Read without ads and support Scribd by becoming a Scribd Premium Reader.

Language:

Download

Go BackAdd Note

Link

Embed

Save for later

Posterior AmalgamRestorations

Usage, Regulation,and Longevity

Richard J. Mitchell, PhD

*, Mari Koike, DDS, PhD

,Toru Okabe, PhD

Division of Restorative Dentistry, Department of Oral Health Practice,College of Dentistry, University of Kentucky, D641 Medical Center,800 Rose Street, Lexington, KY 40536-0297, USA

Department of Biomaterials Science, Baylor College of Dentistry, The Texas A&M University System Health Science Center, 3302 Gaston Avenue, Dallas, TX 75246-2098, USA

This article is a review of the literature on posterior amalgam restorationspublished during the period between 1996 and 2006. During this period, re-search interest on amalgam signiﬁcantly declined. A Medline search of arti-cles with ‘‘amalgam’’ in the title, ‘‘dental’’ anywhere, and the subject‘‘dentistry’’ yielded 1054 citations (1.4% of all dental citations) between1986 and 1995 but only 553 citations (0.81% of all dental citations) between1996 and 2005. During the latter period, there were only two comprehensivereviews of the literature on dental amalgam, and both appeared early in theperiod[1,2]. Several articles referred to amalgam in the context of reviewingthe advantages and disadvantages of alternative restorative materials, how-ever[3–7].Because there have been many recent reviews of amalgam biocompatibil-ity[8–19]and the eﬀects amalgam waste on the environment[20–22], this article focuses solely on amalgam restorations. Similarly, because recent re-views have focused on dental amalgam in primary teeth[23,24], the focus of this article is on amalgam in permanent teeth. Because of space limitations,an update on the metallurgical, physical, and mechanical properties of den-tal amalgam must await another venue.

The authors thank the National Institute of Dental Research of the US NationalInstitutes of Health for more than two decades of support for the authors’ research and thatof other investigators who have greatly expanded our knowledge of this key dental material.* Corresponding author.

E-mail address:

rjm1@uky.edu(R.J. Mitchell).0011-8532/07/$ - see front matter

dental.theclinics.com

Dent Clin N Am 51 (2007) 573–589

Current usage

In 2004, Burke[25]reviewed trends in amalgam and composite usagearound the world. The following discussion summarizes and updatesBurke’s excellent review.

North American dentists

Several reports suggested that the overall use of dental amalgam in theUnited States has declined signiﬁcantly during the last decade[26–28]. Inone state, the number of resin composite restorations exceeded the numberof amalgam restorations in 1999[27]. Amalgam continues to be the mostwidely used direct restorative material for posterior load-bearing restora-tions, however. In 1999, US dentists placed 71 million amalgam restora-tions compared with 46 million posterior resin composite restorations[28]. The number of posterior composites was up from 13 million in1990; the number of amalgam restorations was down from 99 millionplaced in that year[28]. From 1990 to 1999, amalgam restorations declinedfrom 88.4% to 60.6% of the sum of amalgam and posterior compositerestorations.

North American dental schools

The best judgment of dental educators may be of interest. In a 1997 sur-vey, 53 of 54 North American dental schools responding reported that theytaught the use of resin composite to restore posterior teeth[29]. Thirty-sevenpercent of the schools devoted less than 5% of operative dentistry curricu-lum time to teaching class I and II composite restorations; 85% of theschools reported that they spent less than 20% of available curriculumtime on these restorations. Only 30% of the surveyed schools taughtthree-surface class II posterior composites in molars. This study did not ex-plicitly ask about the percentage of the operative curriculum devoted toteaching amalgam restoration. It is plausible that increased curriculumtime for posterior composite restorations is an indicator of increased prob-ability that composite will be selected over amalgam.The trend was

and continues to be

toward greater emphasis on resincomposite for posterior restorations. For example, in a 2005 survey, 68%of 47 US dental schools reported that they used resin composite for three-surface class II restorations[30]. This study also found that in 80% of USschools amalgam was taught ﬁrst and that amalgam was used in 60% of the posterior restorations placed by students. A recent survey suggestedthat Canadian dental schools have a similar philosophy for direct posteriorrestorations[31]. Amalgam continues to be favored among Canadian educa-tors: in all schools responding, amalgam and resin composite posterior res-torations were taught, with either equal or greater emphasis being placed onamalgam[31].

574

MITCHELL

et al

European dentists

The use of amalgam in the United Kingdom is similar to that in theUnited States. In a 2001 survey of 654 British general dentists, 35%reported that they ‘‘sometimes’’ used resin composites in extensive load-bearing restorations in molar teeth[32]. Fifteen percent responded ‘‘often,’’and 1% responded ‘‘always’’ to this question. Presumably amalgam wasused when resin composite was not. In a smaller survey, 30 UK dentistsreported that 87% of class II and 67% of class I restorations were amal-gam[33].Amalgam is used less frequently in some Scandinavian countries. In2002, Ylinen and Lofroth[34]reported that only 28% of Finnish dentistsand 40% of Swedish dentists used amalgam. In the two other Scandina-vian countries, however, amalgam was used by most dentists (88% of Dan-ish dentists and 92% of Norwegian dentists). Use of amalgam isparticularly low in Finland, where a 2000 survey returned by 548 dentistsreported all the restorations they placed in a single working day. Amalgamaccounted for only 8% of the class I restorations (resin composite: 80%)and 9% of the class II restorations (composite: 80%). When asked whatmaterial they would use to restore an occlusal lesion in the lower secondmolar in a 20-year-old patient, amalgam was the choice of 52.4% of 173Danish dentists, 19.9% of 759 Norwegian dentists, and 2.9% of 923 Swed-ish dentists[35]. A 2005 report commissioned by the Swedish governmentfound that amalgam ﬁllings were no longer used in children and youngpeople and that by weight amalgam made up only 6% of all Swedish ﬁll-ings[36].

European dental schools

Responding to a 1997 survey, 100 of 104 (96%) European dental schoolsreported that they taught resin composites for class I restorations[37].Seventy-nine percent of European schools taught three-surface class IIposterior composites restorations; however, 56% of these schools devotedno more than 20% of the curriculum time for direct restorations to posteriorcomposites. Only 38% of the surveyed schools taught three-surface class IIposterior composites in molars. Overall, the European schools were similarto the North American schools in that amalgam was still taught for class Iand II restorations, and at most schools, most of the curriculum time wasspent on amalgam. A 2006 survey of dental schools in the United Kingdomsuggested that the teaching of resin composite for posterior restoration con-tinues to increase[38]. In this study, 9 of 15 schools (60%) reported that theytaught three-surface class II resin composites.The general trend is that amalgam continues to be taught in Europeandental schools. One dental school in the Netherlands has gradually reducedthe amount of curriculum time devoted to dental amalgam as a restorativematerial[39]. In 2001, it stopped teaching amalgam altogether.

575

POSTERIOR AMALGAM RESTORATIONS