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Dentistry/Crown vs. Bonding Old Silver Fillings


Dear Dr. Kaufman, I would like your opinion on opting for replacing old fillings with new composite material, rather than having teeth crowned. I have 6 old, large fillings in upper teeth (molars,premolars). The dentist I am seeing, a prosthodontist, wants to replace with crowns. Of course, he is concerned with cosmetic appearance. I am not. The work I want would be the underneath side of the teeth. No one ever sees that. A crown takes the whole top of the tooth off, forever gone!! I have one crown already. It's lousy looking, looks horrible. I didn't want it to begin with. I trusted dentist. Mistake on my part. Now, the fillings in question are large, but if a dentist takes his time and carefully replaces all old amalgam with resin, why won't that suffice?? I don't eat aggressively anymore. I eat soft foods now. The teeth won't be under high stress anymore. I won't be chewing on a tough piece of steak. I don't eat meat anyway. I'm a vegetarian and I process my vegetables. This dentist really wants to do crowns, and of course they are expensive. I just want the teeth fixed to avoid future cracking apart, which is what they are beginning to do/ What's your opinion, sir. Thank you very much.   Mark S.

Dear Mark:
I understand your concern.  However, your prosthodontist is RIGHT.  He is NOT concerned with cosmetics.  He is actually concerned with the structural integrity of your teeth in the long run.
Composite fillings are designed for small restorations which involve restoring small portions of teeth.  They ARE NOT designed to replace tooth parts such as cusps.  The material is not strong enough to take the burdens of use in the mouth, and in addition, if the filling is large, the bond are is too big and is subject to failure.
If you have a crown that is not great, it does not mean that the ones that the much more qualified Prosthodontist, who is the expert in this field, will give you a similar result.  Have the Prosthodontist show you photos of crowns he had made in the past and judge for yourself.  Most prosthodontists keep an extensive photo library of their work, I do.
No matter how careful the dentist is, very large composite fillings are NOT a smart option for the posterior (back) teeth.  Listen to your prosthodontist.  It might cost you more at the outset, but it will save your teeth for a lifetime.
Best of luck,


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Zev Kaufman, D.D.S.


I can answer any question from simple routine dentistry to very complex dentistry with emphasis on reconstructive, cosmetic, and implant dentistry. My expertise is in co-ordination of very complex treatment plans with other dental specialists or as a one-man-team, since I have extensive training in Prosthodontics, Surgical Implantology, and orthodontics.


Over a decade in private practice of Surgical Implantology and Prosthodontics. Founder and owner of Prosthodontics & Implant Surgery of Manhattan, PC. Clinical Assistant Professor at the Post-Graduate Department of Periodontics & Implant Dentistry at New York University College of Dentistry. Lecture weekly since 1999 on advanced Implant Prosthodontics at New York University College of Dentistry Post-Graduate Program in Periodontics & Implant Dentistry. Former clinical assistant professor of Dental Radiology at the NYU College of Dentistry. Former clinical and lecture faculty at Lincoln Hospital, Dental residency program. Former clinical and lecture faculty at St. Barnabas Hospital (Bronx, NY) dental residency program. Lecture nationally on Prosthodontics and Implant Dentistry.

Memeber of the American College of Prosthodontics. Memeber of the Acacdemy of Osseointegration. Member or the Omikron Kappa Upsilon (OKU) Honors Dental Society. Member of the American Dental Education Association.

Graduated with Honors from New York University College of Dentistry. Post-Graduate training and certificate in the specialty of Prosthodontics. Post-Graduate training and ceritificate in Surgical and Prosthetic Implant Dentistry. Honors-program in Comprehensive and Applied Practice Management. Honors-program in Orthodontics.

Awards and Honors
NYU Cervice award to the community. OKU honor society. National Dean's List. National Who's Who.

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