By: Dr. Scott R. Harden
Just recently, I had the privilege and honor to treat a 94 year-old dentist as a new patient in my office. His name is Dr. William Book. Now blind, he is an absolutely delightful person, still possessing a very a sharp mind and a keen remembrance of dates during his illustrious dental career. To avoid running behind in my schedule, since I quickly learned he likes to talk, I set up a dinner with him and his daughter along with my wife and I to travel down memory lane. In standard fashion, he walked to our table directly behind his daughter, his hands on her shoulders, in a train-like manner. Dr. Book commanded great respect as he recounted his career and the great developments in dentistry over the last sixty years. The more Dr. Book spoke, the more it became very clear to me just how far dentistry has truly advanced.
It was clearly the not-so-distant past when dentistry was associated with very few options for dental materials and dental procedures that conjured up many of the phobias still seen by dental patients today and that have unfortunately been passed down through several generations. The exclusive use of “amalgam” (silver fillings) and gold was all that was available for dental restorations. If you were to take a guess, how many silver fillings are still placed every year in dentistry? The answer is staggering; one hundred million.
One of the greatest advancements in dentistry today is the use of “composite” (white filling) material. Composite has become the new standard of care for dental fillings, in place of amalgams. Composite has many advantages over amalgam. It is tooth colored and preferred by patients for it’s esthetic properties. Composite is more similar to actual tooth structure and therefore undergoes more similar hot and cold dimensional and more similar wear resistance, as observed with natural teeth. It chemically bonds to teeth allowing more conservative tooth preparations for fillings. Dental “Composite” fillings also bonds the walls of the tooth together making the tooth stronger than amalgams, which tend to create a wedge affect inside the tooth that can promote fractures from chewing on them. Composite fillings can be placed on both back teeth and front teeth.
The chemical bonding to tooth enamel is rather fascinating because it all takes place at a microscopic level. This was clearly shown back in dental school by microscopic pictures demonstrating how tooth enamel has thousands of little pores that allow the dental bonding agents to get down into the pores and become mechanically anchored in them when a “curing light” is placed over the adhesive chemistry. Now the sticky surface is ready for the composite (white filling) material and creates an amazingly strong bond that can withstand chewing forces without coming loose. The composite is placed in the tooth and shaped to achieve the same contour and appearance as the natural tooth and then it is also cured with the light. This is another advantage of the composite fillings because they harden instantly under the light while the amalgams need a day to set before the patient can chew on them.
Composites have advanced tremendously in recent years and now are available in many shades that can be combined together or layered to achieve almost any desired cosmetic look possible.
Composite performs amazingly well during complex dental reconstructions that are needed for patients with a history of mismatched dental work over the years including missing teeth, broken teeth, worn teeth and large old fillings. This process is commonly seen in middle age patients and elderly patients and often begins by using composite to reestablish a patient’s bite level back to where it was originally prior to heavy wear. The composite can be meticulously applied to the teeth recreating the original contours of teeth, instantly rejuvenating the patient’s teeth, function while reducing stress placed on jaw muscles and jaw joints (“TMJ” problems) associated poor tooth position and tooth wear.
The other day, I used composite to modify the color of a patient’s tooth on an old partial denture that did not match the person’s natural teeth. This was a great benefit for the patient and saved her lots of money by not having to have expensive lab work or a new denture.
Composite is great for placing on the front surfaces of teeth and allows amazing esthetic transitions for patients. New composite has a principle called a “chameleon” effect and not only permits the material to match better and easier than ever before, but can also accommodate changes in tooth color following a whitening procedure without having to replace the composite. Convenient.
Composite is such a wonderful gift to dentistry and one I appreciate every day. Composite fillings are much more detailed that amalgams and require many more steps to place them. The additional effort is certainly worthwhile for the patient because the outcome is beautiful and as close to natural teeth as possible.
It has been many years since Dr. Book graduated from Atlanta-Southern Dental College down near Grady Hospital in 1944. Life is full of amazing coincidences, and in true fashion as I discovered during our dinner, Dr. Book represented the first class to ever graduate Emory Dental School in 1944 and ironically I represented the last class to ever graduate Emory Dental School. How fantastic to realize on a day in June 2009 in Woodstock, GA that an alpha and omega Emory Dental School graduate separated by fifty-five would meet and create a bond of their own.