.), the type of the dent (e.g., enamel fracture, root fracture, etc.), the specifics of the patient’s organism (e.g., idiosyncrasy to metallic mercury, etc.), and the dentist’s experience.
Conclusion
The research has shown that gold inlays and onlays are clearly the most efficient types of restoration. Ceramic inlays and onlays, though also quite efficient, do not stand the longevity test and deteriorate quickly. Though amalgams and composites are still used widely as common filler for dental cavities, their usage should be reconsidered, since they deteriorate very quickly and, therefore, bring more harm than positive effects.
Works Cited
Cullough, Michael J. and Mitchell J Tyas. “Local Adverse Effects of Amalgam Restorations.” International Dentistry Journal 58.1 (2008), 3–9. Print.
Kantardzić, Ivana, Darko Vasiljević, Larisa Blazić and Ognjan Luzanin. “Influence of Cavity Design Preparation on Stress Values in Maxillary Premolar: A Finite Element Analysis. Croatian Medical Journal, 53.6(2012), 568–576. Print.
Lavelle, Charles B. L. “A Cross-Sectional Longitudinal Survey into the Durability of Amalgam Restorations.” Journal of Dentistry 4.3 (1976), 139–143. Print.
Letzel, Hans. “Survival Rates and Reasons for Failure of Posterior Composite Restorations in Multicentre Clinical Trial.” Journal of Dentistry 17.1 (1989), S10–S17. Print.
Opdam, Neil J., Edward M. Bronkhorst, Beatrice A. C. Loomans and Michelle Huysmans. “12-year Survival of Composite vs. Amalgam Restorations.” Journal of Dental Research 89.10 (2010), 1063–1067. Print.
Reinhard, Hickel and Manhart Juergenn. ”Longevity of Restorations in Posterior Teeth and Reasons for Failure.” Journal of Adhesive Dentistry 3.1 (2001), 45–64.
Van Nieuwenhuysen, Jean-Pierre, William D’Hoore, Joanna Carvalho and Victor Qvist. “Long-Term Evaluation of Extensive Restorations in Permanent Teeth.” Journal of Dentistry 31.6 (2003), 395–403.