Alternatives to amalgam include composite resin, glass ionomer, porcelain, and gold, among other options. Most consumers choose direct composite fillings because the white coloring matches the tooth better and the cost is considered moderate.
In the past, a common argument against composite fillings was that they were not as durable as amalgam. However, recent studies have debunked this claim. Researchers of a study which was published in 2016 and conducted on over 76,000 patients for over ten years found that posterior amalgam fillings had a higher annual failure rate than composites.1Two separate studies published in 2013 found that composite fillings performed as well as amalgam when comparing failure rates2and replacement filling rates.3Other research has offered similar findings: a study published in 2015 documented “good clinical performance” of composite resins over a 30-year evaluation,4a meta-analysis published in 2014 noted “good survival” of posterior resin composite restorations,5a study published in 2012 showed certain types of composite materials last as long as amalgam,6and a study published in 2011 found “good clinical performance” of composites over a 22-year period.7
Composite fillings have also been criticized because some of them contain the controversial material bisphenol-A (BPA). Dentists have a variety of opinions about the safety of BPA and other types of bisphenol, such as Bis-GMA and Bis-DMA. There has likewise been concern about glass ionomers, all of which contain fluoride.
Patients who are concerned about the ingredients in their dental materials often choose to speak with their dentists about using a material that does not contain certain ingredients. For example, a product named Admira Fusion8/Admira Fusion X-tra9released in January 2016 by the dental company VOCO is reported to be ceramic10and not to contain Bis-GMA or BPA before or after it has been cured.
Another option for dental patients concerned about which mercury-free alternative to use as a filling material is to do their own research and/or take a dental biocompatibility test. If biological testing is used, a patient’s blood sample is sent to a laboratory where the serum is evaluated for the presence of IgG and IgM antibodies to the chemical ingredients used in dental products.11 The patient is then provided with a detailed list of which name-brand dental materials are safe for their use and which ones could result in a reaction. Two examples of labs that currently offer this service are Biocomp Laboratories12and Clifford Consulting and Research.13
Also, in regards to dental allergies, Dr. Stejskal introduced the MELISA test in 1994. This is a modified version of the (Lymphocyte Transformation Test) LLT designed to test for metal sensitivity type IV delayed hypersensitivity to metals, including sensitivity to mercury.14
In addition to considering which material to use for dental fillings, it is essential that dental patients and professionals be familiar with and utilize safety measures when removing dental amalgam mercury fillings.
Materials used in dentistry
Also commonly named “filling”, the amalgam is a sealant made of small particles of silver, tin and copper allied with mercury. Its mechanical properties and longevity has made it a first choice for many years. Its main flaw however is the fact that it contains mercury (admittedly in a stable form). Its unaesthetic aspect is also a shortcoming. This is why its use has become very limited in todays dentistry.
The aesthetic fillings exist since a long time, but the recent development of composite resins (by 3M) made a great impact in dentistry. Today this material is the first choice in conservative restorative dentistry, thanks to the important progress made for pulp protection and in the adhesive techniques. The composite is inserted into the cavity and hardened with a polymerisation lamp. These fillings are sometimes sensitive to cold for a couple of weeks.
Composite is also used to seal permanently crowns and bridges.
This material is used for temporary fillings of deciduous teeth.
It is also used for permanent sealing of crowns and bridges as is very well tolerated.
In dentistry gold is found in the form of gold alloys. It is an ideal material because of its harmlessness, precision, and rigidity, which is essential for important prosthetic realisations. It is mainly used for posterior reconstructions. Grey gold is usually chosen because it is less visible.
Because of the vast aesthetic possibilities they offer, the ceramic restorations have become the material of choice in fixed prosthetics (Crowns and Bridges). Its drawback is that it is extremely hard and can sometimes fracture.
This material is used in removable prosthetics for framework and clasps.
It is used in implantology due to its antiallergic qualities. It can also be used in rare cases of metal allergy with removable prosthetics.
It is used to make the artificial gingiva in removable dentures. The teeth of dentures are made of acrylic resin or ceramics.
Zirconium is mainly used for the framework of fixed prosthetics. It is a type of CADCAM ceramic used in dentistry for the last 20 years, popular due to its biologic compatibility and its aesthetic properties. However, it is very expensive due to the advanced technology it requires.
Unfortunately it has given poor results in implantology and cannot be recommended in this field.
Tooth bleaching products
These are used to optimize the aesthetics of yellowed front teeth. For night use, they consist of “carbamide peroxide” gels. For day use, derivatives of hydrogen peroxide are used. For internal bleaching, for example a tooth having darkened after a root treatment, carbamide peroxide is also used.
The gels used for micro-abrasion are composed of phosphoric acid.
Bone filling products
Bone filling with artificial bone grafts has made considerable progress and has largely replaced heterogeneous transplants (no longer used) and homogenous transplants (still occasionally used). The bone grafts are made of a micro porous ceramic, which is biocompatible (Bio-Oss).
The resorbable membranes used for guided osseous regeneration are now the choice of technique in oral surgery.
Particular products and drugs are used for root treatments. Their aim is to prolong the vitality of the tooth when this seems possible (Calcium hydroxide). If the vitality of the tooth cannot be preserved, the pulp chamber and the root canals will be disinfected and hermetically sealed. The disinfectants will be active (for example corticoids) but the permanent seal of the canals will be done with an inert substance (for example gutta- percha).
The MTA (Mineral Trioxide Aggregate) is a very biocompatible material that has been used successfully since several years, particularly in endodontics involving apical resection.