So your dentist told you that you need a dental filling but you’ve never had one before. Would you like to know what happens step by step during the tooth filling so that there are no surprises?
If you know what to expect, you’ll be less anxious and more prepared for the appointment. We will go over what the entire process entails, which includes amalgam and composite resin fillings. The former is often known as a silver filling while the latter is a tooth colored restoration.
Overview of the steps:
- Administer local anesthesia
- Excavate tooth decay
- Preparation for the filling
- Place the filling material
- Let the material set and harden
- Adjust the restoration
- Polish the restoration
The overall steps for both types of restorative material are similar except for steps 3 and 5.
Step 1 – Local anesthesia
The first step involves administering local anesthesia because without it, the cavity filling will be painful. This is the universal step for the vast majority of dental procedures.
Your dentist will apply the pre-numbing gel first, followed by the injection with a local anesthetic.
- Pre-numbing gel. This gel is made of 20% benzocaine and is very similar in composition as orajel. The purpose is to pre-numb the injection area so that it causes less discomfort.
- Local anesthetic injection. The injection involves the syringe to deliver the anesthetic to numb the tooth nerve. Some anesthetic options from your dentist includes: Lidocaine, Mepivacaine, Septocaine, and Bupivacaine.
After the injection, it will take roughly 3-5 minutes for the anesthesia to start working. Once you’re numb, you can proceed to the next step.
Step 2 – Excavate decay
The second step is to remove all of the tooth decay and that involves the high speed drill. Your dentist will drill out all of the decayed tooth structure.
What decayed tooth structure looks like:
- Brown or black in color
- Soft and can be scraped off with a spoon excavator
Your dentist may double check to make sure it is clean with a dye called caries indicator. This is a pink dye that will stain all tooth structure that cannot be remineralized.
Essentially your dentist will keep cleaning out the tooth until all of the cavities has been fully removed. They may leave hard staining inside the tooth. The stained parts look light brown but is hard to the explorer.
Step 3 – Filling preparation
Once the tooth is free of cavities, your dentist will get ready to fill the tooth. This step will differ depending on if you’re getting a silver filling or a tooth colored one. Basically this part will get the tooth ready to have the filling material put in.
Amalgam preparation
The amalgam comes in little capsules that cannot be used straight out of them. These capsules need to be placed inside of an amalgamator which is a machine that shakes it. After sufficient shaking with the amalgamator, the capsule is ready to use.
Composite preparation
The composite resin cannot simply be placed into the tooth because it needs to be bonded in. This process involves using three separate agents to prepare the tooth.
- Conditioner. This agent is a type of acid which will etch the surface of the tooth. The purpose is to create more surface area for the bonding agent to bond to.
- Primer. This agent wets the surface of the etched tooth, it helps to create a stronger bond between tooth, bonding, and filling.
- Bonding agent. This agent is what you traditionally think of as the glue. It holds the filling to the tooth surface.
Although we say that the bonding process uses three different agents, there are products which combine them. We refer to these different types of bonding systems as using a certain number of steps.
- 3 step bonding has a separate conditioner, primer, and bond.
- 2 step bonding has a separate conditioner and primer + bond.
- 1 step bonding has all three agents combined into one bottle.
Which one your dentist uses is completely up to their personal preference and what they’ve had the best results with.
Step 4 – Place filling material
The fourth step of the tooth filling process is to place the material inside of the tooth. Your dentist will typically place or condense them into the cavity preparation layer by layer.
- Place a small layer of restorative material (amalgam or composite) into cavity
- Condense the layer
- Light cure if it is composite
- No curing necessary if amalgam0230
- Repeat steps 1-2 until the cavity is completely filled
The purpose for doing it in layer is that it prevents void formation and under filling. If you place too much at once you could end up with gaps.
Note: There has been a recent trend of composite materials that were designed to be “bulk filled”. That means there is no need to place it in layers. You can glob it on with one big layer and call it a day.
Fillings involving interproximal surfaces
If your cavity filling involves the interproximal surfaces, mesial or distal, there is an additional step. These surfaces are where you floss in between your teeth.
These 2 surface fillings are different vs a 1 surface filling because it requires the use of a matrix band. The purpose of this band is to prevent the composite filling restoration from bonding to the adjacent teeth.
Step 5 – Wait for filling to set
For amalgam filling, the material will set within a few minutes all on its own. You don’t need to do anything for it. In fact, if your dentist works too slowly, the material may set on them while they’re packing or condensing it into the cavity.
For composite filling, the material needs to be light cured with a LED curing light for it to set. This device beams light at a certain frequency onto the composite and then it turns hard.
Note: Composite resin can st ill set with visible day time light but it just takes a lot longer. If your dentist leaves the composite out without a light cover, it will turn hard.
Step 6 – Adjust the restoration
The sixth step of a dental filling is to adjust it once it has finished hardening. This process involves grinding down the occlusal of the restoration. In other words, your dentist will be adjusting your bite so that it feels even when you bite down.
What to expect:
- Place articulating paper into mouth (blue paper).
- Ask you to bite down a few times.
- Grind away the blue spots (high spots).
- Repeat steps #1-3 until the bite feels normal.
- Place articulating paper into mouth.
- Ask you to bite down and grind side to side.
- Grind away the blue spots.
- Repeat steps #5-7 until it feels normal to bite down.
It may be a little difficult for you to tell if your bite feels okay or not since you’re numb. That is why your dentist uses the articulating paper to help them determine.
However there are times where you may THINK it feels good but find out a day or two later that it hurts to bite down. If that is the case you should return to your dentist to have a filling adjustment. It’s not your fault since you were numb and you couldn’t really tell on the day of the procedure.
Step 7 – Polish and finish
The seventh and final step of a cavity filling is to polish the restoration. Your dentist will run a couple of polishers over it until it looks and feels glossy. This process is painless and very quick.
After this, you will be dismissed from the chair. Don’t forget to check out at the front because most fillings do have copayments if you have insurance.
Now wasn’t that easy? A filling procedure can be explained in seven steps.