Amalgam vs. Composite.....

[MsPurtell]

---

Members don't see this ad.

Hey guys, I'd like your opinion on whether it's better to restore posterior teeth with amalgam or composite. I'm struggling a bit with this ethically because we are required to do a certain number of Class 2 composites to graduate, yet I don't feel right talking a patient into getting composite over amalgam. I know amalgam seals over after a year or so, whereas composites are more likely to leak and will need to be replaced within 5-10 years. I also have heard a resident describe posterior composites as "root canals just waiting to happen"! The only advantage I can think of to placing composite is for esthetic purposes.

Any other opinions on this? TIA!

Margaret

 

[ItsGavinC]

Sure, I have lots of opinions on this.

First, in many circumstances, you'll probably find that you won't have to talk patients into this. Many will ask you for composite in their posterior teeth.

A lot of the strength of the composite in posterior teeth is going to be based on YOUR skills--how well the prep is designed and how well the composite is placed. A properly placed composite can last for much longer than 5 years, according to recent literature. Most of the recent research shows composite lasting just as long as many amalgams (15+ years).

Having said that, there are some situations where composite doesn't make sense. I think it would be going overboard to assume composite can be used in all situations. But still, I do think there are MANY situations where composite could be placed in the posterior just fine, but it isn't even looked at as an option.

 

[USAF_Dentman]

Hey guys, I'd like your opinion on whether it's better to restore posterior teeth with amalgam or composite. I'm struggling a bit with this ethically because we are required to do a certain number of Class 2 composites to graduate, yet I don't feel right talking a patient into getting composite over amalgam. I know amalgam seals over after a year or so, whereas composites are more likely to leak and will need to be replaced within 5-10 years. I also have heard a resident describe posterior composites as "root canals just waiting to happen"! The only advantage I can think of to placing composite is for esthetic purposes.

Any other opinions on this? TIA!

Margaret

My composite in one of my posterior tooth lasted about 6 years, then the darn thing fell out. But, i didnt want the "metal mouth" look, so it was worth it. So it all depends...

 

[Gutta Percha]

Composites are better than amalgam. Amalgams crack teeth.

If you place a composite like herculite with a strong flowable with clearfil se, the comp will last. But if you use a bonding agent that has a strength of 10MPa then the comp won't last. Anyone who says comps cause RCT's just doesn't know how to place comp--they are probably placing a base under it or using a bad bonding agent or using etch. But the comp has to be well placed--no wet field. I would want a large comp over alloy in my mouth if needed.

 

[mariyaBG]

Hi everyone,everything you've said about composits is true,but I think they are not as good for the posterior teeth as the amalgam.Amalgam is still widely used,and let me tell you why.You should all remember the most importat quality of the amalgam-wear,or abrasion. That is what makes amalgam supperior to composits and better for posterior teeth. I know that the new generation composits better wear that the old ones ,but still not as good as amalgam.

 

[Gutta Percha]

So you would rather have an amalgam that will eventually produce cracks in your teeth and weaken it, than a composite b/c its wear rate is better than composites(but the difference is insignificant). Alloys cause severe sensitivity after they are placed while comps do not. They say alloy self seals, but if you take a diagnodent to an alloy after a few years you will probably get a reading of decay. Plus, if you place alloy in a class II--the prep has corners which is idiotic from an engineering perspective. Have you ever listened to ray bertolotti or G. christiansen? If you are still in school or even if you are out of school, then I recommend attending both of their seminars. They are both very good at what they do and will actually shed light on the truth of dentistry instead of antecdotal myths which dental schools keep spreading.

 

[DcS]

I'll give my 2c on this. In most situations, composite is as good as amalgam. Sure, amalgam can last 10-15 years + in some patients, but you will also see many that will come out after 5 years or so for recurrent decay, ratty margins, lack of marginal ridges/anatomy/contact, overhangs....etc. So, while I do think it is a semi-valid point of the life-span of amalgam vs composites, the newest resin generations are much improved as far as their lifetime, ability to withstand stress, polym shrinkage, etc.

To me, there is one main question to ask when deciding to place a composite versus amalgam. Assuming the patient desires the composite for esthetics (which many will prefer), if I can obtain the proper conditions for placement of the composite, I think it is a valid tx option. By that, I mean that the site must be able to be kept completely dry from saliva, blood etc while placing it. Unless it is a class I that can be placed w/ good cotton roll isolation, I will place posterior composites under a rubber dam. I know it's a couple of extra minutes, but IMO those extra couple minutes to assure ideal placement conditions will get much more time out of the restoration.

A couple notes worth saying...if the patient is a bruxer, amalgam would probably be the material of choice. Also, a problem that may come up w/ post composites (all composites really, but more so w/ post composites due to occlusal forces) is marginal leakage and post-op sensitiviy. I personally to this day cannot eat on a class II on 30 because of the sensitivity. This is because the dentist who placed it did not do a good job sealing the tooth surface before placement. As a result, I get microleakage and much sensitivity, which a patient or two of mine experiences on occasion.

Other than that, I think composites are a good choice if the restoration can be properly placed and isn't extensive. For larger restorations, I think that amalgam is the better choice (foundations, etc).


As always, just my opinion of course.

 

[DcS]

So you would rather have an amalgam that will eventually produce cracks in your teeth and weaken it, than a composite b/c its wear rate is better than composites(but the difference is insignificant). Alloys cause severe sensitivity after they are placed while comps do not. They say alloy self seals, but if you take a diagnodent to an alloy after a few years you will probably get a reading of .

I would be interested in reading any research that you may have (from a reputable source of course) concluding that with identical sized restorations amalgam will cause cracks in teeth to weaken them while composite will not. Esp with ideal cavity prep and placement, I would be very interested to read any research supporting that.


As far as post of sensitivity, you are incorrect to say that composite does not cause that. I discussed it in my previous post.

 

[Scott_L]

Why is it that manufacturers can't make (or don't make) amalgam white?

 

[12YearOldKid]

Why is it that manufacturers can't make (or don't make) amalgam white?

Well, I guess they're just waiting on you to invent white silver and white mercury. And while you're at it, how about some transparent aluminum.

Back to the original question... a lot of current research is showing that posterior comps are every bit as good as amalgam. So many old-timers just have trouble letting go of things they were taught in dental school decades ago. When the original studies declaring amalgam to be better than composite came out, composite truly was an inferior material. But the material science has changed, the technique has changed, and today's dentists are much more skilled at placing composites.

I would put comps in my posterior teeth without a second thought. In fact, I have several posterior comps in my mouth that are 15 yrs old and doing fine.

 

[Gutta Percha]

My research on composites was given to me by ray bertolotti. He is a dds phd--the guru of bondodontics (ask anyone). If you think composites cause sensitivity, then the bond is horrible. If you use a product like clearfil SE with a bond strength of 29 MPa that doesn't require etch, you will not have sensitivity. Dentists who say they don't have faith in comps usually don't know how to do them properly. If your composite is sensitive to eating, its not microleakage in its classic sense. Either the tooth was etched which ruins the hybrid layer and the dentinal channels never got sealed. Or the bond on the pulpal/gingival floor was bad, and the dentinal channels are open. So everytime you bite(release the bite), you feel sensitivity as the fluid comes out of the dentinal channels causing discomfort.

Alloy is still widely used, but if you do contemporary dentistry then alloy isn't used that much.

I'm trying to educate you students to what is out there. Don't just believe what the dental school instructors are saying. They are trying to get you to pass the boards which is good, but they aren't expanding your thinking.

 

[mariyaBG]

My research on composites was given to me by ray bertolotti. He is a dds phd--the guru of bondodontics (ask anyone). If you think composites cause sensitivity, then the bond is horrible. If you use a product like clearfil SE with a bond strength of 29 MPa that doesn't require etch, you will not have sensitivity. Dentists who say they don't have faith in comps usually don't know how to do them properly. If your composite is sensitive to eating, its not microleakage in its classic sense. Either the tooth was etched which ruins the hybrid layer and the dentinal channels never got sealed. Or the bond on the pulpal/gingival floor was bad, and the dentinal channels are open. So everytime you bite(release the bite), you feel sensitivity as the fluid comes out of the dentinal channels causing discomfort.

Alloy is still widely used, but if you do contemporary dentistry then alloy isn't used that much.

I'm trying to educate you students to what is out there. Don't just believe what the dental school instructors are saying. They are trying to get you to pass the boards which is good, but they aren't expanding your thinking.

Hi to answer to our quetion,I am not a student. I am a dentist with 6 years of experience.I don,t agree with you,amalgam is not the cause tor tooth to crack.Any falure of an amalgam filling is the result of improper cavity prep.As you should now cavity prep for amalgam is more difficult that composite prep . I totally agreee whit Dcs about compozits and amalgam. You should take into consideration a lot of things before chosing a material.
The only reason that composites have been used so much lately is purely comercial-patients like to have white teeth and are ready to pay more to hava them.

 

[Cudental007]

Depending on where the restoration and the type of restoration, class 1, 2, or 3 etc makes a huge impact on which material to use. For a regular run of the mill Posterior class 1 prep, amalgam is the best choice, esthetics aside because posterior teeth are subject to heavy masticatory stress- causing plucking of the particles on the surfaces of resin leading to porosity and weakening of the restoration over time. During placement, resin polymerization causes contraction and expansion of the composite and the cusps, which is responsible for post-op sensitivity and "contraction gaps" and eventually microleakage.
Microleakage can be minimized by the proper bases or sealers, but in this case, amalgam (or gold) is a better choice, personally. Amalgam reduces the tooth-restoration gap over time due to the release of corrosion-by-products. It does, however have its disadvantages, but if properly placed, it will have a longer life span than a nicely placed composite resin.

CUdental007 👍

 

[cusp of carabelli]

Composites are better than amalgam. Amalgams crack teeth.

If you place a composite like herculite with a strong flowable with clearfil se, the comp will last. But if you use a bonding agent that has a strength of 10MPa then the comp won't last. Anyone who says comps cause RCT's just doesn't know how to place comp--they are probably placing a base under it or using a bad bonding agent or using etch. But the comp has to be well placed--no wet field. I would want a large comp over alloy in my mouth if needed.

i don't understand how you can say amalgams crack teeth. if anything that statement should apply more towards composites b/c of the constant polymerization shrinkage that occurs with the restoration over the life of the restoration. if it has good bonding to the tooth, the stress that it places on the tooth might contribute to the weakening of tooth structure. I think both amalgam and composite has their places and the pros and cons of each material should be weighed and presented to the patient before formulating a treatment plan for the patient.

 

[ItsGavinC]

The only reason that composites have been used so much lately is purely comercial-patients like to have white teeth and are ready to pay more to hava them.

Not true. It is true that patients are requesting them, but it isn't true that that is the "the only reason".

Composites are easier to do, both from a prep standpoint and a fill standpoint. As has been mentioned, newer generation composites stand up VERY well against amalgam. Future generations will exceed the strength and usabilty of amalgam.

It's only a matter of time.

 

[Darksunshine]

Well, I guess they're just waiting on you to invent white silver and white mercury. And while you're at it, how about some transparent aluminum.

Back to the original question... a lot of current research is showing that posterior comps are every bit as good as amalgam. So many old-timers just have trouble letting go of things they were taught in dental school decades ago. When the original studies declaring amalgam to be better than composite came out, composite truly was an inferior material. But the material science has changed, the technique has changed, and today's dentists are much more skilled at placing composites.

I would put comps in my posterior teeth without a second thought. In fact, I have several posterior comps in my mouth that are 15 yrs old and doing fine.

Technique, technique, technique, and then of course the type of the composite that was placed. (And of course we have to allow for pt factors).
Real world experience has shown me (Yes, I learned to place composite's in hygiene school and have talked to many Doc's outside of that in the last 6 years about this issue. NO, I don't do it now because it is not legal in OR. It is legal in WA to place amalgam as a hygienist if you have taken their restorative board, which I have.) Whoa, got off on a tangent, but back to the point. Sorry, I digress.

Composites are an "ethical" alternative to amalgam's in many situations and like 12yearoldkid points out a lot of GP still do amalgam's because of the school of thought they were taught dentistry under. Which brings me to my next point, a lot you guys have some really good arguments, and I think it is always better to do what is in the patients wishes and of course the best option for them. This isn't going to be the same for everyone. On a side note, I have seen teeth with large crack in them that also have large amalgam fillings. Given that amalgam expands in the mouth it is reasonable to assume that it could be a factor on causing some internal pressure in the tooth. But, I need to look up some research before I comment more on that.

 

[tx oms]

My research on composites was given to me by ray bertolotti. He is a dds phd--the guru of bondodontics (ask anyone).

Alloy is still widely used, but if you do contemporary dentistry then alloy isn't used that much.

Wow, you managed to sneak in two opinions disguised as facts.

My dad can beat Ray Bertolotti up and my dad doesn't like posterior composites; therefore, posterior composites are bad (ask anyone). BTW, I've never heard of Ray Bertandernie so I guess that blows away your arguement.

I practice contemporary dentistry and I prefer alloy. That means everyone who REALLY practices contemporary dentistry and isn't a poopy head should use alloy.

 

[tx oms]

But, I need to look up some research before I comment more on that.

Or go to dental school. Just a thought.

 

[Darksunshine]

Or go to dental school. Just a thought.

Dude, you just can't resist can you? Just like Aug2uag you want to throw rocks at me because it is so much fun.

Well I have a posterior composite in my mouth that was placed in hygiene school by a HYGIENIST and it is doing fine.

Last time I checked mean and evil denists like you don't corner the market on doing research, finding research or looking research up. In fact just because you are a dentist doesn't make you God, but I think someone forgot to tell you that in school.

That is why I am becoming a dentist because there unfortunately are a few rotten ones like you out there.

 

[aphistis]

Dude, you just can't resist can you? Just like Aug2uag you want to throw rocks at me because it is so much fun.

Well I have a posterior composite in my mouth that was placed in hygiene school by a HYGIENIST and it is doing fine.

Last time I checked mean and evil denists like you don't corner the market on doing research, finding research or looking research up. In fact just because you are a dentist doesn't make you God, but I think someone forgot to tell you that in school.

That is why I am becoming a dentist because there unfortunately are a few rotten ones like you out there.

Between this and your other posts the last few days--thank God you're the non-judgmental type, lady. I'd hate to see what might happen if you carried grudges. 🙄

 

[Darksunshine]

Between this and your other posts the last few days--thank God you're the non-judgmental type, lady. I'd hate to see what might happen if you carried grudges. 🙄

Your intellect blows me away! 😱 Not to mention your psychic ability. And yah, I am insulted that I was called a "hoe" by a total stranger and my children bastards, and then txoms agrees. Yep, I have no idea what my problem is.

 

[tx oms]

Your intellect blows me away! 😱 Not to mention your psychic ability. And yah, I am insulted that I was called a "hoe" by a total stranger and my children bastards, and then txoms agrees. Yep, I have no idea what my problem is.

I never agreed you were a hoe or that your kids are bastards. I just think it's funny how offended you get. I went to school with a hygienist turned dentist. You remind me of her. Everyone in my class picked on her b/c she got so offended. You need to drop the Napolean complex before dental school. Also, do not ever let the following words come from you mouth, "Dr. So-and-so, I have a question. You said blah blah blah, but in my practice/in my patients/in hygiene school I did/was told this..."

 

[aphistis]

I have no idea what my problem is.

Let me help, then--how about "a complete inability to ignore"? You're dealing with two total strangers on an anonymous internet message board. Does it really *matter* what they think, or are you just actively searching for reasons to get indignant & pissy?

You're going to have one hell of a rough time in dental school if you don't figure out fast how to not be offended by everything under the sun.

 

[Darksunshine]

I never agreed you were a hoe or that your kids are bastards. I just think it's funny how offended you get. I went to school with a hygienist turned dentist. You remind me of her. Everyone in my class picked on her b/c she got so offended. You need to drop the Napolean complex before dental school. Also, do not ever let the following words come from you mouth, "Dr. So-and-so, I have a question. You said blah blah blah, but in my practice/in my patients/in hygiene school I did/was told this..."

Yeah thanks for pointing out the obvious, men have huge ego's and far be it from me to "take" them serious and get offended.

Also I do agree with you on the mentioing my background during school. I am sure you are 100% right about how the dentist faculty will react.

 

[Darksunshine]

Let me help, then--how about "a complete inability to ignore"? You're dealing with two total strangers on an anonymous internet message board. Does it really *matter* what they think, or are you just actively searching for reasons to get indignant & pissy?

You're going to have one hell of a rough time in dental school if you don't figure out fast how to not be offended by everything under the sun.

Aphistis, what is this forum for? Apparently, we all need to completely ignore what any one says in this forum, lest someone take something personal. I must clearly apologize for taking it personal since I am female with kids and shouldn't take complete (and clearly deranged strangers) comments seriously.

No, I don't search for reason's to get "indignant and pissy". Although, apartently having the nerve to stand up for myself is against the rules according to you.

Yep, I appreciate your advice on growing a thick skin.

Thanks Aphistis, you have been a huge help.

 

[aphistis]

Aphistis, what is this forum for? Apparently, we all need to completely ignore what any one says in this forum, lest someone take something personal. I must clearly apologize for taking it personal since I am female with kids and shouldn't take complete (and clearly deranged strangers) comments seriously.

No, I don't search for reason's to get "indignant and pissy". Although, apartently having the nerve to stand up for myself is against the rules according to you.

Yep, I appreciate your advice on growing a thick skin.

Thanks Aphistis, you have been a huge help.

Take it or leave it, lady; whether you listen to what we're telling you or put it in File 13, it doesn't impact me either way. I don't know how successful your little crusade is going to be, but I'm doing just fine in dental school studying to become a dentist without the extra baggage.

That's all from me on this topic. Ciao.

 

[Darksunshine]

Take it or leave it, lady; whether you listen to what we're telling you or put it in File 13, it doesn't impact me either way. I don't know how successful your little crusade is going to be, but I'm doing just fine in dental school studying to become a dentist without the extra baggage.

That's all from me on this topic. Ciao.

That comment wasn't directed at you Aphistis. SEE BELOW Directed at TXOMS.

But if you choose to take it personal because you are a "male" than you have no right to preach at me about being "indignant" and "pissy" on the hoe/bastard comment from Aug2uag and then thought "good humor" by TXOMS.

This is not a crusade, this is a discussion that has gotten out of hand. Not sure why you got it confused with a crusade, heh. 😕

 

[Gutta Percha]

I'm sorry that I am a follower of a certain type of dentist like Ray Bertolotti. But you have to choose to be a type of dentist, and he is the type I want to follow. And if you haven't heard of him, it's because you are an OMFS not an adhesive dentist. But if you were a GP and hadn't heard of him then I would say you have no place to comment which I still say b/c you appear to be an OMFS. It would be like saying you had never heard of steve buchannan and are an endodontist. Everyone on this board will eventually (I hope) pick a few guru's that they follow to produce better patient care and better dentistry. And yes I know you don't have to be an absolute follower of this person, but you do need to believe in the research they show you.

 

[tx oms]

adhesive dentist

I agree with following a mentor. I just don't think you can prove, with studies, that amalgam is the great evil you make it out to be. I also think it's pretty silly to claim that using alloy is not being a modern dentist.

Finally, THERE IS NO SUCH THING AS AN ADHESIVE DENTIST OR A COSMETIC DENTIST. These are not ADA recognized specialties. The terms are misleading to the public b/c they seem to convey a level of training that is nonexistant (eg the ADA does not recognize these terms). Also, "Cosmetic Dentist" implies that there are non-cosmetic dentists. Try to find anyone who considers themselves to be a non-cosmetic dentist.

 

[GoGatorsDMD]

Try to find anyone who considers themselves to be a non-cosmetic dentist.

Oh come on now, I plan on practicing non-cosmetic dentistry. Got some fluorosis on #8? Let's take care of those unsightly white flecks with a cast gold crown.

 

[adamlc18]

Oh come on now, I plan on practicing non-cosmetic dentistry. Got some fluorosis on #8? Let's take care of those unsightly white flecks with a cast gold crown.

No, no no...I don't think a gold crown is what is needed in this case. I owuld recommend 12 amalgam veneers for those anterior teeth. No more white specs anywhere.

 

[trypmo]

[....]As has been mentioned, newer generation composites stand up VERY well against amalgam. Future generations will exceed the strength and usabilty of amalgam.

It's only a matter of time.

Yay for research, coming up with better materials! 😍 That's the kind of thing I hope to be doing someday soon. Maybe in a decade this kind of "amalgam vs. composite" thread will be obsolete.

(Banishing flame wars to obsolescence would be nice too, but I don't think any amount of research could do that.) 😉

 

[trypmo]

"adhesive dentist" ... does that mean we'd get injected with genetically-engineered substances in order to start growing velcro all over, like fur?


(just trying to lighten the mood a little)

 

[Gutta Percha]

Sorry TX OMS, I don't remember calling myself a cosmetic dentist. Also, I don't remember saying that I am in an ADA recognized specialist. You just came to those conclusions without any basis.

I know that you are upset that maybe a general dentist knows more than you do about composites. Because how could a GP know more than an OMFS about anything? It's a mystery for someone as all knowing as you are.

I believe in practicing dentistry to the best of my ability, and obtaining as much current knowledge I can in dentistry. I am an adhesive dentist b/c I try to place as little alloy as possible. When you get in to private practice you will meet (I hope) many general dentists like me. However, if you talk down to them like you do on this board, then I can only hope you never own your own business because you will go bankrupt since none of them will refer to you.

 

[Darksunshine]

"adhesive dentist" ... does that mean we'd get injected with genetically-engineered substances in order to start growing velcro all over, like fur?


(just trying to lighten the mood a little)

You are so cute Trypmo, I have always like your sense of humor! Nice try, though!

 

[tx oms]

Sorry TX OMS, I don't remember calling myself a cosmetic dentist. Also, I don't remember saying that I am in an ADA recognized specialist. You just came to those conclusions without any basis.

I know that you are upset that maybe a general dentist knows more than you do about composites. Because how could a GP know more than an OMFS about anything? It's a mystery for someone as all knowing as you are.

I don't remeber saying you made these claims. I did say that the terms adhesive dentist and cosmetic dentist have no meaning. I bet you can't find a dentist who doesn't do some kind of bonding.

I believe in practicing dentistry to the best of my ability, and obtaining as much current knowledge I can in dentistry.

So do I. I finished dental school just a couple years ago and I am quite familiar with composite. Remember, I am a licensed and trained dentist. Just because I'm studying OMFS doesn't mean I've forgotten everything else I learned.

I am an adhesive dentist b/c I try to place as little alloy as possible.

I think you're a dentist who prefers composite over amalgam. I'm an adhesive dentist too, if you want to use that term. I still use composite in my practice routinely.

When you get in to private practice you will meet (I hope) many general dentists like me. However, if you talk down to them like you do on this board, then I can only hope you never own your own business because you will go bankrupt since none of them will refer to you.

I hope I meet many general dentists who fancy themselves to be good practioners, not superior practioners b/c they don't use alloy. Whether you admit it or not your tone implies that you think anyone who prefers alloy is a fool and out of date. Sorry, you simply can't defend your position.

 

[Gutta Percha]

I guess you are an adhesive dentist since you do use composite in your practice routinely. Can you please discuss the CE that you took that discussed the strength of your composite and bonding materials? (Please include bond strength and modulus of elasticity of all materials, fill rate, etc). (Please include date and instructor) I would like learn from you in order to know all your great information since you readily dismiss mine.

If you are discussing your knowledge in dental school (in reference to composite and bonding) to mine in the real world then that is ignorant. (While I was in school they were still teaching GV Black and that composite shrank towards the light) But if you have practiced for many years as a general dentist (as you reportedly have), then I would like to learn your clinical and evidence based outcomes in regards to bonding agents and composites.

But you are correct, I do regard myself as a superior dentist. I take more CE than most. I use the best materials and products. I hire the best people. I don't practice below average or even average dentistry. I'm always looking to improve my skills, techniques or supplies. If this makes me a bad "adhesive dentist" because I discount those than use products and techniques that don't work as well then so be it.


It is always suprising to me that all the oral surgeons I meet are great people, and understand the importance of GP's. It is in such contrast to those that I met who wanted to be OMFS during dental school, and those that I meet on this board who are actively enrolled in OMFS training. Do you learn to respect other dentists in the last year of the program? (I'm not joking, please tell me when this is taught--or do you learn it in private practice)

BTW, just because you are a licensed and trained dentist doesn't mean that you have obtained all the dental knowledge out there. I have attended almost a thousand hours of CE and haven't even come close to knowing everything about dentistry.

I know I appear to be an As*, but I'm fabulous in real life (at least thats what my patients and other dentists tell me). I'm not trying to **** on people; I just don't like it when other dentists comment on antecdotal evidence or info learned in dental school.

 

[tx oms]

Terms without meaning, such as adhesive dentist, can be used by anyone in a variety of ways. My CE was dental school 1999-2003 at UT San Antonio. If you search journals and textbooks you will see a large amount of restorative literature from my school. You more than likely have already learned from the same people I did, unless you only learn from Dr. Burtandernie who did not teach at my school. My dental school did not teach GV Black. Hell, my school pushed the WREB to accept the class II slot prep sans dovetail.

B/c I am a licensed and trained dentist I can intelligently discuss the merits of composite. You seem to claim that only dentists who have taken the same courses as you could have such a discussion. You also want to exclude dental school as a source of information. It's ironic that most dental literature comes from dental schools, but only the literature (of which you have provided none), not the school, is valid. Further, your position forces you to cede that you can only do procedures and hold opinions based on your CE training. Do you do any procedures or have any opinions based on dental school training rather than CE? I suspect so.

As an aside, I use Z-100 and SBMP. Feel free to look up their physical properties on your own.

Next, pick an argument to stick with. Either choose evidence-based or experienced-based dentistry to be your platform (or just admit that you, like everyone else, blend the two together to make your practice). I know that clinical experience makes you faster and more proficient placing restorations. However, I thought this entire discussion was in regards to whether or not anyone can support the claim that amalgam is obsolete or a poor choice. You have yet to provide anything to that end. This claim is similar to saying amalgam gives people mercury poisoning--a bit sensationalistic. In the world of logical thinking, when someone makes a claim the burden is on them to prove the claim, not on the dissenter to disprove the claim. Otherwise I could claim that peanut butter makes a good restorative material and you would have to prove that it does not.

As for your feelings towards oral surgeons, this is the internet, not real life. My views are based on my being a dentist and are unrelated to my specialty. I'm not trying to be offensive, just trying to point out that you claim composite is superior to amalgam, amalgam breaks teeth, and to be an expert on bonding without evidence. Post some articles. I'll even help you: go to pubmed.com and start looking.

But you are correct, I do regard myself as a superior dentist. I take more CE than most. I use the best materials and products. I hire the best people. I don't practice below average or even average dentistry.

I know I appear to be an As*, but I'm fabulous in real life (at least thats what my patients and other dentists tell me). I'm not trying to **** on people; I just don't like it when other dentists comment on antecdotal evidence or info learned in dental school.

This is awesome. I agree with your assessment of your tone. I also laugh at your self-appreciating claim. I can't decide if it sounds more like Stuart Smalley (I'm good enough...and gosh darn it, people like me) or Ben Stiller's character in Dodge Ball. As for your second sentence, you have only commented on anecdotal evidence (CE courses, Dr. Bertandernie, clinical experience, people’s opinions of you) rather than providing any peer-reviewed sources. So, either you like anecdotal evidence or you don't; as I said above, pick a platform and stay consistent.

 

[dentisthubli]

Hello,

My opinion regading placing composite/amalgum is you have to take patient's opinion, as both equally have their advantages and disadvangates.

If they patient is not specific about aesthetis you can go for amalgum as it has good strength and wear resistance and is best for ideal class II cavities, hence it can be refilled after 7 -8 years and its the other way for composities.

 

[12YearOldKid]

Another thing I like about Class 2 composites is that when the patient just has some interproximal caries you aren't mowing down half the occlusal surface just for retention. And nothing against GV Black, but I have an ethical problem with extension for prevention.

 

[omfsres]

Another thing I like about Class 2 composites is that when the patient just has some interproximal caries you aren't mowing down half the occlusal surface just for retention. And nothing against GV Black, but I have an ethical problem with extension for prevention.

I don't think post composites are as good and amalgams in terms of longevity. But I think post composites are ok if the patient understands the restoration will probably have to be replaced sooner and recurrent decay can occur more readily. These restorations are just more high maintanance.

 

[Fullosseousflap]

I don't think post composites are as good and amalgams in terms of longevity. But I think post composites are ok if the patient understands the restoration will probably have to be replaced sooner and recurrent decay can occur more readily. These restorations are just more high maintanance.

Actually, the newer resin materials are quite good and will last as long as an amalgam restoration. There are a number of studies that demonstrate this.

Also, indirect ceramic restorations are actually lasting longer than amalgams.

The era of amalgam is OVER!

 

[aphistis]

Actually, the newer resin materials are quite good and will last as long as an amalgam restoration. There are a number of studies that demonstrate this.

Also, indirect ceramic restorations are actually lasting longer than amalgams.

The era of amalgam is OVER!

And indirect ceramic restorations only cost five or six times the cost of an equivalent amalgam--what a sweet deal for the patient!

 

[Jediwendell]

OK, for all you anti-amalgam guys: What do you put in a partially erupted 6 or 12 year molar that has decay on the buccal or occlusal? Or for that matter squirmers who you can't keep dry? I kmow what I use.

 

[Fullosseousflap]

And indirect ceramic restorations only cost five or six times the cost of an equivalent amalgam--what a sweet deal for the patient!

Yep, and the patients all want them. Natural, tooth colored restorations and now with the advent of a cloned/synthesized type of enamel the bonding/cementation interface should be the best yet.

No more ugly silver amalgam restorations that all fail over time. No more wastewater concerns over mercury disposal or dentists breathing that crap day in and day out.

 

[Fullosseousflap]

OK, for all you anti-amalgam guys: What do you put in a partially erupted 6 or 12 year molar that has decay on the buccal or occlusal? Or for that matter squirmers who you can't keep dry? I kmow what I use.

Glass Ionomer!

If they squirm, then work you charm + Septocaine. If they continue to squirm....sedate them a bit.

Amalgam fails big time in the presence of moisture.... you may not see it for a few years but it expands right out of the prep.

 

[joel4sale]

WOW! I am missing all the fun! 😀

Composite for me!

Rubber dam Isolation....If I can

If not, Tons of 2x2 and cotton roll + Matrix band, Constant air stream. (all my assistants seems like they have 4 hands) with occational visco-stat/hemodent

Why all the trouble? Cuz you need keep your working field dry for amalgon anyway. Besides, I am replacing large old amalgon with either fracture tooth or recurrent decay almost everyday but HARDLY came across same situration with large composite (even the posteriors, too). I do, however, replace leaky composite often...not a big deal though, and those composte usually are 5+ years old.

It seems to me it's SOOO much easier to detect leaky margin/recurrent decay for composite.

I rarely have PO senstivity for my composite patient (knock on wood). I perma seal most of my composite. I do have re-do once a while due to defect margin or debond.

As far as for kids?? I totally agree with FULLO. I almost use Glass Ionomer exclusively. If I can't keep the working area dry, I won't even use amalgon. Too much saliva?? Rubber Dam then. Kid cry and kick? Try N20 or Valium 2 mg (or refer).


When do I amalgon?? When it's deep subgingival, viscostate or Expasil only give few min of dry time and I can't risk of containmated area while etech, bond....


Hopefully I am not doing anything wrong all these time.