Amalgam-- "Alternatives" or "Substitutes" ??

Dental amalgam, in widespread use for over 150 years, is one of the oldest materials used in oral health care. Its use extends beyond that of most drugs, and is predated in dentistry only by the use of gold. Amalgam remains popular because it is strong, durable and relatively inexpensive.Carious lesions today are generally smaller, easier to treat, and managed by more conservative treatment that retains tooth structure. Because of this decrease in the frequency and size of dental caries, there has been a relative increase in the use of alternative dental restorative materials.

The most commonly used and less expensive of the alternate materials, however, cannot be used for large lesions and need more frequent replacement. The use of amalgam substitutes for stress bearing restorations in permanent teeth cannot be recommended without serious concerns.

Because of the increasing aesthetic concerns and because of availability of tooth adhering tooth coloured materials, patients are opting these restorative materials over amalgam as restorative material in total.

Approximately 70 percent of such resotrations placed annually are replacements of amalgam. But Most of these replacements finally again require amalgam or other metallic materials replacements at the end, because composite materials often lack sufficient strength or durability to be considered adequate substitutes.
What materials can be better than amalgam in these areas?

Criteria when considering amalgam substitutes:

· Service life,

· Radiopacity

· Wear properties

· Marginal adaptation

· Setting expansion/contraction

· Technique sensitivity

· Potential secondary caries risk.
A true substitute has NOT been found yet.

Amalgam still has a place in restorative dentistry, particularly for restorations that are extensive and need to withstand a heavy occlusal load.

Amalgam Alternatives (Not substitutes)

· Direct composites (Heliomolar RO, Hybrids, Condensables such as Alert, Solitaire, SureFil, Pyramid, Prodigy Condensable, Glacier, Filtek P60)

· Ariston pHc - "Alkaline Glass Restorative" - advertised as a non-bondable, non-retentive amalgam alternative.

· Direct / Indirect or Indirect (lab) composites

· Cast metal Porcelain inlay / onlay / veneer / full veneer crown / full porcelain crown / PFM crown

· Metal ionomers

To summarize:

  • While the search for suitable tooth-coloured alternative materials continues, dental amalgam still remains in extensive use internationally.
  • Continue to use amalgam unless esthetics is a concern.
  • Dentists cannot ethically tell patients that dental amalgam is a health hazard or that removal of amalgam restorations will benefit their health.
  • Use conservative preparations
  • Practice safe mercury hygiene
  • Stay informed!

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