Direct Restoration

Direct Restorations are custom formed in the mouth by your dentist, and placed directly into a treated tooth without any intervening laboratory steps.

Selecting the appropriate direct restoration to meet the needs of the patient and the individual tooth depends on a large variety of factors. Each material has different advantages and disadvantages as a consequence of different properties. The weight of scientific evidence is that all of these materials are safe and effective for their intended use.

The following chart illustrates some common considerations your dentist takes into account when determining which material is best for a particular tooth needing a Direct Restoration:

FACTORS	SILVER AMALGAM	COMPOSITE RESIN (Direct)	GLASS IONOMER	RESIN- IONOMER
General Description	A mixture of mercury and silver alloy powder that forms a hard solid metal filling. Self-hardening at mouth temperature.	A mixture of tiny glass filler particles and acrylic that forms a solid tooth-colored restoration. Self- or light–hardening at mouth temperature.	Self-hardening mixture of fluoride containing glass powder and organic acid that forms a solid tooth-colored restoration able to release fluoride.	Self or light- hardening mixture of sub-micron glass filler with fluoride containing glass powder and acrylic resin that forms a solid tooth colored restoration able to release fluoride.
Principal Uses	Dental fillings and heavily loaded back tooth restorations.	Esthetic dental fillings and veneers.	Small non-load bearing fillings, cavity liners and cements for crowns and bridges.	Small non-load bearing fillings, cavity liners and cements for crowns and bridges.
Leakage and Recurrent Decay	Leakage is moderate, but recurrent decay is no more prevalent than other materials.	Leakage low when properly bonded to underlying tooth; recurrent decay depends on maintenance of the tooth-material bond.	Leakage is generally low; recurrent decay is comparable to other direct materials, fluoride release may be beneficial for patients at high risk for decay.	Leakage is low when properly bonded to the underlying tooth; recurrent decay is comparable to other direct materials, fluoride release may be beneficial for patients at high risk for decay.
Overall Durability	Good to excellent in large load-bearing restorations.	Good to fair in small-to-moderate size restorations free of biting forces. Fair to poor durability when subject to biting forces.	Good to fair in non load-bearing restorations, but poor in load-bearing areas (biting surfaces).	Fair to good in non load-bearing restorations; poor in load-bearing areas (biting surfaces).
Cavity Preparation Considerations	Requires removal of tooth structure for adequate retention and thickness of the filling.	Adhesive bonding often permits removing less tooth structure.	Adhesive bonding usually permits removing less tooth structure.	Adhesive bonding usually permits removing less tooth structure.
Clinical Considerations	Tolerant to a wide range of clinical placement conditions, moderately tolerant to the presence of moisture during placement.	Must be placed in a well-controlled field of operation that is totally & completely dry. But very little tolerance to presence of moisture during placement, which compromises bond strength to the tooth and increases risk of leaking or recurrence of dental caries..
Resistance to Wear	Highly resistant to wear.	Moderately resistant, but less so than silver amalgam.	Poor resistance to wear when placed on chewing surfaces. Not well suited to such applications.
Resistance to Fracture	Brittle, subject to chipping at filling edges, but with proper placement technique has good bulk strength in larger high- load restorations for back teeth.	Moderate resistance to fracture in high-load restorations.	Low resistance to fracture.	Low to moderate resistance to fracture.
Biocompatibility	Well-tolerated with rare occurrences of allergenic respose.
Post-Placement Sensitivity	Early sensitivity to hot and cold possible.	Sensitivity to heat & cold rarely occur. A more common problem when material is not placed properly or when bond of restoration to the underlying tooth fails.	Low.	Occurrence of sensitivity highly dependent on ability to adequately bond the restoration to the underlying tooth. Rarely a problem with modern materials.
Esthetics	Silver or gray metallic color does not mimic tooth color.	Close to natural tooth color and translucency, but can be subject to staining and discoloration over time. (Porcelain restorations have more natural appearance).	Mimics natural tooth color, but lacks translucency making restorations look opaque and "paste-like".	Mimics natural tooth color, but lacks translucency making restorations look opaque and "paste-like".
Relative Cost to Patient	Generally lower; actual cost of fillings depends on their size.	Moderate; actual cost of fillings depends on their size and technique.	Moderate; actual cost of fillings depends on their size and technique.	Moderate; actual cost of fillings depends on their size and technique.
Average Number of Visits To Complete	One.	One.	One.	One.

Direct Restorations ("fillings")