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What to consider when replacing metal restorations

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  Posted by: Dental Design      20th November 2023

Historically, metal has been used to restore the teeth. Still very common today are materials such as amalgam. While this material offers the benefits of strength and durability, making it a popular choice for posterior restorations, its aesthetics are less than ideal.

Metal restorations usually leave patients with a grey appearance to their teeth, which can put patients off, despite their many benefits. Because of this, some patients who have previously recieved metal restorations, may ask for these to be replaced with a tooth-coloured restorative material down the line. Should this happen, it’s important to have a good understanding of restorative materials used in the posterior region, and what the best options are for each patient, depending on their unique situation.

Metal restorations

Amalgam fillings, were traditionally a popular option for restoring the teeth. This is particularly true in the posterior region, as they are durable, able to withstand force, and can take much wear and tear. Lasting for around 10-12 years, they provide patients with a solution which is long-lasting.[i] However, they are not without their disadvantages.

Amalgam fillings may result in increased sensitivity, as the metal might shrink or expand when exposed to hot or cold stimuli.[ii] This could cause patients pain and discomfort. Additionally, amalgam fillings require a minimum of 2mm cavity depth, as they can be brittle if placed in thin sections.[iii] Because of this, in some cases, healthy tissue may need to be removed to facilitate an amalgam filling. As mentioned above, amalgam is a silver colour which can cause issues with discolouration. This makes them more noticeable than tooth-coloured materials, and less favourable from an aesthetic standpoint.[iv] There have also been concerns regarding the mercury content of amalgam restorative materials, which has led to a gradual phasing out around the world.[v]

Challenges in the posterior region

A key challenge when providing posterior dental restorations is durability. There can be large amounts of force placed on the molars, so it is important to provide fillings which are able to withstand high occlusal forces and be resistant to wear for a long-lasting solution. The act of placing posterior restorations itself can also present challenges, with moisture control noted as a common difficulty by many,[vi] so it’s important to ensure you have the tools and materials you need to hand to help produce the best possible result.

Choosing the best material

If a patient presents with an amalgam filling which they would like replaced, or they request a tooth-coloured filling from the outset, it’s important to consider the pros and cons of any material. Composite materials can be a fantastic alternative to metal for patients looking for a more aesthetic result. It is important to select a material which is suitable for use in the posterior region.

When providing posterior fillings, clinicians will also need to consider the best technique, dependent on the needs of the case. Incremental placement is the standard technique, typically used to reduce the effects of polymerisation shrinkage. It does, however, require extra time to place and light cure the material in stages. Bulk filling is another alternative which, thanks to the continued evolution of restorative materials, can allow clinicians to produce highly aesthetic outcomes while saving time, and without increasing post-operative sensitivity.

If the clinician is comfortable with the bulk fill technique, they and their patients are able to benefit. It is still important to use reliable materials which prioritise durability, stability, and aesthetics.

A fantastic option for posterior fillings, the 3M Filtek One Bulk Fill Restorative material from 3M Oral Care is able to simplify and speed up the posterior restoration procedure without sacrificing aesthetics.* Designed specifically to elevate posterior restorative treatment, it features unique optical properties and superior opacity to ensure you have the simplicity of one-step placement – up to 5mm – without compromising aesthetics, or reducing depth of cure.* The award-winning** 3M Filtek One Bulk Fill Restorative from 3M Oral Care also features excellent wear resistance,* and innovative AFM and AUDMA to reduce shrinkage and relieve stress.*

If you and your patients are seeking more aesthetic restorative outcomes in the posterior region, without compromising on durability, consider alternative materials to traditional metal options. Many patients are concerned about the overall appearance of their smile, and may request that special care is taken, even in the posterior region, to ensure that their teeth have a natural appearance. This is key when replacing older amalgam restorations, as patients will understand the discolouration that metal fillings can produce.

For more information, call 08705 360 036 or visit

Filtek is a trademark of the 3M Company.

** Dental Advisor 2023:

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[vi] Gilmour, Alan SM, et al. “Placement of posterior composite restorations in United Kingdom dental practices: techniques, problems, and attitudes.” International dental journal 59.3 (2009): 148-154.

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