Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as to the replacement of such structure supported by dental implants. They are of two broad types—direct and indirect—and are further classified by location and size. A root canal filling, for example, is a restorative technique used to fill the space where the dental pulp normally resides. Restoring a tooth to good form and function requires two steps:

1. preparing the tooth for placement of restorative material or materials, and
2. placement of these materials.

The process of preparation usually involves cutting the tooth with a rotary dental handpiece and dental burrs, a dental laser, or though air abrasion (or in the case of atraumatic restorative treatment, hand instruments), to make space for the planned restorative materials and to remove any dental decay or portions of the tooth that are structurally unsound. If permanent restoration cannot be carried out immediately after tooth preparation, temporary restoration may be performed.

The prepared tooth, ready for placement of restorative materials, is generally called a tooth preparation. Materials used may be gold, amalgam, dental composites, glass ionomer cement, or porcelain, among others. Preparations may be intracoronal or extracoronal. Intracoronal preparations are those which serve to hold restorative material within the confines of the structure of the crown of a tooth. Examples include all classes of cavity preparations for composite or amalgam as well as those for gold and porcelain inlays. Intracoronal preparations are also made as female recipients to receive the male components of removable partial dentures. Extracoronal preparations provide a core or base upon which restorative material will be placed to bring the tooth back into a functional and aesthetic structure. Examples include crowns and onlays, as well as veneers.

In preparing a tooth for a restoration, a number of considerations will determine the type and extent of the preparation. The most important factor to consider is decay. For the most part, the extent of the decay will define the extent of the preparation, and in turn, the subsequent method and appropriate materials for restoration. Another consideration is unsupported tooth structure. When preparing the tooth to receive a restoration, unsupported enamel is removed to allow for a more predictable restoration. While enamel is the hardest substance in the human body, it is particularly brittle, and unsupported enamel fractures easily. A systematic review concluded that for decayed baby (primary) teeth, putting an off‐the‐shelf metal crown over the tooth (Hall technique) or only partially removing decay (also referred to as "selective removal") before placing a filling may be better than the conventional treatment of removing all decay before filling. For decayed adult (permanent) teeth, partial removal (also referred to as "selective removal") of decay before filling the tooth, or adding a second stage to this treatment where more decay is removed after several months, may be better than conventional treatment.

This technique involves placing a soft or malleable filling into the prepared tooth and building up the tooth. The material is then set hard and the tooth is restored. Where a wall of the tooth is missing and needs to be rebuilt, a matrix should be used before placing the material to recreate the shape of the tooth, so it is cleansible and to prevent the teeth from sticking together. Sectional matrices are generally preferred to circumferential matrices when placing composite restorations in that they favour the formation of a contact point. This is important to reduce patient complaints of food impaction between the teeth. However, sectional matrices can be more technique sensitive to use, so care and skill is required to prevent problems occurring in the final restoration. The advantage of direct restorations is that they usually set quickly and can be placed in a single procedure. The dentist has a variety of different filling options to choose from. A decision is usually made based on the location and severity of the associated cavity. Since the material is required to set while in contact with the tooth, limited energy (heat) is passed to the tooth from the setting process.

Journal Homepage: https://orthodontics-endodontics.imedpub.com/

Regards,
Catherine
Journal Co-Ordinator
Journal of Orthodontics and Endodontics