Sir, a former prisoner came to our clinic. According to the patient, he had been imprisoned and was released five months ago. While being in jail, more than seven months ago, he 'suffered from toothache and he also found a cavity in his tooth'. As he was denied access to dental assistance, he manufactured a self-made tooth filling using toothpaste and tin foil. In fact, he constructed a Class I inlay for tooth #37!

He explained that, at first, he folded a piece of tin foil so that it could match the shape of the cavity. Then, he applied a layer of toothpaste to the cavity and afterwards he placed the tin foil inlay. Finally, he applied slight pressure and thus condensed the materials and also shaped the occlusal surface.

His restoration was still intact when he visited the clinic and the tooth appeared to be asymptomatic (Fig. 1). The toothpaste probably acted as cement, as it hardens over time. It could have also released fluoride and caries did not progress further. The margins were generally acceptable. Moreover, the colour and the texture of the restoration resembled a new, well-polished amalgam filling. Apart from taking the patient's history, only a caries-implying discolouration located at the non-cavitated lingual groove would lead a clinician to the replacement (or maybe just a repair!) of this restoration.

Figure 1
figure 1

The homemade Class I inlay

Full size image

Although rarely encountered nowadays, the idea of using tin foil as a filling material is not new at all; in fact, there was a book published back in 1897 by H. Ambler that reviews this exact use of tin foil and traces it back to 1783.1 However, the patient's ingenuity remains remarkable.

Clinicians should also have in mind that amalgam-resembling restorations are not always what they seem to be and additional attention may be required.