09/05/2026
Let’s talk about metal fillings and broken teeth . . .
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First of all, there a bunch of debate over silver fillings. They served their purpose historically in dentistry- a true work horse that rescued decayed teeth for decades. There is a scientific debate over the safety of mercury amalgamated in the metal. I personally don’t get hung up over this (despite never placing these fillings in my career). For over thirty years, silver fillings have been replaced- sometimes in a very hyperbolic fashion with resin fillings- under the guise of material safety. Oh the irony that our greatest fear today is microplastics! So historically, there was a great purge of many silver fillings in the nineties and early 2000s- often to meet esthetic demands but sometimes with motivator of removing toxins.
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And then there is the mechanical reality of a well done metal filling. They are extremely resilient. In fact metal doesn’t care what you throw at it. A well done silver filling can last forever. The problem is usually the tooth that surrounds it cracking. This either leads to physical breaks or leaks that cause decay. So all along during the great silver filling purge, larger fillings cracked teeth and most of these became indirect restorations (crowns). There are several mechanisms for this. All seem to fit into the classic pattern of geological change- time and pressure. For one, metal fillings expand and contract with temperature fluctuations at a different rate than tooth structure. (Think sip of coffee, sip of OJ- sip of cold drink, bite of hot food). Also, the metal is just malleable enough to very slightly mushroom like a bullet deforming slowly over time. This acts like a log splitting wedge cracking the cusps around the intact fillings. This fracture mechanism was the bread and butter of my dad’s practice from 1974-2011, also mine for the last 25 years (and really every other restorative dentist for that matter). When a tooth cracks- it is really a matter of catching it at the right time- remedying the problem before it is catastrophic and the tooth fractures. More often than not, this is done with a crown that’s wraps the tooth like . . . (Read more in comments)
