Common Procedures


What’s Right for Me?

Several factors influence the performance, durability, longevity and expense of dental restorations:

  • The components used in the filling material
  • The amount of tooth structure remaining
  • Where and how the filling is placed
  • The chewing load that the tooth will have to bear
  • The discussion regarding financial restraints

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The ultimate decision about what to use is best determined in consultation with your doctor. Before your treatment begins, discuss the options with your doctor. To help you prepare for this discussion it is helpful to understand the two basic types of dental fillings: direct and indirect.

    • Direct fillings are fillings placed immediately into a prepared cavity in a single visit. They include dental amalgam, glass ionomers, resin ionomers, and composite (resin) fillings. The dentist prepares the tooth, places the filling, and adjusts it during one appointment.


  • Indirect fillings generally require two or more visits. They include inlays, onlays, veneers, crowns and bridges supported either on your natural tooth or implants fabricated with gold, high noble metal alloys, ceramics, or composites. During the first visit, the dentist prepares the tooth and makes an impression of the area to be restored. The dentist then places a temporary covering over and/or in the prepared tooth. The impression is sent to a dental laboratory which creates the dental restoration. At the next appointment, the dentist cements (or lutes) the restoration into the prepared cavity and adjusts it as needed. For bridges, there are some additional steps and visits involved.

Bonding is a conservative way to repair chipped, discolored, or crooked teeth. It is also used as a traditional, silver-filling (amalgam) substitute in most cases. During dental bonding, a “tooth matched color” filling is placed in or onto your tooth to improve its appearance, repair decay or fracture. The filling “bonds” with your teeth, and because it comes in a variety of tooth-colored shades it closely matches the appearance of your natural teeth.

Tooth bonding can also be used for teeth fillings instead of amalgam fillings. Many patients prefer bonded fillings because the “white” color is much less noticeable than the silver amalgam fillings. Bonded fillings can be used on front and back teeth depending on the location and extent of tooth decay.

Bonding is less expensive than other cosmetic treatments and is completed in one visit at our office. However, bonding can stain, is less wear-resistant and is easier to break than other cosmetic treatments such as laboratory fabricated porcelain veneers or other porcelain restorations (metal-less crowns and onlays). If it does break or chip, tell your doctor. The bonding can generally be easily replaced in one visit or converted to a stronger alternative restoration, like a crown, should the need arise.


A bridge may be used to replace missing teeth, help maintain the shape of your face, and alleviate stress in your bite.

A bridge replaces missing teeth with artificial teeth, looks great, and literally bridges the gap where one or more teeth may have been. Your bridge can be made from gold, alloys, porcelain, or a combination of these materials and is bonded or cemented onto surrounding teeth for support. Implant-borne bridges are also made by Dr. Duca and attached to implants he places right in his office.

The success of any bridge depends on its foundation — the supporting teeth or implant(s), gums, and bone to which it is attached. Therefore, it’s very important to keep your existing teeth, gums, and jaw healthy and strong. This is a must and is evaluated before any bridge or implant crowns are considered, again to ensure the best success rate for you.


Crowns are both a cosmetic and structurally strengthening restoration used to improve your tooth’s longevity or esthetics. Crowns are most often used for teeth that are broken, worn, or have portions destroyed by tooth decay. They are also used to prevent the likelihood of fracture when teeth are extensively restored or root canal treated.

Crowns are “caps” cemented onto an existing tooth which fully cover that portion of your tooth above the gum line. In effect, the crown becomes your tooth’s new outer surface. Crowns can be made of porcelain, metal, or both. Porcelain crowns are most often preferred because they mimic the translucency of natural teeth and are very strong.

Crowns are often preferable to silver amalgam fillings or large bonded fillings. Unlike fillings which apply metal or bonding material directly into your tooth, a crown is fabricated away from your mouth. Your crown is created in a lab from your unique tooth impression which allows a dental laboratory technician to examine all aspects of your bite and jaw movements. Your crown is then sculpted just for you so that your bite and jaw movements function normally once the crown is placed. Also, the fact that the crown completely covers the tooth is significant in enhancing the tooth’s future durability for chewing.


Traditional dental restoratives (fillings) include gold, porcelain, and composite/ amalgam. The strength and durability of traditional dental materials continue to make them useful for situations where restored teeth must withstand extreme forces that result from chewing, such as in the back of the mouth.

Newer dental fillings include ceramic, zirconium and plastic compounds that mimic the appearance of natural teeth. The plastic compounds, often called composite resins, are usually used on the front teeth where a natural appearance is important. They can be used on the back teeth as well depending on the location and extent of the tooth decay.

The ceramic and zirconium restoratives are utilized in laboratory fabricated restorations which are accomplished in a two-visit process. They are generally stronger and more durable, and therefore, somewhat more costly.

If your teeth are filled with dark metal amalgam fillings, your smile could be aging your appearance. Your discolored teeth may also cause embarrassment. Of most concern, however, is the fact that metal fillings can also damage teeth when they are very large. They can act as a wedge with your biting force supplying the force. This emphasizes the need for crowns when Dr. Duca recommends them based on his extensive clinical experience. Amalgams expand with heat and contract with cold. This movement weakens the tooth wall, leading to fractures and allowing bacteria to enter and cause decay.

Tooth-colored composite fillings are more attractive and a great amalgam substitute. They are a conservative restoration which will enhance your teeth in terms of strength and appearance.

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