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Composite Resin Versus Amalgam for Dental Restorations: A Health Technology Assessment

I had the pleasure to host Chris Kamel, Director of Health Technology Assessments and Rapid Response, Medical Devices at CADTH. CADTH recently published a Health Technology Assessment that compared amalgam to composite resin for dental restorations. The report is available for download here: Composite Resin Versus Amalgam for Dental Restorations: A Health Technology Assessment.

CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs and medical devices in our health care system. Learn why we are a trusted pan-Canadian source of credible health care evidence.

I hope you find the report and the conversation helpful. Please ket us know what you think or if you have a question suggestion, or feedback to improve our communication with you. You can email us at oasisdiscussions@cda-adc.ca or call us at our toll free number 1-855-716-2747.

Until next time!

Chiraz Guessaier, CDA Oasis Manager

Highlights

Dental caries (also known as tooth decay or cavities) is a significant oral health issue worldwide. In Canada, based on data from 2007 to 2009, 96% of adults and approximately 60% of children and adolescents are affected by dental caries. Standard treatment aims to restore the structure of the affected tooth using filling material to replace decayed dental tissue. The most commonly used filling materials for dental restorations are amalgam and composite resin.

  • Dental restorations with dental amalgam last longer and cost less compared with restorations with composite resins.
  • The evidence shows no clinically important differences in the safety of amalgam compared with composite resin dental restorations.
  • Whereas the environmental impact of the release of mercury from dental amalgam in Canada is small, the environmental impact of chemicals included in composite resin materials is not known.
  • Shared decision-making between dental providers and patients is encouraged to address the use of the optimal dental material for a given situation.

Resources

 

Oasis Moment – Take Away Message (1.45″)

 

Full Conversation (17.29″)

 

3 comments

  1. I could not agree…… MORE. And if we are behaving more responsibly as a profession we would do two things:
    1. Advocate for our fee guides to make remuneration for amalgam and composite resin restorations the same.
    2. Commission a manpower study which would show we are graduating too many dentists. Dentists that I am afraid have to “renovate” amalgam restored dentitions with composite resin.
    I might also add that restoration longevity studies can never be undertaken because there is no academic career that can be had by studying restorations in situ – holding everything else constant-for the necessary length of time to be clinically meaningful.

  2. Dr. G. Blischak

    Call it what it is – GREED. Amalgam free dental offices are not having conversations with their patients about the choice of restorative material. You only get composite. Then the endo, then the crown, then the extraction, then the implant.
    What dentist looks at a Class II posterior preparation and believes that the composite is easier to place? They don’t. They look at the fee. I agree with Bob Wood that the fees should be identical for amalgam and for composite.
    I’m not sure about the numbers of graduating dentists but I am certain that they have an entitled attitude that they need more income. The corporate and group practices that tell new associates that they aren’t going to place amalgam in this office is not a choice given to the patient in consultation with their dentist.
    “Amalgam-free” dentists aren’t watching this video. They aren’t following the recommendations of the CDA and the ADA regarding the safe use of amalgam. They aren’t researching the evidence for the high secondary caries rate in composite. Why would they? They would, if they genuinely cared about their patients more than they do about themselves.
    Dentists telling patients that the amalgams are toxic and they need replacement – this from my patients from other dental offices.
    Evidence-based dental practitioners? You won’t find them in Las Vegas.
    Composites in primary teeth? It’s a race between failure and exfoliation.
    Greed. They’re crooks.

  3. I refuse to use amalgam. I still let patients know that statistically, amalgam lasts longer, and is associated with less recurrent caries, but I feel good quality composite materials, when placed properly, can last comparably as long; and as long as the patient practices good oral hygiene, their chances for recurrent caries will be low. I can’t say I’ve had any patient demand an amalgam filling.

    I’m not saying be dishonest; it’s every dentist’s duty to be honest, but if you’re an amalgam-free dentist like myself, there’s no need to push amalgam’s efficacy on the average patient who’s exposed to endless misinformation online that says amalgam will poison you with mercury, and give you cancer; but aside from granting the patient’s wishes, I feel placing shiny metal fillings in peoples’ mouths is unaesthetic and down right archaic.

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