Composite Resin and Porcelains YES Amalgam NO

One of the most common questions asked in our practice concerns our choice of the material that we use to restore small and moderate sized cavities.

Amalgam fillings were introduced to dentistry in the 18th century (yes, 18th!). At the time, this mixture of silver and mercury was considered a miracle material (of course, at that time, so was indoor plumbing). Today, amalgam fillings are made of a mixture of silver/tcopper/other alloy and mercury in about 50/50 proportions. And as of today the American Dental Association believes that amalgam is a safe and effective material for use in the human mouth. Fine. They are entitled to their opinion. Here is my personal opinion about amalgam:

It is possible that the mercury in amalgam is not harmful to us. However, mercury is a toxic substance and according to the EPA, must be disposed of in a Toxic Waste Disposal Site. In my opinion, anything that must be disposed of in a Toxic Waste Disposal Site should maybe not be placed in our mouths. But this may simply be an over-cautious position on my part. I do not actually know what the long term outcome of on-going research will be. I do know that some European countries and a several states in the U.S. have regulated amalgam use, mostly because of environmental contamination reasons. Some European countries have banned the use of amalgam in pregnant women and young children and several states, including Californai, Maine Connecticut and Vermont have regulations restricting its use. New York State iis considering such regulation and has already put amalgam disposal regulations into effect.

I want to be clear on this. I have not used amalgam since April of 1982. And the reason has nothing to do with its safety or non-safety. The jury is still out on that.

The reason I do not use amalgam is that, in my opinion, it is a poor restorative material compared to newer materials we have now. Like everything else, improvements have been constant over the last 100 years. It took science until the 70’s to develop an alternative to amalgam, and into the early 90’s to improve it to its current level. It continues to improve and we have wonderful alternatives to amalgam.

The materials I favor and use as my first choice are bonded composite resin and variopus ceramics. These materials are extremely biocompatible and can be strongly bonded to the natural tooth. A silver amalgam restoration has no bond to adjacent tooth structure. Expansion and contraction of this material over many years causes cracks in teeth and eventually, many teeth will fracture. You may have had this happen to you, even when you were eating something soft. Amalgam tend to leak after five or ten years, causing recurrent decay. Amalgam corrodes and turns black. And, perhaps most important, placement of amalgam in a previously unrestored tooth requires the removal of tremendously more tooth structure than bonded materials and this wekens the tooth dramatically.

There is no way I will ever place amalgam in a patient’s mouth again.

When aging amalgam restorations are replaced by bonded composite resin or porcelain restorations, the strength of the tooth is increased and underlying tooth structure is sealed.

Plus, of course, composite resin and porcelain restorations are tooth colored and so much more attractive than metal fillings.

Now let me talk with you about the economics of composite resin and porcelains. Bonded restorations are much more technique sensitive and are more time consuming to place. Special care must be exercised to operate in a controlled environment that can be moist when desired and dry when desired. Bonded restorations are much more sensitive to moisture control procedures than amalgam. When placing composite resin and porcelain, we seal the dentin against bacterial infiltration and protect the pulp from irritation. As a result of the necessary expertise and the increased time associated with composite resin and porcelain placement, the cost of restoring teeth with these materials tends to be a little higher than with amalgam.

Insurance companies, and the employers and unions that are the purchasers of the policies, are slow to embrace new techniques, especially when it could cost them money to provide state-of-the-art care to their insured. Most insurance companies, under the direction of the employer or union, will only cover the cheapest material to restore teeth. That’s amalgam, and many will pay their amalgam benefit even when composite resin or porcelain are used. Yes, they are allowed to do that.

My patients have mostly learned about the ways insurance carriers pay benefits. For example, they have learned not to be fooled by the “usual and customary fee” jive. They know that this is bogus and is intended to drive a wedge between patient and doctor. If you are concerned about anything you read in an Explanation of Benefits you receive, just call. We’ll explain it with straight, honest talk.

Composite resin and porcelain are wonderful, modern, state-of-the-art and beautiful materials we use to help you have the strong, functional teeth and great smile you have always wanted.

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