Dental fillings, restorative materials used to repair damage from tooth decay, are common among individuals seeking to straighten their teeth with braces. Fillings are typically made of composite resin (tooth-colored) or amalgam (silver-colored metallic material). The question of whether these existing restorations complicate the use of braces is frequent among both adolescents and adults pursuing orthodontic treatment. Modern orthodontics has developed specific protocols to ensure that a history of restorative work does not prevent a patient from achieving a straight, healthy smile.
Compatibility of Braces and Existing Dental Work
Having dental fillings does not prohibit a person from undergoing orthodontic treatment. Contemporary techniques and materials are designed to accommodate existing restorations, allowing the straightening process to proceed effectively. The decision to begin treatment depends less on the presence of a filling and more on the overall structural health and integrity of the tooth itself.
An orthodontist will conduct a thorough examination to assess the condition of all existing dental work. If the fillings are secure and the underlying tooth structure is sound, they are generally not a concern for the planned tooth movement. The primary requirement for starting braces is a healthy oral environment, including stable gum tissue and teeth free of active decay.
The orthodontic process is customized to work around existing restorations. Only in cases where a filling is clearly failing or has severely compromised the tooth’s stability would a pre-treatment intervention be necessary. The goal is to ensure that the teeth are robust enough to withstand the gentle, continuous forces applied by the braces throughout the treatment duration.
Applying Brackets to Filled Teeth
The process of bonding a bracket to a tooth with a filling involves specialized steps, particularly when the filling is composite resin and covers a portion of the tooth surface needed for attachment. Unlike bonding to natural enamel, bonding to a composite filling requires a different approach. The orthodontist must specifically prepare the resin surface to facilitate a strong, reliable attachment.
This surface preparation often involves roughening the old composite material with a bur to expose a fresh surface, sometimes followed by the application of a specialized dental adhesive or primer. This step creates a suitable interface for the orthodontic bonding agent, which is a type of composite resin engineered to hold the bracket firmly in place. The clinical requirement for bond strength is achievable on composite material with proper surface treatment.
If the filling is amalgam and located on the chewing surface, the bracket is typically placed on the surrounding natural enamel, which offers superior bond strength. However, if a bracket must be placed partially or fully on a restoration, a specific protocol is followed to prevent the bracket from detaching. These specialized techniques ensure the bracket remains secure while minimizing the risk of damaging the underlying restoration when the braces are eventually removed.
When Fillings Influence the Treatment Plan
The size and location of existing fillings can influence the orthodontic treatment plan, requiring strategic modifications before or during the process. A filling that is particularly large and covers a substantial portion of the tooth, especially near the cusp or biting edge, may destabilize the tooth under orthodontic force. Teeth with such extensive restorations are more prone to fracturing or failure because the filling material has replaced a significant amount of the natural tooth structure.
In these situations, the orthodontist may recommend having the general dentist replace the filling with a more structurally robust restoration, such as a crown or an onlay, before the braces are placed. This pre-treatment step ensures the tooth can withstand the necessary movement. Alternatively, for molars with large fillings, the orthodontist might choose to use a cemented metal band that encircles the entire tooth rather than a bonded bracket.
If a patient has numerous or failing restorations, the orthodontist may suggest an alternative appliance, such as clear aligners, which do not require brackets to be bonded to the tooth surface. Clear aligners exert force through custom-fitted plastic trays, bypassing the need to adhere to potentially compromised enamel or filling material. Ultimately, a successful treatment relies on a comprehensive assessment to determine the most stable and conservative approach for moving teeth that have a history of restorative work.