Pinned retention for tooth filling

moneyistooshorttomention

My dentist proposes to do this. I haven't had this explained to me, but am assuming that they wish to do this when replacing a filling that has fallen out.

What exactly is this? I am envisaging a little metal stick thing holding the filling into the tooth. Would this metal stick retention thing go into the gum (whether by accident or design)?

Is there any risk at all to me of either pain or a metal pin showing in my mouth (thus damaging my looks)?

What will this metal pin be made of? (presumably it won't include mercury and it's only amalgam fillings that have mercury in)?

They have stated they will do this. I am making the decision myself whether to agree to this or no or tell them that the replacement filling will be put in in the same way as the previous (fallen out) one.



Is it okay for me to proceed with this and I wont have any regrets?

moneyistooshorttomention

Update

I've just had a quick google and there would be appear to be some risk of nerve damage (and attendant long-term pain) from having a pin done according to a couple of websites I read. If that is the case, then I wouldn't have that done.


Have I answered my own question there?

Am guessing my best bet is to tell the dentist I will have an identical filling to my previous one and hope that holds and, if it doesn't, then I'll have a crown (another thing I've never had done before)?

elsien

In your position I'd be putting all these questions to my dentist before deciding. After all they're the ones familiar with your mouth. If you haven't understood what they've said, if they're half way decent they'll make the time to clarify.

Toothsmith

That's right - you need to talk to your dentist about why he feels this is appropriate. No-one here can tell, and only give you the general pros & cons that you can find by googling.

I haven't placed a pin in maybe 15 years. I do not like them at all. But dentistry is a broad church, and there are many who still feel they have a place. There is probably no right or wrong answer (although obviously, I think I'm right! ) Just personal experiences and preferences.

moneyistooshorttomention

Toothsmith

As you say, there will be different opinions on that.

Can I ask why you personally don't like pins please?

Toothsmith

moneyistooshorttomention wrote: »

Toothsmith

As you say, there will be different opinions on that.

Can I ask why you personally don't like pins please?

Personally - I find I can fix the things that I see with the adhesive agents we have now.

Done carefully, with good moisture control of the site, you can generally get modern dental materials to stick very well.

The reasons I avoid pins are for the reasons you found when using Google. The possibility of them setting up micro-cracks that can adversely affect the health of the tooth.

The way my practice works though is that I am purely private, and have the time to slow down enough to make these things work, and buy the good materials.

If I was working in a target driven system where I felt I was rushed, banging in a pin might well be a bit more appealing.

moneyistooshorttomention

Thank you.

Put like that rather confirms my feeling that its best for me to say to the dentist that I will be having another "stick on" type filling instead and, hopefully, that one will last okay.

I am a private patient (in a "mixed" practice) and think they may possibly be used to people expecting the cheapest option automatically (rather than the "best" option).

I always choose the "best" option personally.

welshdent

I dont use pins much either but never say never. I think you need to speak to your dentist who can actually see your tooth. There is no point us saying do this or dont do that as we do not know what your tooth is like. Personally I prefer indirect bonded restorations made of composite or a ceramic when a pin is likely to have been indicated, but then I dont much like working with amalgam anyway. You need to be aware that often if you decline the pinned amalgam filling that an inlay on the NHS falls in to the higher band 3 in wales and england and may not be available on the NHS in scotland and northern ireland (I say may as I do not know for sure). Speak to your dentist, ask what your options are and see what they say. FWIW I have seen pinned amalgam fillings in peoples mouths, still going strong some 30 years after they were put in with no fractures or nerve problems. However as TS alluded to. They do increase the risk of similar problems happening compared to bonded restorations.

welshdent

sorry I missed you said you were private.

Ask about composite and ceramic inlays and onlays and if they may be an option. They work well in my hands.

moneyistooshorttomention

welshdent wrote: »

sorry I missed you said you were private.

Ask about composite and ceramic inlays and onlays and if they may be an option. They work well in my hands.

Thank you.

1. What is the difference between composite and ceramic?

2. What is the difference between an inlay and an onlay?

welshdent

composite is the stuff used in white fillings but in the case of an indirect restoration it is fomed outside the mouth then cemented in to the tooth. They are resins and then polymerised to form a solid material. They are tooth coloured. They are not as hard wearing as metals but they are tooth coloured. When prepared out of the mouth the "polymerisation shrinkage" is less of an issue and it is easier to sculpt it to the right shape/form IMHO. They are also reasonably repairable.

Ceramics are a broad term for what one would generically call porcelain. There are a number of types. Feldspathic porcelain, lithium disilicate to name a few. They are more brittle out of the mouth but when bonded are very strong. They usually have a more natural look that composites but that may be a personal opinion issue. They are also bonded in as per composites but repairing is not as easy. They are normally a bit stronger than the equivalent composite but to a large extent that depends on what ceramic you use. Feldspathic porcelain is not as strong as lithium disilicate but then in a lot of applications that is not something that is clinically relevant anyway. Usually they are more expensive than the composites.

Preparation for both is more or less the same.

An inlay as the name implies goes IN your tooth. So if you have a normal hole in the tooth as you would have filled by an amalgam filling then with slight modifications, the inlay is placed in to this having been fabricated out of the mouth. An onlay goes a step further and overlays some or all of the biting surface of the tooth. Its probably not a distinction you need worry about as what restoration is chosen is dictated by the extent of tooth tissue loss of the tooth.