Fillings, Sealants & PRR’s
The term “fillings” is commonly used to refer to restorations that are placed by the dentist to replace missing tooth structure (due to cavities, tooth fractures, abrasion, etc.).
These are done in one appointment, and can be made out of different materials, including glass ionomer, zinc oxide euginol, silver amalgam, and the most common nowadays, “white fillings” (composite resin).
Resin comes in many different shades, allowing your dentist to match to your tooth colour and can result in some very beautiful restorations that look like natural tooth structure. White fillings are strong, but in some cases, we still use silver amalgam for its strength, and its ability to do better in moist areas. For example, if a cavity is found under the gumline, the dentist may advise you to use silver, since a white filling may not stick too well to the tooth since it is hard to make sure it’s completely dry at time of placement. The type of material used for your filling will be based on the location for the filling, the esthetic and functional demands, your bite and your preference.
Our goal is to have your fillings last for many years, even decades, however their longevity will depend on many factors, including how well you brush and floss your teeth, your genetic risk for decay, the location of the filling (in an area easy to clean, or below the gum where it’s tougher to clean), how much force the filling experiences over time, and many other factors. When a filling wears down, breaks, or starts to leak, it may be time to replace it with a new filling. It is important to be proactive as fillings that are not intact can allow bacteria to reach the inside of the tooth and cause decay that may not be noticeable until more of the tooth is affected.
Sealants and PRRs (Preventive Resin Restorations)
Teeth are created from several tooth buds, and like the bones of the skull, teeth can have “suture lines” where these different buds join to form the tooth.
These are the grooves and valleys you can feel on your teeth. In some people, these pits and grooves are very deep, and your toothbrush cannot clean deep inside these areas. Sealants and PRRs (preventive resin restorations) give your teeth extra protection against decay and help prevent cavities.
Dental sealants are a thin white filling coating that is placed in these deep pits and grooves to “seal” these areas. Your dentist may prescribe sealants if the grooves and pits of your tooth are deep, the tooth is brand new (has “come in” within the past year) but is erupted enough so that proper isolation can be achieved, and there is absolutely no visible stain or debris in the grooves and pits. Sealants will be done by your dental hygienist or specially trained dental assistant, since no drilling of the tooth is required. The tooth is cleaned with pumice (a cleaning slurry similar to toothpaste), etched (special acid cleaner needed for the material to stick to the tooth), and then the sealant material is placed. When a tooth is sealed, the tiny grooves become smooth, and are less likely to harbor plaque. Sealants can last several years, though some can last well into adulthood. If a sealant chips or comes off, let our office know as it works best when it is intact.
In cases where there is already stain or debris in the grooves and pits of your teeth, your dentist may prescribe a PRR. This is basically a “shallow filling.” The purpose of the PRR is to prevent cavities in the tooth, however, in some teeth with stained pits and grooves, there is already cavities that have started. This is why the dentist will do the PRRs. Your dentist will drill away the stain and debris, and then seal the tooth with a shallow filling. If extensive cavities are found, you may need freezing for the dentist to remove all the decay.
In certain cases, though the grooves and pits may be deep, we may not be able to place a sealant at all. For example, if the child patient cannot open and cooperate enough to allow the area to be well isolated from saliva. in these cases, it is best to leave the tooth alone since some saliva may contaminate the sealant during placement, which can leave the sealant not fully glued in and cavities may start below the sealant that may not be noticeable until the cavity is large.
Tooth has deep pits and grooves, and it also has stain. A sealant is not appropriate because of the stain present. A PRR is recommended.
Decay is found on the enamel of the grooves after the stain is removed.
The decay extends into the dentin (the inner level of tooth structure). If it is any deeper, the patient may need freezing to be comfortable during the procedure.
Only clean tooth structure is left after all the decay is removed, and now the tooth is ready for the filling to be placed.
The tooth is etched in order for the filling material to stick to the tooth.
The tooth is filled with a composite resin (white filling) material, and restored to natural form and function, with no decay, and the pits and fissures sealed.