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November 17th, 2011

How dental materials have changed in a relatively short time.  As the emphasis in dentistry turned more towards prevention of disease in the 1960’s and early 1970’s, the drive to have fillings look less obvious began in earnest.  Until that time, the choices were either gold materials (somewhat expensive and more complicated) or silver amalgam.Neither of these are particularly esthetic or natural looking but both did the job of providing long lasting restorations.
The earliest attempts used cements that were not very strong, not very
long lasting and not very esthetic.  The big breakthrough initially came with the development of the first resin fillings.  These were a bit stronger and longer lasting in limited applications and were more esthetic.  But they wore out too quickly and stained readily.  Next came the addition of filler particles to the resin forming a composite.  Think of it as concrete with the acrylic resin as cement and the fillers as the rocks (aggregate) mixed in to provide wear resistance and strength.
Development continued with different fillers and smaller particles.  The early particles were large (over 50 microns) and could not be polished well since polishing would knock out filler leaving potholes behind to stain.  As particles got smaller and the processes to incorporate more filler got better, the materials got polish able, long lasting and strong.  Today, filler particles are measured in nanometers.
In a great change in dentistry, today almost 50% of fillings placed in the United States are tooth colored.  As more patients want the better esthetics of natural looking fillings, more of these restorations are likely to be placed.
Much of the technology leading to the latest composites came from the space program.  Learning to filter finer ceramic particles and mix them in higher ratios has led to the strongest composites to date.  The biggest challenge is in refining the resin binders.  All resins shrink slightly when they cure and this can leave gaps between the filling and the cavity margins.  As newer filling materials are developed, these challenges will be met and better fillings are in the future.

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