Should amalgam fillings be changed to the latest white composites?
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
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.
- 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.
- 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].
- 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