Restorations or " fillings" are the most commonly performed dental procedure. the need for teeth to be restored could result from trauma, dental caries known as " cavities", fractures or chips, birth defects in teeth or other. all those different processes cause destruction or loss of tooth structure. Dental caries are by far the most common cause for destruction of tooth structure. Dental caries vary from being small to being very large. if the nerve of the tooth is not effected by the destruction of the protective tooth structure around it, then a simple restoration is placed on the tooth. 
At Viva Dental Dryden, Dr. Ibrahim only places Composite Resin restorations " White Fillings". Dr. Ibrahim developed high skills in using the white filling material and does not restore teeth with silver fillings. Dr. Ibrahim will remove silver or white fillings only when necessary and will replace them with white fillings. 


Many permanent and baby teeth have deep grooves that develop small dental caries (cavities). Ideal treatment is a conservative white filling that allows the restoration of the cavity area and also seals the remaining deep grooves to prevent new cavities from forming. Differentiating between staining which is not a cavity and a true cavity in a groove requires clinical experience and sound diagnostic skills.

This document was prepared to help our patients better understand the details of this procedure. We will continue to provide the highest quality and standards of dental care. We welcome your questions about this procedure or any others which might be of concern to you.

DIAGNOSIS - The photo on the left shows a new cavity and the one on the right shows a cavity under an existing filling. Both require careful removal of caries which will be achieved by drilling the tooth structure (left) or existing filling (right).The red circles outline the location of cavities that were diagnosed by your dentist during careful examination, black arrows show the point where cavity originated.

REMOVING THE CAVITY/DRILLING - The first step requires the use of a dental drill to reveal the full extent of the cavity which is usually larger than the point of origin on the cavity shown in the first set of photos. The depth of the cavity and patient comfort will determine whether or not there is a need for local anesthesia (freezing). Most of these cavities can be fixed without freezing if detected early enough.

COMPLETE REMOVAL OF CAVITY - These photos reveal complete removal of the cavities. As seen, the extent of the cavity in most cases is larger than the initial point of origin. The grooves that don’t have cavities are also included in the final preparation which would prevent any new cavities. At this stage the tooth will be treated with several steps of cleaning and bonding in preparation for the white filling.

DIFFERENCE BETWEEN A PRR AND A SEALENT - The photos show the completed white filling after polishing. There are many differences between this procedure and a “sealant”. Sealants are done on teeth with no cavities in which drilling and bonding of a white filling is not required. Sealants are preventive procedures performed at a young age before cavities develop in the grooves of the teeth.

Case 2 - (1) Existing failing Silver Filling

(2) Initial Removal of the Silver Filling

(3) More necessary cleaning of tooth structure

(4)Final Result

Case 3 - (1) Primary dental caries (cavities on unfilled teeth)

(2) Caries cleaning process

(3) Final Result
Case 4 - (1)  Severe dental caries on front top teeth
Gingival overgrowth and highly irregular tooth surface. this case was treated with both gum surgery with a specialized technique called " electro-surgery" and composite resin restorations ( white fillings) especially made to mimic the shine of a natural tooth.

(2) Final restorative and surgical result achieved on the same day
Dr. Ibrahim performs this procedure regularly to produce utmost cosmetics and long term successful restorations. the gingiva  usually heals within 5 to 7 days with a good brushing technique and dedicated home care. 

PLEASE NOTE *All images, audio, and case studies are the sole property of Dr. Ghada Ibrahim and Viva Dental Dryden*