After decay is removed from a tooth, something must be placed in that space to give strength back to the tooth. so here where dental fillings come in mouth.

Fillings: Fillings are the most common restorative procedure

Types of fillings:
1. Temporary filling
2. Tooth coloured filling/white filling
3. Glass ionomer cement filling
4. Silver alloy filling
5. Pit and fissure sealant

1.Temporary filling:
this are fillings which are made of weaker cement.this are generally used during root canal procedures,inlays onlays.used for very short

2.Tooth coloured/White fillings:
White fillings are an alternative to silver (amalgam) fillings.
White fillings are made of a strong composite resin that is matched to the surrounding tooth color.
In the past, white fillings were placed only on front teeth, but recently a stronger more durable material has been developed that can withstand the chewing pressure of back teeth.
White fillings are most commonly used for:
Cosmetic reasons
Patients who prefer mercury-free fillings
Patients with sensitivity to heat or cold - the tooth coloured filling doesn't conduct temperature changes as fast as silver or gold.
Types of tooth coloured fillings:
1. Composite filling

Composite
This is a tooth coloured material based on a plastic resin with a glass filler. It is mainly used at the front of the mouth but can be carefully placed in back teeth.
The picture below on the right shows a tooth-coloured filling compared to a gold filling and an amalgam filling.

Amalgam Filling	Gold Filling	Tooth Coloured Filling

Compomer filling:

it is mixture of of composite and glass ionomer cement thus combines the advantage of both
It is specially formulated for pediatric dentistry/kids.
It has Excellent wear resistance for a long-lasting restoration
It has Sustained fluoride release
It has Excellent adaptation to tooth structure
Its Sustained, rechargeable fluoride release on tooth internal surface to avoid secondary caries

This are avalable in tooth colours matching shade
Compomer filling material are also available in 6 attractive colours with glitter effect for restorations of deciduous teeth offers a perfect solution for nervous, frightened and impatient children. The possiblity to choose their favourite colour impoves motivation and co-operation of children. Fear will disappear and they will accept the dental treatment.

3.Ormocer filling:
Ormocer (ORganically MOdified CERamic) is a brand-new material which was recently developed for all filling indications in the anterior and posterior area which serves as an optimum and up-to-date replacement for Amalgam, composites and compomers.

STEPSFOR TOOTH COLOURED FILLING MATERIAL: TOOTH COLORED MATERIAL SETS UNDER BLUE COLOURED LIGHT WHICH WE CALL LIGHT CURING MACCHINE.

Direct tooth coloured Restoration

Figure 1: Preoperative view of an upper second bicuspid and first molar with two amalgam restorations with insufficient margins.
Figure 2: Shade selection is made with the manufacturer's shade guide on the wet tooth, after cleaning the tooth with prophylaxis paste.
Figure 3: Situation after removal of the amalgam restorations and primary cavity preparation.
Figure 4: Caries removal with a low-speed handpiece is accomplished and cavities are finally cut with a finishing diamond bur. Application of rubber dam.
Figure 5: Placement of a calcium hydroxide liner on deep dentinal areas.
Figure 6: Situation after restoration of the premolar WITH TOOTH COLORED MATERIAL
Figure 7: Placement of a metal matrix band and wooden wedges. 37% phosphoric acid is applied on the enamel margins.
Figure 8: After 15 seconds, the cavity is filled with phosphoric acid to etch the dentin for a maximum of 15 seconds (total etch).
Figure 9: 30 seconds after starting the etching procedure, the etchant is thoroughly rinsed with waterspray. Typical frosty white appearance of etched enamel after drying with compressed air. Before application of the bonding agent the dentin surfaces are rewetted with a microbrush . to ensure a proper resin infiltration of the slightly moist collageneous network
Figure 10: The cavity is saturated with the adhesive Bond.
Figure 11: The adhesive is gently air-dried after 30 seconds to evaporate the solvent.
Figure 12: Light-curing of the bonding agent for 20 seconds.
Figure 13: After the bonding procedure, the cavity depicts a glossy surface.
Figure 14: A thin layer (0.5 mm) of flowable COMPOSITE is placed on the gingival seat of the proximal box and the cavity floor with a disposable canula directly out of the syringe. This layer acts as a stress breaker.
Figure 15: Situation after placement and light-curing (40 s) of
Figure 16: After re-contouring the metal matrix band towards tooth 15 with a hand instrument to ensure a tight proximal contact, a first horizontal layer of ormocer-based restorative material (Admira) is placed. This increment is of a relatively dark shade (A4) to built-up a dentin core. The material is light-cured for 40 seconds.
Figure 17: Further increments of restorative material are placed to fill the cavity. Excess material is removed and the occlusal anatomy is preshaped while the restorative material is still plastic. Each increment is ligt-cured separately for 40 s. Before removal of the rubber dam, the restorations are visually controlled for underfilled areas.
Figure 18: Situation after removal of the rubber dam. The restorations show already good contours. Occlusal contact points are marked with articulating paper. Finishing and polishing will be achieved in short time.
Figure 19: After adjusting static and dynamic occlusion and finally contouring the anatomy with fine-grit diamond burs, the contact points are again marked with articulating paper.
Figure 20: Completed and highly polished restorations with excellent marginal adaptation and color match. Proximal contacts are contoured physiologically. Before discharging the patient a fluoride containing varnish is applied on the tooth to protect the enamel adjacent to the restoration, which is inevitable touched during conditioning/priming and finishing of the restoration.

3.Glass Ionomer Cements
These are materials based on acid soluble alumino fluoro-silicate glass. They are tooth coloured but have fairly low strength. However they leach fluoride and so can be appropriate in some situations (e.g. for decay on exposed roots)

4.Amalgam/SILVER ALLOY FILLING
This is the silvery material used most widely for filling back teeth. It has been around in one form or another for over 100 years although recent improvements to its formulation have reduced its setting times and increased its strength.

PIT AND FISSURE SEALANTS: PIT & FISSURE SEALANTS
Over the years dentistry has developed great ways and methods of preventing dental problems. One of these methods is placement of sealants on tooth surfaces, which prevents decay in teeth. While sealants are by no means a cure-all in preventing all forms of tooth decay, they are helpful to patients in controlling decay in certain areas of the mouth.
Almost 9 out of every 10 cavities in children occur on the biting surfaces of the teeth. While children have been the primary recipient of sealants in the past, recent advances in bonding technology and caries (decay) detection have led to more adults having sealants bonded to certain areas of their teeth.
Sometimes it is impossible for children to brush deep grooves or pits on the chewing surfaces of their teeth effectively. These grooves are very deep and often, tinier than the bristles on a toothbrush. A cavity will usually begin in these grooves because they are ideal places for cavity, causing bacteria to hide.

Sealant material bonds to the chewing surface of the back teeth forming a protective barrier covering the depressions and groves (pits and fissures) of the chewing surface. Decay-causing bacteria normally reside in these groves and are difficult to remove with even the best of tooth brushing habits.
By sealing the groves, bacteria are not present and the tooth will not decay in this susceptible area. Sealants are only applied to the chewing surfaces of back teeth. Sealants are not meant for areas between the teeth or for the front teeth. Also, teeth that have decay or old fillings present are not sealed
Sealants are composite / plastic-like material that helps shield out decay-causing bacteria from the chewing surfaces of the back teeth. It is bonded to the tooth surface in a procedure that is quick and painless.
It is best to apply sealants to the permanent molars and premolars as soon as they appear in a child's mouth - generally between the ages of six and fourteen years of age. Adults can also take advantage of this decay preventing treatment if their teeth have not been treated in the past. Sealant makes the chewing surface smooth, making it easy clear these surfaces.
Procedure:
First, the teeth to be treated are cleaned and polished. A mild acidic solution is placed on the chewing surface. This roughens the enamel surface to effectively bond with the sealant material. After rinsing and drying the tooth, the sealant material is flowed onto the tooth.

These areas which were earlier difficult to clean are now filled in by the sealants which after finishing and polishing procedures are barely detectable.

Then the dentist shines a bright light on the area for a few seconds. This light hardens the sealant instantly. Finally the bite is checked. That's all there is to it!

With advances in dental technology and materials, properly applied sealants can last for many years. At checkup visits, we will check the sealants to make sure they are intact.

Do Sealants take the place of Fluoride?
Sealants and fluoride are both designed to prevent decay to prolong the life of your natural teeth. Sealants are applied topically to only certain susceptible areas of the back teeth. Fluoride is used to prevent or reduce dental decay on all surfaces of all teeth. It is absorbed by the teeth most effectively during developmental years and is retained in tooth enamel permanently.
Final Thoughts

Many dental problems can and should be prevented. If you have any further questions regarding Pit and Fissure Sealants or other preventive measures, please ask us. Our goal is to preserve your natural teeth and smile for a lifetime and sealants help make this possible.

At your child’s dental visit, we will let you know which teeth are good candidates for this procedure.

Inlays and onlays: In addition to fillings, lab fabricated inlays and onlays are available in gold and white porcelain or resin. Although many patients think of these as fillings as well, they are actually different since they are laboratory fabricated.

Gold inlay or onlay:
A gold inlay or onlay is used when the cavity is too big for a silver filling, but isn't so big that a crown is required. An inlay is a filling within the cusp tips of the tooth. Onlays (also known as overlays) will overlay one or more cusps in order to protect and strengthen the tooth.

Gold
A gold alloy is usually used because pure gold is quite soft. The use of gold has a long history and is a very suitable material for restoring teeth. It is very strong even in thin sections and lasts very well, especially in people with low decay rates.

White Porcelain or Resin inlay or onlay: A porcelain or resin inlay or onlay is used when the cavity is too big for a white resin filling, but isn't so big that a crown is required. An inlay is a filling within the cusp tips of the tooth. Onlays (also known as overlays) will overlay one or more cusps in order to protect and strengthen the tooth.

Porcelain
Porcelain has been used as a tooth coloured alternative to gold because of its appearance. However it is a brittle material and it can fracture if over-stressed which limits its use.

inlays/onlays are made using either conventional technique or using cad/cam technology .cad cam restorations for inlays onlays.


The cad/cam system
Introducing the amazing CEREC system
CEREC is a CAD/CAM chairside system that delivers superb quality porcelain restorations quickly, precisely and efficiently. Just look at these benefits!

• A single-appointment restoration — only one visit needed
  
• A natural-looking filling — no more silver metal-mouth
  
• No messy impressions or ill-fitting temporaries
  
• A restoration that matches the natural color of your teeth
  
• A restoration that is anti-abrasive and bio-compatible
  
• A durable restoration — CEREC® fillings are less likely to fracture or leak like traditional fillings
  
• Proven technology — ten years of clinical research and over four million restorations performed worldwide

Most teeth with existing silver/mercury fillings that need restoration can be completed with a CEREC chairside restoration that is completed in one visit, like the picture above. The replacement of the silver/mercury restorations above was completed in one visit.

The cad/cam IN-LAB SYSTEM

What is cad/cam In-LAB?
In-Lab is a technology that allows laboratory technicians to utilize CAD/CAM technology to create dental restorations in the laboratory, eliminating the need to use metal in the restorations. Restorations that are created utilizing the CEREC In-Lab technology require two visits, due to the customization necessary.
CEREC In-Lab provides maximum flexibility, in that it is able to mill various type of Ceramic material including Zirconia frameworks. Zirconia is a ceramic that is virtually as strong as metal! In restorations where metal is indicated, full crowns and bridges CEREC In-Lab enables the technician to create these frameworks out of a very natural looking and strong ceramic material.

As you notice in the photo above, the Zirconia framework doesn’t really look very good, therefore our in house Ceramist Thomas Kuter, is able to take these frameworks turn them into beautiful natural looking teeth.

The four teeth on the upper right have been restored with a 4 unit Zirconia bridge. The CEREC In-Lab technlogy in conjunction with the artistry of Thomas Kuter, our office is able to create restorations that mimic nature.
No matter what type of restoration a tooth may need our office has the capability to create very natural looking life like restorations, under the same roof!

Ceramic Onlays

Ceramic onlays created with CEREC 3D technology, completed in one visit!

CEREC onlay

There was decay underneath this silver filling. Once the filling and subsequent decay was removed it left a very weak cusp tip that was covered with the onlay.

CEREC onlays

This tooth had a very large silver filling that was failing, notice the gap between the filling and tooth, also notice the fractured pieces of enamel… This tooth was restored with a CEREC onlay, for a very aesthetic result.