Addressing Uneven Dental Fillings in Upper Molars: Concerns and Solutions

Filling the interproximal space of a premolar?

Hello Doctor, I have a cavity on the side of my upper left premolar, specifically in the interproximal area, which extends into the gum tissue above.
The size of the cavity is classified as medium to large.
After receiving a composite resin filling at the clinic, I have not experienced any pain or sensitivity; however, the filling is uneven and protrudes.
When I use dental floss, it gets caught and tears, especially when pulling it out, as if it is snagged in a lightning-shaped groove.
This uneven area is located in the gingival sulcus, making it difficult to clean (it feels like there is a large calculus deposit there).
I returned to the clinic for a follow-up, and the dentist expressed concern that smoothing it with a scaler might cause the composite to break down entirely, so they advised me to use an interdental brush for cleaning.
I have the following questions:
1.
I am very worried that the lightning-shaped groove will accumulate bacteria, leading to gum inflammation or secondary cavities.
Is there a way to use a machine to smooth out the composite resin that is in the gum area?
2.
If the resin cannot be smoothed to align with the original tooth surface, is the only option to remove it entirely and refill?
3.
I have three other premolars with similar interproximal cavities.
Would it be better to see a prosthodontist or a dental restoration specialist for a more even filling? Or is it common for composite fillings to be uneven?
Thank you, Doctor, for taking the time to answer my questions.

Liang, 30~39 year old female. Ask Date: 2021/03/20

Dr. Lin Jiayong reply Dentistry

Hello,
I will answer your three questions as follows.
Cavities below the gums are indeed quite challenging to fill with composite resin, as controlling the shape of the margins is particularly difficult (because resin is very moisture-sensitive before it hardens).
Therefore, if the filling is not complete, it can easily trap food, leading to gingivitis or secondary caries.
If the area can be cleaned thoroughly, the chances of developing gingivitis or cavities can be reduced.
However, for a more permanent solution, it is recommended to use metal or ceramic materials for inlays or crowns.
Unfortunately, health insurance does not cover metal or ceramic materials.
I suggest discussing with your original dentist whether it is possible to switch to better materials (such as metal alloys or 3D ceramic restorations) for a re-fill.
Using resin again may likely lead to the same issues, causing you further distress.

Sincerely,
Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2021/03/20

More Info

Addressing uneven dental fillings, particularly in upper molars, can be a source of concern for many patients. Your situation, where the filling is uneven and creates difficulties with dental hygiene, is not uncommon. Here’s a comprehensive response to your questions, along with some additional insights into dental fillings and their management.

Firstly, it’s important to understand that dental fillings, especially those made of composite resin, can sometimes result in an uneven surface if not applied or finished properly. The issue you’re experiencing, where the filling feels “bumpy” and creates a “lightning-shaped” groove, can indeed lead to challenges in cleaning and may increase the risk of plaque accumulation, which can subsequently lead to gum inflammation or secondary cavities.

1. Can the filling be smoothed out with a machine?
Yes, in many cases, dentists can use specialized dental instruments to polish and smooth out composite fillings. This process typically involves using a high-speed handpiece with a polishing bur or disc. However, the dentist must be cautious not to compromise the integrity of the filling. If the filling is too rough or has sharp edges, it can trap food particles and bacteria, leading to potential gum issues. If your dentist is hesitant to smooth the filling due to concerns about it breaking down, it may be worth seeking a second opinion from another dentist who may have more experience with composite materials.

2. If the filling cannot be smoothed, is removal the only option?
If the filling cannot be adequately adjusted to create a smooth surface, then yes, the dentist may recommend removing the existing filling and replacing it with a new one. This process involves carefully drilling out the old material and ensuring that the cavity is clean and free of decay before placing a new filling. A well-done filling should not only restore the tooth's function but also create a smooth surface that is easy to clean.

3. Should you consult a specialist for better results?
Consulting a specialist, such as a prosthodontist or a dentist who specializes in restorative dentistry, can be beneficial. These professionals often have advanced training in the aesthetics and function of dental restorations and may be able to provide a more precise and aesthetically pleasing result. They can also assess whether the materials used are appropriate for your specific dental needs and ensure that the fillings are contoured correctly to prevent future issues.

In addition to these points, it’s essential to maintain good oral hygiene practices, especially around areas with fillings. Using interdental brushes or flossing aids can help keep the area clean, even if the filling is not perfectly smooth. Regular dental check-ups are also crucial, as they allow your dentist to monitor the condition of your fillings and address any issues before they escalate.

Lastly, if you have concerns about the quality of the materials used in your fillings or the technique employed by your dentist, don’t hesitate to discuss these openly. A good dentist will appreciate your concerns and work with you to find the best solution for your dental health.

In summary, while uneven fillings can be frustrating, there are several options available for addressing this issue. Whether through polishing, replacement, or consulting a specialist, it’s important to prioritize your dental health and ensure that your fillings are functioning as intended.

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