Riley,
I feel bad for you. Getting the color and texture right for these fillings isn’t that difficult to do. While I recommend an expert cosmetic dentist for smile makeovers or complex bonding, doing fillings at the gumlines of the teeth that have the correct color and are polished should be within the abilities of a good family dentist.

Do the fillings need to be totally replaced, or can they just be re-surfaced? That depends on how far off they are. My guess would be that another dentist could just remove some of the surface of these fillings and re-surface them with another color of composite. Although replacing them is no big deal. Even if they have to be totally replaced, there is very little chance of doing any damage to the teeth. Replacing the fillings a second time is also not a problem. It isn’t hard to tell where the composite ends and the tooth structure begins, especially if the color is off. Even if the color is similar, there are dental burs that will selectively remove composite without drilling away the tooth.

One point I’d like to make about doing fillings over these sensitive areas that develop at the gumlines of teeth. These are called abfraction lesions.

You can see in the photograph that the enamel of this tooth near the gumline has worn away, leaving a notch that is very likely to be quite sensitive to air or touch. It used to be thought that these lesions were caused by brushing too hard, but recent research has revealed that, while toothbrushing can be a contributing factor, the major culprit is excessive clenching of the teeth. Clenching causes the tooth to flex a little right at the gumline, and this weakens the tooth right there, which leads to the wearing away of the tooth at that point.

The reason this understanding is important is that it influences the choice of materials a dentist will use to restore this lesion. If the dentist uses a hard material that is stiff, the slight flexing of the tooth will often cause the filling to pop out. I wrote about this in a blog post several years ago: My fillings keep popping out. The dentist needs to use a softer, more flexible composite. A couple of examples of materials I gave were Silux Plus and Renamel. A slight amount of bending of the filling material with the tooth is all that is needed to insure that these fillings stay in.

Good luck,
Dr. Hall

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