Composite or ceramic fillings

Composite is the direct restorative route. Direct restorations generally do not require laboratory preparation, and tooth-coloured composite fillings are used to repair cavities.

Ceramic is an indirect, tooth-coloured restoration material. Its clinical use is matched to mechanical strength and chemical-solubility requirements, rather than chosen by appearance alone.

The two options involve different restorative routes: composite is generally placed directly on the tooth, while ceramic restoration is prepared indirectly. Laboratory preparation is therefore part of the indirect route, not the usual direct route.

Dental fillings do not last a lifetime and may need replacement. In a review of posterior onlays, estimated survival was 94.2%, while survival fell over time and was lower with composite onlay material.

Ceramic can fracture if it is flexed excessively, and a hard ceramic surface can wear an opposing tooth. For composite restorations, fracture is a common reason for failure and secondary decay is also a major cause of posterior restoration failure.

A badly broken-down tooth may need a crown instead of a filling. Crown materials include gold or other metals, porcelain, and stainless steel, which is usually used for baby teeth.

The choice begins with the restoration route: direct placement for composite or indirect preparation for ceramic. For ceramic, intended clinical function, strength requirements, fracture risk and wear on opposing teeth all matter.