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Chirstopher Basiago DDS | Dental Procedures in Long Beach

Basiago Family Dentistry

Christopher Basiago, DDS

Jonathan Basiago, DDS

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(562) 429-5965

Dental Procedures

Dental Procedures

White Fillings vs. Silver Amalgam Fillings

Silver amalgam dental fillings are a valuable dental procedure that has been used in dentistry for over 100 years. Compared to more complicated dental crowns, they provide simple, durable, affordable tooth restorations.

Over the years, concerns of mercury toxicity have called the safety of these fillings into question. There have been numerous large scientific studies that have all concluded that there is no relation between the presence of silver fillings and any adverse health effects. I have had silver fillings in my mouth since I was a teenager and I have never felt the need to remove them because of safety concerns. Some feel that the patient would be exposed to more mercury by grinding the fillings out compared to leaving them alone.

With that being said, I have not used silver amalgam fillings in my dental practice for 15 years. I prefer white fillings made of composite resins. The big advantage with this restorative material is that I can keep a white filling much smaller than a silver filling. The reason is that the composite material bonds to the tooth structure so I don't need to be concerned with making the hole a particular shape or depth like I have to for silver fillings. All I have to worry about is removing the decay as conservatively as possible and then fill the void. A smaller filling translates into a stronger tooth in the long run.

The tooth will be much less prone to cracks and fractures as the patient ages. The other big advantage, of course is that they look good and blend into the surrounding tooth structure nicely. I have never been told by a patient that a silver filling "looks great." Almost everyone favors the appearance of a white filling.

I don't consider replacing an existing silver filling with white composite to be as advantageous as far as the strength of the tooth is concerned. The size of the filling has already been dictated by the size of the previous silver filling. I don't consider a large white filling to be that much better than a large silver filling. The size is key as it relates to tooth strength. 

Dental Crowns

A dental crown (cap) is one of the most common restorations in my dental practice today. My patients are keeping their teeth longer because of better education and dental care. They have better periodontal health and are not losing their teeth to gum disease. As a result, they need more upkeep to restore their aging dentition.

Dental crowns are needed most often because of cracked tooth syndrome. A common scenario is that the patient has a large silver filling in a back molar since childhood. The bigger the filling, the thinner and weaker the supporting tooth structure around that filling. Due to the normal wear and tear from heavy chewing forces in the back of the mouth, posterior teeth tend to crack. Our teeth get more brittle every year they are in use.

Teeth are not like bone. Cracks will not heal and supplements like calcium do not help the strength of the tooth structure. A dental crown is the only restoration that will hold a cracked tooth together.

Crowns can be made of porcelain, porcelain fused to metal (PFM), or gold.Porcelain crowns are used most often in the front of the mouth. They don't have the strength of PFMs or gold crowns but that is not necessary for a front tooth. The light will transmit through an all porcelain crown and look similar to natural tooth structure.

Porcelain fused to metal crowns are stronger because the porcelain is bonded to a substructure of metal. These crowns are best used for posterior teeth where the chewing forces are much greater and the cosmetic demands not as great.

Gold is still the strongest and most durable restorative material available. Its greatest advantage is for use on the back molar (second molar). It provides a more predictable restoration for the back molar because PFMs can tend to chip due to less space available for thickness of porcelain. When the porcelain layer is too thin, it tends to chip because of lack of strength. Even with that knowledge, many patients still opt for PFMs. They do not like the look of gold crowns.

Dental Implants and Root Canals

Dental implants provide a great advancement in the ability to replace a missing tooth. Rather than using a traditional fixed bridge or a removable partial denture, the implant provides the foundation to attach a dental crown. Multiple implants can be used to replace many missing teeth or provide the foundation for a fixed denture.

The implant is made of titanium and is shaped like a threaded bolt in most cases. It is surgically placed where the lost tooth used to be. The bone heals to the implant as if it were a natural part of the body. Implants are placed most successfully where the bone is thick for strong support. The lower molar area is the most ideal location in the mouth. Implants are a very simple and routine restoration in this area.

The upper molar areas are a little trickier. Because of the presence of the maxillary sinus above the upper bony ridge, the ridge has to be thickened by adding a bone graft to the floor of the sinus. This makes for an additional surgery and added cost. Anterior areas also often require bone grafts due to thin bony ridges.

Oral Surgeons or Periodontists often place the implant and the General Dentist places the crown. The nicest advantage of an implant is that it does not require altering and utilizing adjacent teeth to support a traditional fixed bridge. This makes maintenance and longevity of the restoration more predictable.

Root canals involve removing infected nerve tissue from the middle of an abscessed tooth. In this way, the hard tooth structure is preserved and used to support a dental crown. A General Dentist or Endodontist can provide this type of treatment. This treatment has come a long way since the old days and most patients don't find them to be any more difficult than any other restorative procedure.

With the advancement of dental implants, some feel that root canals will be eliminated in favor of removing the tooth and replacing it with an implant and crown. Although I can foresee this possibility in the future, I feel it is better to restore the natural tooth with root canal and crown, if possible.

A very badly broken down tooth with poor bone support or failing previous root canal therapy may be better served by replacing the tooth with an implant. The more routine cases can be nicely restored with root canal and crown.


Long Beach Dentist | Dental Procedures. Christopher Basiago is a Long Beach Dentist.