Due to the Minamata convention we will slowly see the demise of amalgam as a restoration that dentists can rely on for provision of restorations in the posterior dentition. What will be the implications of this significant change to our armamentarium in managing molar teeth with extensive tissue loss especially?
This insightful paper, from 2004, was written by a Professor in Dental Materials provides a thorough appraisal of the different factors to consider moving into a world of amalgam free dentistry.
August 19, 2018 at 3:37 pm
I have not placed amalgam in 25 years. I do not place crowns in in vital teeth in patients who are in their 20s, 30s or 40s. Therefore, my material of choice has been direct composite placed under rubber dam. All surfaces are air abraded, all cavosurface margins beveled. The cavity prep is bulk filled and carved to ideal contour and anatomy with the resin being brushed over the cavosurface margins with a #2 sable brush. All composite is cured with bilateral, trans enamel illumination using two powerful lights (VALO) simultaneously from the buccal and lingual. Final cure is from the occlusal surface. The results? No recurrent caries at the margins, no broken natural teeth and a handful of broken composite. In 25 years, I have replaced my direct composite with an Emax onlay in fewer than 10 teeth. This will increase in the future but has not happened. The bottom line: composite is a fabulous material when placed correctly.
August 19, 2018 at 6:57 pm