Dental Fillings: materials compared and what to choose

A patient came in with the typical question: «Doctor, I have a cavity. Should we use the cheap GKV option or pay for ceramic privately?» She had read that ceramic lasts 20 years while composite only 5. I showed her the tooth: small defect, about a quarter of the crown, on a canine. For this size, paying for ceramic would not make financial sense. A properly placed composite will last 10-12 years on this kind of patient. We went with composite, cost zero, identical result.

I share this story often because many believe the most expensive is automatically the best. It is not. The material has to fit the cavity size, location, and bite forces. Otherwise you pay for something that brings no real-world advantage in your specific case.

German dentistry offers several materials for dental fillings (Zahnfüllungen). The choice depends on tooth location, cavity size, aesthetic preferences, and budget. For GKV (statutory insurance) patients: basic filling treatment is covered, but the material and technique may differ from what you have in mind.

Filling materials compared

Amalgam

Silver-coloured alloy of mercury, silver, tin, and copper. Lifespan: 10-15 years. The most durable option for back teeth. Banned in the EU since 2025 (Regulation 2017/852) as a standard material, except in cases of absolute medical necessity.

Composite (Komposit)

Tooth-coloured, light-cured resin. Lifespan: 5-10 years. Aesthetic but less durable on back teeth with large cavities. Since the 2025 amalgam ban, GKV covers composite as the standard material on all teeth.

Ceramic inlay (Keramik-Inlay)

Custom-made in a dental lab. Lifespan: 15-20 years. Best aesthetics, excellent biocompatibility. Not covered by GKV, fully private cost.

Gold inlay (Gold-Inlay)

A classic in German dentistry. Lifespan: 20-30 years. Maximum durability, but not tooth-coloured. Not covered by GKV.

When a filling is not enough

If more than 50 percent of the tooth crown is lost, a filling will not provide sufficient stability. A crown or ceramic onlay with cusp coverage is the better choice.

With deep decay reaching the pulp (nerve), a filling will not heal the inflammation. Root canal treatment is needed first, then a crown.

If you have a cracked tooth, a filling will not save it. The crack keeps growing under chewing forces. A crown with cusp coverage or an onlay is required.

What a filling costs in Hamburg

Cost drivers: filling size (1, 2, 3 surfaces), accessibility, additional techniques (rubber dam, microscope, layering for aesthetics). I always use rubber dam on back teeth, which increases longevity by 30-50 percent.

Supplementary dental insurance (Zahnzusatzversicherung) typically covers 70-90 percent of ceramic inlays. If you plan major work, take out the policy before treatment.

How I decide what to use

During the consultation I look at several parameters and choose the material together with the patient. I do not push.

• Cavity size. Small (up to 1/3 of the crown), composite, free. Medium (1/3-1/2), composite or ceramic. Large (over 1/2), ceramic or crown.
• Location. Front tooth, only composite or veneer. Back tooth, composite or ceramic with cusp coverage.
• Bite forces. If the patient has bruxism (grinding), composite fillings do not last. Ceramic plus a night guard is the better option.
• Aesthetics. Front teeth, only tooth-coloured. Back teeth can be gold technically, but few choose it for the colour.
• Budget. Without supplementary insurance and limited means, GKV composite is fully adequate for most situations. In 5-7 years you can upgrade to something more durable.

My principle: never push a more expensive material when the GKV option is adequate for the specific case. Honesty over profit.