Our Restorative V and VI classes are built around reading ‘classical’ literature of basic dental concepts. We read articles, discuss the topics in class and have writing assignments where we use our brains and come to conclusions and postulate ideas, etc. A recent assignment posed the following question. I have already turned in my opinion, so I am not asking you to do my homework, but I wanted to hear the opinions of those that read this. Enjoy and please comment or form your own questions. Note that I have paraphrased his question from memory, it was taken down from our online access program.
You have recently graduated from dental school and are interviewing for an associate position at your dream dental office. The senior dentist just stopped using amalgam a few years ago and asks you what your opinion is on amalgam. Note that he has been practicing for several years and is well aware of the benefits and controversies surrounding amalgam. He can tell if you are BSing him.
We were asked to cite some of the articles we are assigned to read. I will list them here for your own pleasure.
RT Kao and others. Understanding the mercury reduction issue: The impact of mercury on the environment and human health. Calif Dent Assoc J. 2004; 32(7): 574-579.
JR Mackert and MJ Wahl. Are there acceptable alternatives to amalgam? Calif Dent Assoc J. 2004; 32(7): 601-610.
AV Ritter. Posterior composites revisited. J Esthet Restor Dent. 2008; 20(1): 57-67.
What would you say to this dentist? Back up your answers if possible.
10 responses so far ↓
1 Joyce // Jan 25, 2009 at 12:07 pm
I spent a lot of painful time at the knees of the AK’s in Dental School who, among other things, taught me how to place amalgams. And, I’m still not too sure about how to get a good interproximal contact on a composite. If you hire me, I’ll only get to see your PPO patients, anyway. So, I’ll stick with amalgam, Thank You, and download your patient database while I’m at it.
2 Michael // Jan 25, 2009 at 7:50 pm
Based on vast benefits of using composite fillings instead of amalgam, which I have observed, my personal preference would be to use composite. Even though, the price of a composite filling is a bit higher than amalgam, benefits are far greater. A composite filling allows for a smaller area of removal due to use of etchants, has amazing bonding properties and aesthetically appealing. An amalgam filling may leak over time due to being less compliant and a slight CTE mismatch. Having said that, some cases may still require an amalgam filling when restoring an older one or possibly a larger filling on molars.
3 Ben // Jan 25, 2009 at 9:43 pm
For those of you wondering CTE stands for: coefficient of thermal expansion.
4 Barry // Jan 26, 2009 at 1:10 pm
I would say, ‘could you repeat the question’ a few times while I think up something clever. Then I would echo what Michael said. Composite is more expensive, but amalgam leaks over time. At least in my experience. I’m big on presenting the pros and cons to the patient and allowing them to make the decision. Of course I recommend the one that fits them best, but I’m a big advocate that it’s got to be something the patient chooses if cost and long term efficacy are involved. That’s what I would say.
5 Torunn Birkeland // Feb 15, 2009 at 9:09 am
Usually it’s not a problem to get a good interproximal contact with composite. With the right equiptment including bonding agents this works prefectly. In Norway the amalgam/composite discussion no longer presents a problem: amalgam is prohibited…
6 Gil // Feb 16, 2009 at 5:41 pm
The composite just plainly looks better. I don’t want amalgam fillings in my mouth.
7 Craig // Mar 5, 2009 at 1:40 pm
I would say ‘I can’t even use amalgam.’
Coming from a British Dental school, all teaching of amalgam has been abolished in replacement for composite. I have been taught that it is far superior in aesthetics, and new composites can match or outlast amalgam restorations even when being placed posterior. Most importantly, it requires less sacrifice of healthy tooth tissue as no mechanical locks need to be placed.
Sure, I understand that composite can be a little more tricky to place, especially in children as it requires multiple steps. But it provides a much nicer looked result and using composite over amalgam will probably lead to the tooth surviving a lot longer having entered the ‘restorative cycle’ because the large amalgam restorations weaken the tooth structure.
It also helps to avoid patients issues with mercury.
8 Josh Hudson // Jul 6, 2009 at 11:47 pm
The issues with mercury should not be considered. If properly mixed, the mercury is unreactive and in such small amounts, that it has been ruled completely unharmful. Amalgams last much longer, and whoever is saying they don’t is simply lying to themself. A recent study shows that an overwhelming majority of dentists all continue to use amalgams and other metals for their own personal restorations in their mouth, and fewer than 10% of dentists actually use composites for their own restorations. I think that tells which is the better product right there. Composites’ only advantage is esthetics.
9 Sarah // Nov 18, 2009 at 4:31 pm
I very much agree with Josh! and this is coming from someone who works in a third world country, amalgams are cheaper and last longer, sure composite is more esthetic but you’ll probably have to replace it every 5-10 yrs and it can also leak. And yes, it would depend on the type of prep your going to do and the tooth structure you have to work with, because you would need appropriate retention to place an amalgam.
10 Amanda (Taba) Nelson // Nov 18, 2009 at 10:30 pm
Ahhh, the voice of Dr. Mark Meraner rings clearly… even after 5 and 1/2 years. This was probably the best class in all of dental school. It was the only one that wasn’t just memorization of dental dogmas…we actually had to think and come up with what our own philosophy was going to be when we were “on our own.” Well, in 51/2 years, I have become a diplomate of the American Board of General Dentistry, served in the Army in Germany for 3 years and have seen some well placed composite restorations placed by European dentists. While we have come a long way in “bonded” restorations I am still not eliminating amalgam from my practice. After being in Europe, I thought I was near the point of eliminating amalgam. However, coming back to the US has shown me a different patient population, one the does not have the luxury of frequent and regular recall appointments to follow these lovely “white” restorations. So no, I am not going “amalgam-free,” not yet anyway! Ask me about posterior CAD/CAM all ceramic restorations and I’ll tell you I am all for it (with a few exceptions)!
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