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Video: Amalgam Removal and Replacement
Question:
Amalgam Replacement: Is there a "best" technique for amalgam placement to help reduce hypersensitivity (e.g. to cold) and improve bond strength? ...Visitor from PA
Answer:
There are several good ways to reduce sensitivity and increase bond strength in amalgam (silver) restorations. Since amalgam is a strong metallic tooth filling material it can more readily carry cold and heat sensations than natural tooth structure.
One good thing to know is that even if an amalgam restoration is placed without a base or desensitizing medicines, the hypersensitivity to cold and hot will eventually go away over time as the nerve moves away and accomodates to the "new" material in the tooth. But how fun is that when the problem can be reduced at the time of placement!
One technique to reduce discomfort and sensitivity after an amalgam restoration is placed is for the dentist to place a "base" or protective cover over the floor of the prepared tooth.
What this means is that when a tooth has deep decay, the dentist has to carefully remove all the decay to make sure that none is left behind which could continue to fester under the new filling. If the decay was deep, it means that there is little natural tooth structure between the actual nerve of the tooth and material that fills the tooth.
So now you can understand why a new silver filling, which is a great conductor of temperature changes, can be very sensitive to cold foods and drinks. Thus, in a very deep preparation a calcium hydroxide or a fluoride releasing base can be applied over the nerve area essentially moving the nerve away from the offending new restoration.
A second way to reduce sensitivity and to gain strength is with an amalgam adhesive bonded technique that help the silver to bond and hold onto the tooth surface better. In fact several coats of a tooth varnish or amalgam adhesive can futher reduce sensitivity.
Another thing to consider is that resin bonded "white" restorations can be just as hypersensitive as silver fillings if they are not bonded correctly. If the decay was very deep and close to the nerve, a composite white filling needs to be very carefully based to protect the nerve.
When a bonded restoration, or porcelain veneer, inlay, onlay, or crown is bonded, the tooth surface is carefully etched with a mild acidic gel that prepares the tooth to receive the porcelain restoration. A methodical, careful technique is required by the dentist and dental team to assure a well bonded, painfree, long lasting esthetic restoration.
West Chester Cosmetic and Implant Dentistry
Ron Briglia, DMD
845 West Chester Pike
MainLine Pennsylvania
West Chester PA 19382
(610) 692-4440
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