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Dental Materials Restorative Dentistry

Should amalgam fillings be changed to the latest white composites?

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This question was submitted by a general dentist: As a practicing dentist I am often asked whether it is recommended to change amalgam fillings to the latest white composites. What information should I be giving patients in order for them to make a well-informed decision?

Dr. Anuradha Prakki, Restorative Dentistry Assistant Professor, in the Faculty of Dentistry at the University of Toronto, has provided this quick initial response.

Drafted by Alexandra Rabalski, JCDA Oasis Summer Intern

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It is important to inform patients about the benefits and drawbacks of both restorative materials.

Amalgam generally tends to have a longer lifespan when compared to resin composite. In a long-term retrospective study conducted by Van Nieuwenhuysen et al. (2003), the mean survival rate of amalgam restoration was found to be 14.6 years, while resin composite restorations survived for 7.8 years.

Interestingly, the short-term longevity of resin composite with regard to clinical performance in oral cavities appears to be no different than that of amalgam (Rho et al., 2013). However, once a resin composite restoration begins to fail, it occurs in a rapid manner. Therefore, resin composite fillings must be carefully monitored with periodic dental follow-ups for early detection and timely repair of failures.

It is also important to mention that resin composite restorations tend to primarily fail due to secondary caries (Bernardo et al., 2007). For this reason, resin composites are not ideally recommended to patients with poor oral hygiene, dry mouth, and other risk factors that make them high-risk for future caries.

Although composite fillings are aesthetically desirable, it is evident that they require more maintenance. Less durability may lead to additional replacements, thus contributing to the re-restoration cycle and weakening the tooth structure. There is also a higher risk of post-operative sensitivity with resin composite restorations.

 References

  1. Van Niewenhuysen JP, D’Hoore W, Carvalho J, Qvist V. Long-term evaluation of extensive restorations in permanent teeth. J Dent. 2003:31(6):395-405.
  2. Rho YJ, Namgung C, Jin BH, Lim BS, Cho BH. Longevity of direct restorations in stress-bearing posterior cavities: a retrospective study. Oper Dent. 2013 Apr 3. [Epub ahead of print].
  3. Bernardo M, Luis H, Martin MD, Leroux BG, Rue T, Leitão J, et al. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc. 2007;138(6):775-83

 

 

4 Comments

  1. Robert Murray August 20, 2013

    It is unethical to replace a serviceable restoration. Its never a good idea to place a composite in a place it was never meant to go.

    Reply
    1. Paul Belzycki August 22, 2013

      Robert, you are wasting your time here. I have followed some of these blogs. Most of the discussions seem to be carried by the very folks that do think it is a great idea to change amalgam into comp resin. This is usually done for the misinformed fear of mercury poisoning found on Quack sites. The good days are gone my friend. There is a new breed out there who are driven by criteria other than what is best for patient.

  2. Jamie Bumbac August 28, 2013

    I totally agree. The fact that this question is even posted on a cda website is ridiculous…what does that say about the amalgams that I’m placing everyday. The days of dentistry where you thought about the patient first are long gone. I say make the fees the same for amalgams and resins and see how many guys go back to placing amalgams. No one will do this but it would show a very interesting thought process. The fact that this question is posted shows the public that there might be something “wrong” with amalgams. Unreal!!!

    Reply
  3. Jeffrey Erlich August 28, 2013

    The question was not answered. Should you replace amalgam fillings…………..?

    Reply

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