Composite & Amalgam:Which Lasts longer?!?!

[DentPursuer88]

Amalgam & Composite:Which Lasts longer?!?! Hey guys, I am sure there are enough well experienced dentists who can help me with this question.

Basically, I had an argument with my teacher in dental assisting school. I tried to answer a question for a student saying that amalgam usually lasts longer than composite. Amalgam's life span can range from 20-30 years "if delivered well" and composite can last up to 10-15-20 years if delivered appropriately. She said "Mr. Bakkar, I totally disagree with you. In fact, composite lasts just as long as amalgam, if not better and longer." I was shocked and felt stumped. I talked to my dentist, and he agrees with me.

So what's the deal? Is there more information I am missing? I know that micro leakage can occur both in composite and amalgam restoration, yet they appear more in amalgam. Also amalgam isn't technique sensitive while composite is. One more question. Why do amalgams have more OPEN MARGINS than composite? Does it have to do with the bonding or material?

Thank you for your time.

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[pmantz]

[B Also amalgam isn't technique sensitive while composite is. One more question. Why do amalgams have more OPEN MARGINS than composite? Does it have to do with the bonding or material?

Thank you for your time.

😱 An amalgam preperation is very technique sensitive considering there is no micromechanical bonding. I am just a newbie and can answer your question because I haven't got to work with compostite yet(technical dificulties). BUT from what I have been told an amalgam prep is much more dificult then a compostite prep.

Please someone who knows something pipe in.

 

[armorshell]

😱 An amalgam preperation is very technique sensitive considering there is no micromechanical bonding. I am just a newbie and can answer your question because I haven't got to work with compostite yet(technical dificulties). BUT from what I have been told an amalgam prep is much more dificult then a compostite prep.

Please someone who knows something pipe in.

While this is true, the composite restoration is far more technique sensitive than an amalgam. You have to have a dry field, proper bonding times, good sectioning if it's a larger prep. Even if you have all that the composite is going to shrink, pulling it away from the margins, which contributes to microleakage.

 

[tinman831]

Those seem like pretty inflated numbers. There are amalgam restorations that have been in peoples mouths for decades. But these are the rare exceptions. I was taught on average, a patient should expect at least 5 years, minimum, of worry free service for a composite and just about 10 years for an amalgam restoration. If it's placed by a competent dentist, you could expect even longer.

 

[shinji]

The three factors which contribute to open margin that I can think of are deminiralization around the cavo surfaces, mechanical wearing (occlusion), and material properties. Amalgam utilizes mechanical retention, the outline form of the prep, to hold it in place. It is technical sensitive becuase the amalgam will have a high risk of falling out from the prep if the specific amalgam prep criteria are not followed. When filling the prep with amalgam, you can only do it in one shot; you can't add addtional amalgam to a set amalgam.
Amalgam will oxidize over time and the oxidized layer will seal the margin due to creep, plastic deformation. In contrast, composite will shrink over time but there is no other mechanism to prevent the open margin formation.
Also, amalgam has a higher strength than composite so it can take a high loading force than composite.

 

[peter3blood]

I know of several #30 amalgams that are 30+ years old. I don't know the exact number they are quoting for composites today but I think 5-15 years is possible.

 

[SuperC]

I agree with all of the other posts. Most data sited in our texts says that amalgam lasts longer than composite. However, you have to remember that many of these composites (10-15-20 years old) were placed BEFORE we had good dentin bonding materials. We will have to wait until new studies show where we are in terms of bonding.

But for now, ask your prof where he/she is getting their information? I am sure that there is no one here with a text that says otherwise.
-C

 

[DentPursuer88]

thanks to you all...I appreciate your help.

 

[m-dmd]

Here are some articles. You decide.

Here are 2 articles published in JADA in July I think. I could not find the other article.
http://jada.ada.org/cgi/content/abstract/138/6/763
http://jada.ada.org/cgi/content/abstract/138/6/775

And on this one there are a bunch of articles listed.
http://www.dentalwatch.org/hg/myths103.html

In dentistry, it is great to have an opinion, but it is better to practice based on research. With that said, I tell my patients that an amalgam has a lifespan of 10 years and a resin has a lifespan of 3-5 (more dependant on their diet and oral hygiene - the bonding agent hydrolyzes over time). I have seen big cuspal coverages, done well, last longer than that. I have NEVER seen a resin last that long, but this may also be because is it more difficult to do a great and long lasting resin than a great amalgam.

 

[DrJeff]

Composite, Amalgam restoration lifespan, ahh this great topic.

Here's what I see in my practice. Both types of restorations can AND DO fail. Both types of restorations can AND DO break. Generally speaking, you'll see more broken teeth around amalgams than composites, but then again there are WAY more amalgam restorations in peoples mouth than composite restorations Porportionately in my practice, I'll see the cusp of a molar fracturing adjacent to a large composite as much as with a large amalgam, on an absolute basis, you'll see the fractured cusp more often next to an amalgam restoration.

True, you will see a higher failure rate of older composite restorations compared to amalgam restorations, and here's why in most circumstances. As you have learned(or will learn), composite placement technique is alot more exacting than amalgam placement technique. Many dentists in their mid 40's or older learned most of their composite placement techniques via continuing education courses as opposed to in clinical school based courses. Plus many practitioners of this age demographic have seen a HUGE change in how composites are placed including multiple generations of bonding agents, etching controversies(total etch, enamel + dentin seperate), the "dry vs. moist" dentin debate, etc, etc, etc. So not only for many practitioners was their composite placement eductaion way different than what you in school get, but then those same practitioners have had multiple materials and concepts "thrown" at them by many, many, many CE lecturers and journal articles for them to digest. It's very easy to see how some difficulties in placement could arise over the years which can lead to failure at a higher rate than amalgams of similar "vintage"

As a clincian, you need to find a composite placement technique that not only is clinically successful, but also one that is reproduceable in your own hands, and then be real meticulous about the details each and every time. IMHO, the 2 most important things for success in this area are far and away MOISTURE CONTROL and then secondly using enough bonding agent in the proper way.

Realistically though, if you're looking at restoring a tooth that should be crowned via direct restoration, you'll be much more likely to see that direct restoration fail independent of the material you use, than that crown.

 

[OceanDMD]

Composite, Amalgam restoration lifespan, ahh this great topic.

Here's what I see in my practice. Both types of restorations can AND DO fail. Both types of restorations can AND DO break. Generally speaking, you'll see more broken teeth around amalgams than composites, but then again there are WAY more amalgam restorations in peoples mouth than composite restorations Porportionately in my practice, I'll see the cusp of a molar fracturing adjacent to a large composite as much as with a large amalgam, on an absolute basis, you'll see the fractured cusp more often next to an amalgam restoration.

True, you will see a higher failure rate of older composite restorations compared to amalgam restorations, and here's why in most circumstances. As you have learned(or will learn), composite placement technique is alot more exacting than amalgam placement technique. Many dentists in their mid 40's or older learned most of their composite placement techniques via continuing education courses as opposed to in clinical school based courses. Plus many practitioners of this age demographic have seen a HUGE change in how composites are placed including multiple generations of bonding agents, etching controversies(total etch, enamel + dentin seperate), the "dry vs. moist" dentin debate, etc, etc, etc. So not only for many practitioners was their composite placement eductaion way different than what you in school get, but then those same practitioners have had multiple materials and concepts "thrown" at them by many, many, many CE lecturers and journal articles for them to digest. It's very easy to see how some difficulties in placement could arise over the years which can lead to failure at a higher rate than amalgams of similar "vintage"

As a clincian, you need to find a composite placement technique that not only is clinically successful, but also one that is reproduceable in your own hands, and then be real meticulous about the details each and every time. IMHO, the 2 most important things for success in this area are far and away MOISTURE CONTROL and then secondly using enough bonding agent in the proper way.

Realistically though, if you're looking at restoring a tooth that should be crowned via direct restoration, you'll be much more likely to see that direct restoration fail independent of the material you use, than that crown.

Rubber dam, proper bonding technique, and dont place huge composites. 3-5 year failure rates is ridiculous. I do not place amalgam. If a posterior restoration is greater than 1/3 the occl surface in isthmus size, it will be a indirect resin or porcelain inlay. Look I realize that there is no "scientific" backing that says amalgam is poison. Face the facts, we are trending towards eliminating this material. patients dont want metal showing in their mouths. In California, if you place amalgams you have to have a sign about mercury filled fillings in your office. In several countries in Europe, amalgam is banned.

If your resins are failing, its called operator error. Proper tooth preparation and good bonding technique results in longterm results. Like Jeff says, a large amalgam is nothing but a precursor to a broken tooth and resultant onlay/Crown.

 

[nhasigioi]

If done right, composite can last up to 15-20 years. Amalgam can last for decades as well. Amalgam is much stronger but can lead to fracture more than composite if the restoration is large enough. Amalgam will corrode and seal the margin which is good for poor hygiene patients. Composite will shrink and may cause sensitivity. Base lining and section filling will definitely help.

 

[armorshell]

If your resins are failing, its called operator error. Proper tooth preparation and good bonding technique results in longterm results. Like Jeff says, a large amalgam is nothing but a precursor to a broken tooth and resultant onlay/Crown.

I don't want to start a landslide here, because I do believe amalgam is on the way out simply because of esthetic demands, and correct me if I'm wrong, but there's no amalgam ban in any european country I'm aware of. Prposed bans sure, but nothing concrete.

 

[DrJeff]

I don't want to start a landslide here, because I do believe amalgam is on the way out simply because of esthetic demands, and correct me if I'm wrong, but there's no amalgam ban in any european country I'm aware of. Prposed bans sure, but nothing concrete.

Unless some legislation has been passed this morning and has not hit the media wires yet, there are any not countries that have banned amalgam. Certain countries such as Sweden and Norway have slightly different regulatory controls over it, but there is no ban, just talk.

Personally I still offer and place them in/on my patients. I find though more and more that my patients request, where feasible, that I not use amalgam. Just looking at the numbers from my practice management software, year to date in 2007 of the direct restorations I've placed 77.6% have been composite/glass ionomer with the remainder amalgam. Retrospectively from 5 years ago I was at about 50/50 composite/amalgam.

 

[OceanDMD]

I am incorrect in using the word "banned". In countries like Norway and Sweden there is a big push to ban the material. This has been on going for several years. Obviously you can see my anti-mercury silver filling stance. Answer me this, If you had your choice between a pin retained MOB amalgam filling, or a indirect bonded porcelain or Cristobal restoration, which would you choose? What are you going to place on your spouse?

 

[EuroOMFS]

Rubber dam, proper bonding technique, and dont place huge composites. 3-5 year failure rates is ridiculous. I do not place amalgam. If a posterior restoration is greater than 1/3 the occl surface in isthmus size, it will be a indirect resin or porcelain inlay. Look I realize that there is no "scientific" backing that says amalgam is poison. Face the facts, we are trending towards eliminating this material. patients dont want metal showing in their mouths. In California, if you place amalgams you have to have a sign about mercury filled fillings in your office. In several countries in Europe, amalgam is banned.

If your resins are failing, its called operator error. Proper tooth preparation and good bonding technique results in longterm results. Like Jeff says, a large amalgam is nothing but a precursor to a broken tooth and resultant onlay/Crown.

While I agree with most of what you say, I don´t agree at all that it´s always "operator error" if a resin filling fails. You haven´t had patients that grind their teeth so hard, it´s nearly impossible to put anything that lasts in their teeth?

As for an amalgam ban, I don´t know of any country in Europe where it´s banned. In Denmark, it´s use in children is dicouraged, but not banned.

 

[DrJeff]

I am incorrect in using the word "banned". In countries like Norway and Sweden there is a big push to ban the material. This has been on going for several years. Obviously you can see my anti-mercury silver filling stance. Answer me this, If you had your choice between a pin retained MOB amalgam filling, or a indirect bonded porcelain or Cristobal restoration, which would you choose? What are you going to place on your spouse?

If I need a large restoration on a posterior, personally I'm having indirect gold placed. My wife has a few Captek crowns, as do my parents. Plain and simple if the restoration is 50% or greater of the width of the tooth, indirect of whatever material you want is the choice with the most predictable and dependable long term results. This is the big concept for students to learn. If I have a patient tell me that they can't do the crown, and my office can really make some affordable payment plans when needed, what I tell the patient is "if the filling breaks, you'll pay me full price again, and again, and again if it keeps breaking. Quickly, you'd have bought the crown anyway!" Bottomline, as a dentist you want to

As for the amalgam stance and myself, I still place them, heck I have 3 glorified "amalgam sealants" that were placed by my GP back when I was a lowly snot nosed adolescent back in the early 80's in #'s 3,15 and 30 that are still caries free and functioning today. Are they pretty, not really, fine and functioning after close to 30 years yup. If I go amalgam free in the next few years, it will liekly be more over environmental issues(even though dentistry is a less than 1% contributor of envirnomental mercury discharge) than anything else. I will also really miss carving the stuff and the squeak it makes during carving if I go amalgam free. What I will like is the sudden and immediate increase in my production as my composite fees are basically 25% more than my amalgam fees😀

 

[armorshell]

I am incorrect in using the word "banned". In countries like Norway and Sweden there is a big push to ban the material. This has been on going for several years. Obviously you can see my anti-mercury silver filling stance. Answer me this, If you had your choice between a pin retained MOB amalgam filling, or a indirect bonded porcelain or Cristobal restoration, which would you choose? What are you going to place on your spouse?

Well, if the question is "What would you put in your children?", my dad decided to go with amalgam for all 8 of my restorations. The two that I need replaced (11 years later) are getting indirect gold.

 

[OceanDMD]

Well, if the question is "What would you put in your children?", my dad decided to go with amalgam for all 8 of my restorations. The two that I need replaced (11 years later) are getting indirect gold.

How many years ago was that? Indirect gold is the best as far as wear and marginal integrity, no question. As a dentist, you understand this. How many patients 50 and younger do you think walk into an office and ask for an all gold crown or onlay? How many do you think ask for something tooth colored?

 

[DrJeff]

How many years ago was that? Indirect gold is the best as far as wear and marginal integrity, no question. As a dentist, you understand this. How many patients 50 and younger do you think walk into an office and ask for an all gold crown or onlay? How many do you think ask for something tooth colored?

The "easiest" demographic to sell indirect gold to(aside from fellow dentists) I've found is males aged 40 and over that are engineers. Other than that generally, even after a nice speach singing the praises of gold, I'll hear "Gold sounds great Doc, all except the color"🙄

 

[armorshell]

How many years ago was that? Indirect gold is the best as far as wear and marginal integrity, no question. As a dentist, you understand this. How many patients 50 and younger do you think walk into an office and ask for an all gold crown or onlay? How many do you think ask for something tooth colored?

Hey, I'm totally on board with you, like I said about 3 posts ago.

 

[beezies]

Your opinions seem totally biased when it comes to actual patient care. Don't you want to explain to them that in the long term, gold will hurt their opposing dentition less as opposed to porcelain? And regardless if you think that most patients want the esthetics, and I admit, most do, don't you want to assume that they have a brain, and given the facts will pick the option that best suits their needs?

You can't simply just pick a material because it looks best regardless of situation. It's really irresponsible.

How many years ago was that? Indirect gold is the best as far as wear and marginal integrity, no question. As a dentist, you understand this. How many patients 50 and younger do you think walk into an office and ask for an all gold crown or onlay? How many do you think ask for something tooth colored?

 

[JMJRDH1]

Composite, Amalgam restoration lifespan, ahh this great topic.

Here's what I see in my practice. Both types of restorations can AND DO fail. Both types of restorations can AND DO break. Generally speaking, you'll see more broken teeth around amalgams than composites, but then again there are WAY more amalgam restorations in peoples mouth than composite restorations Porportionately in my practice, I'll see the cusp of a molar fracturing adjacent to a large composite as much as with a large amalgam, on an absolute basis, you'll see the fractured cusp more often next to an amalgam restoration.

True, you will see a higher failure rate of older composite restorations compared to amalgam restorations, and here's why in most circumstances. As you have learned(or will learn), composite placement technique is alot more exacting than amalgam placement technique. Many dentists in their mid 40's or older learned most of their composite placement techniques via continuing education courses as opposed to in clinical school based courses. Plus many practitioners of this age demographic have seen a HUGE change in how composites are placed including multiple generations of bonding agents, etching controversies(total etch, enamel + dentin seperate), the "dry vs. moist" dentin debate, etc, etc, etc. So not only for many practitioners was their composite placement eductaion way different than what you in school get, but then those same practitioners have had multiple materials and concepts "thrown" at them by many, many, many CE lecturers and journal articles for them to digest. It's very easy to see how some difficulties in placement could arise over the years which can lead to failure at a higher rate than amalgams of similar "vintage"

As a clincian, you need to find a composite placement technique that not only is clinically successful, but also one that is reproduceable in your own hands, and then be real meticulous about the details each and every time. IMHO, the 2 most important things for success in this area are far and away MOISTURE CONTROL and then secondly using enough bonding agent in the proper way.

Realistically though, if you're looking at restoring a tooth that should be crowned via direct restoration, you'll be much more likely to see that direct restoration fail independent of the material you use, than that crown.

Please describe YOUR specific technique Dr. Jeff!

 

[DrJeff]

Your opinions seem totally biased when it comes to actual patient care. Don't you want to explain to them that in the long term, gold will hurt their opposing dentition less as opposed to porcelain? And regardless if you think that most patients want the esthetics, and I admit, most do, don't you want to assume that they have a brain, and given the facts will pick the option that best suits their needs?

You can't simply just pick a material because it looks best regardless of situation. It's really irresponsible.

You also can't force a material on a patient either. You can inform/advise the patient of their choices, but ultimately it's the patient that decides. So many times after going through the gold vs porcelain discussion with a patient, I'll hear somethign to the extent of "gold sounds great Doc, BUT no thanks, I'd rather have tooth colored even if it's not as good as the gold." The only demographic generally speaking where I'll do gold on a semi regular basis (even then in my practice it's roughly 1/3 gold, 2/3rds tooth colored) is men over the age of 40.

You'll learn that many, many times your patients will make their final descions not based on what is the best choices scientifically/clinically, but solely on what common culture thinks looks best. It can be a frustrating concept to grasp as a clinician at times.

 

[DrJeff]

Please describe YOUR specific technique Dr. Jeff!

Simple, just as OCEANDMD has already mentioned, rubber dam, and if for any reason I can't use one, I have one of the Isolite systems that does a pretty darn good job of keep things dry. I'm also not afraid to tell a patient if it's not a good case for direct composite due to moisture issues (i.e. extensive sub gingival areas of the prep, poor ginigival tissue health, etc) and in those case if the patient wants tooth colored, it's an indirect cast or pressed ceramic/lab processed composite restoration.

Other than that, prep the tooth, place a sectional matrix (if needed), chlorhexidine rinse of the prep for atleast 30 seconds (sometimes I'll get up and do a hygiene check at this stage so the chlorhexidine may soak for a couple of minutes), rinse, apply a liner in most situations (fuji liner)dry, etch everything for 20 seconds, rinse, dry, LIBERALLY apply multiple coats of bonding agent (personally I still LOVE my 5th generation bonding agent - Bond 1 from Jeneric Pentron😍), air thin/cure for 10 seconds, then incrementally fill the restoration. Final cure, polish, re-etch/reseal the margings with bonding agent. Done.

Works for me. The key is to find a technique that both works in your hands and gives you a very high success rate and then stick to it. Very often in this profession repitition leads to predictabilty which is a great thing.

 

[OceanDMD]

Your opinions seem totally biased when it comes to actual patient care. Don't you want to explain to them that in the long term, gold will hurt their opposing dentition less as opposed to porcelain? And regardless if you think that most patients want the esthetics, and I admit, most do, don't you want to assume that they have a brain, and given the facts will pick the option that best suits their needs?

You can't simply just pick a material because it looks best regardless of situation. It's really irresponsible.

I will take my irresponsibility into consideration. For your information, if a patient is damaging their opposing dentition, its usually not due to the material, but a Malocclusion. The patient may be grinding, clenching, non working interferences, etc. Im sure you are an expert on stabilizing a bite, changing a vertical, treating via neuromuscular princinples, but please hold back your personal opinions directed at other clinicians. I restore with porcelain and indirect resin. If my patient is not interested in treating their malocclusion, or has signs of heavy biting/wear, I'll use Cristobal. Although gold is great, I like my patients teeth looking like they are untouched-no amalgam, no gold in visible areas. If Im treating an upper first,second,third molar, and I have NO clearance, I'll use gold. Thats it. Now be my guest and spend hundreds of hours educating your patients about why they should restore their teeth with all gold. Im sure they will get plenty of complements about those gold fillings from their friends. Definitely a referral builder. Oh, and by the way, have you seen what the price of gold has done in the last 18 months? Always remember your lab bill.🙂

 

[DrJeff]

I will take my irresponsibility into consideration. For your information, if a patient is damaging their opposing dentition, its usually not due to the material, but a Malocclusion. The patient may be grinding, clenching, non working interferences, etc. Im sure you are an expert on stabilizing a bite, changing a vertical, treating via neuromuscular princinples, but please hold back your personal opinions directed at other clinicians. I restore with porcelain and indirect resin. If my patient is not interested in treating their malocclusion, or has signs of heavy biting/wear, I'll use Cristobal. Although gold is great, I like my patients teeth looking like they are untouched-no amalgam, no gold in visible areas. If Im treating an upper first,second,third molar, and I have NO clearance, I'll use gold. Thats it. Now be my guest and spend hundreds of hours educating your patients about why they should restore their teeth with all gold. Im sure they will get plenty of complements about those gold fillings from their friends. Definitely a referral builder. Oh, and by the way, have you seen what the price of gold has done in the last 18 months? Always remember your lab bill.🙂

Isn't that the truth! I just keep reminding myself as I sign the monthly lab bill checks, that big lab bills USUALLY equate to big production numbers😉

 

[Dental916]

quick question...on captek...I am in need or redoing two crowns and as of right now I am getting a PFM, but our school offers captek. Whats the benefits of captek over a pfm?

 

[OceanDMD]

quick question...on captek...I am in need or redoing two crowns and as of right now I am getting a PFM, but our school offers captek. Whats the benefits of captek over a pfm?

Two advantages come to mind.

1- In vivo studies have shown captek subging margins to show considerably less bacterial counts in the sulcus in comparison to natural dentition and porcelain. (bacteriostatic properties)
2- The color is in my opinion much more esthetically pleasing behind porcelain than conventional noble or high noble.

But then again, what do I know. Why dont you just do an all gold crown? I've heard they are better on the opposing dentition.

 

[m-dmd]

I would like to see the studies that indicate that resins last longer than 3-5 years. It is fact that the bonding agent hydrolizes and "washes out" in 3-5 years...so yes, the resin will last quite a while but the bonding agen will not, therefore leaving a gap between the tooth and the restoration. I would not want that in my mouth, therefore the only filling that I have is amalgam...and is gonna stay that way!!! I have read the studies also about amalgam vapor, output, etc, etc...and the amount that is vaporized is very little. In fact, if you read the studies about resins...there are over 120 carcinogens in resins. It is a matter of picking the lesser of the 2 evils...nothing is as good as what was put there in the first place (ie natural tooth structure)

And did anyone read the studies posted in the ADA recently that I cited? Resins do fail, statistically more frequently. I am very careful with my composities ad how I place them (I use a rubber dam, isolate, isolate, isolate) but I see PLENTY of resins that are failing a couple of years out, and yes this is due to practioner failure, but beyond that...hydrolysis occurs. I see WAY more recurrent decay with resins than I do with amalgams. I work in a field in which I see cuspal coverages in place for 20 years that still look good, and are holding up. I also see amalgam filled teeth that have cracked and have led to extraction. IMHO, placing resins are very technique sensitive, and sadly to say, many practitioners are simply not placing them perfectly, leading to restorations that have a very short lifespan, and many of my patients when given this option, choose the longer lasting restoration.

Please, fellow dentists, post research, not just opinions!!!!

 

[DrJeff]

Please, fellow dentists, post research, not just opinions!!!!

On the flipside to this request, just about all research takes place in a CONTROLLED environment, where as what the bits that those of use dentists are posting in this thread is what we actually see in real world conditions. How a material performs in my patient's mouth is alot more important to me than how it performs in a lab controlled experiment Research is great, as long as it easily transfers with the same results in my hands.

 

[m-dmd]

On the flipside to this request, just about all research takes place in a CONTROLLED environment, where as what the bits that those of use dentists are posting in this thread is what we actually see in real world conditions. How a material performs in my patient's mouth is alot more important to me than how it performs in a lab controlled experiment Research is great, as long as it easily transfers with the same results in my hands.

I am a real dentist, that practices real dentistry. IMHO, we should treat based on research, not on opinion. The research I posted was done in a real world setting, the article was peer reviewed, and posted some very real world related facts. I just saw A LOT of opinions here, and just because a person think a resin last "10-15-20" does not make it true. I would rather give my patients choices in treatment that are based on research and rooted in my experience.

If I look at it this way...if I go in and have a hip replaced, if my doc offers me a 2 material choices to pick from and he says that he likes one better than that other just because he does, but has no research to back it up, I am off to find myself a new orthopedist.

 

[toofshucker]

I am a real dentist, that practices real dentistry. IMHO, we should treat based on research, not on opinion. The research I posted was done in a real world setting, the article was peer reviewed, and posted some very real world related facts. I just saw A LOT of opinions here, and just because a person think a resin last "10-15-20" does not make it true. I would rather give my patients choices in treatment that are based on research and rooted in my experience.

If I look at it this way...if I go in and have a hip replaced, if my doc offers me a 2 material choices to pick from and he says that he likes one better than that other just because he does, but has no research to back it up, I am off to find myself a new orthopedist.

Like DrJeff said, research is very conflicting between these two matierials, and how a material acts in a controlled environment and how it acts in a bruxer that smokes and only brushes once every other day are two TOTALLY different things.

Amalgam and composite are both very good materials when USED IN THE RIGHT HANDS. It doesn't matter how well one works vs the other if the doctor can't place the restoration properly. For one doctor, he may be extremely skilled at placing amalgams that last 20 years, but he can't keep the surgical site dry, so his composites fail very rapidly. Is that the composite's fault? No.

As for your hip replacement, that is great. Go find another doctor. I don't care how much research he has done, if he does not know how/has not had enough experience in placing hip number one, then hip number two is always the better choice, no matter what the research says. That is why you, as the patient, need to exercise your freedom to find a doctor that is morally, legally, and ethically competent. Then after you have your list of doctors that fit that criteria, you need to pick one that then reflects what you are comfortable with.

No one material will ever be the "best". Each has its own prso/cons and you need to decide, with the help of your doctor, which is best for YOU. And what is best for YOU isn't going to be what is best for ME in every situation. That is what is great about medicine. No two people are the same, so every situation is different, no matter what the research says.

 

[toofshucker]

P.S. In medicine, especially dentistry, we are not just treating the physiological health, but the patients mental health. If a gold crown is superior in all the clinical trials (amalgam as well), but the patient slips into depression and doesn't eat and sleep, you have harmed your patient a lot worse than the additional wear porcelain would of caused.

I guess the point is, no matter what the research says, when you then throw systemic diseases, patient habits, patient history of following your treatment plans, doctor competence, environmental factors, etc, you, as a doctor, must make a decision regarding your patient's treatment, and that may just go against research, but when all other factors are taken into account, you did the right thing.

That is why it is hard to rip another doctor's treatment ways when you don't know their patients, environment, culture, etc.

 

[OceanDMD]

I am a real dentist, that practices real dentistry. IMHO, we should treat based on research, not on opinion. The research I posted was done in a real world setting, the article was peer reviewed, and posted some very real world related facts. I just saw A LOT of opinions here, and just because a person think a resin last "10-15-20" does not make it true. I would rather give my patients choices in treatment that are based on research and rooted in my experience.

If I look at it this way...if I go in and have a hip replaced, if my doc offers me a 2 material choices to pick from and he says that he likes one better than that other just because he does, but has no research to back it up, I am off to find myself a new orthopedist.

Do you bring out those peer reviewed research documents during your treatment presentations? I am sure it helps with case acceptance. I have patients asking me all the time to show clinical trials of resin versus amalgam restorations.

On a side note, If I go and have my hip replaced, I dont want to pick and choose anything. My faith lies in the skill and reputation of the clinician. He makes ALL the decisions. It doesn't matter what the clinical evidence says if the clinician cant perform.

 

[OceanDMD]

Minnesota Bans Adding Mercury To Cosmetics
First State In Nation To Adopt Safety Standard Tougher Than Feds
ST. PAUL, Minn., Dec. 14, 2007

This was todays news. Although it is with respect to mascara and skin creams, you have to wonder if we will continue to see more of this stuff....eventually getting to amalgam.

 

[m-dmd]

I agree, what works is what works in a provider's hands but I am so tired of hearing how resins are better, blah, blah, blah with no facts to back it up. I am not going to put an amalgam or a gold crown in someone's front tooth (unless of course they want it)...that is just silly, but I am going to give my patients treatment options that are backed in science. I was not ripping another doctor's treatment, if it works for him, that is great, but I also feel that presenting a treatment plan to a patient should also incorporate research.

Do you bring out those peer reviewed research documents during your treatment presentations? I am sure it helps with case acceptance. I have patients asking me all the time to show clinical trials of resin versus amalgam restorations.

On a side note, If I go and have my hip replaced, I dont want to pick and choose anything. My faith lies in the skill and reputation of the clinician. He makes ALL the decisions. It doesn't matter what the clinical evidence says if the clinician cant perform.

Ummm, no, I don't bring those studies, wouldn't that be just silly??? (although I do have them readily available, LOL)...This is what my patients are looking for. A provider that is educated and makes decsions based on research and experience. I want to give my patients the best possible treatment.

And you would take the clinician's advice, just cause he said so...hmmm, sounds to me like you may not be geting the best possible treatment if you just blindly believe what he says as fact. Just because a clinician says they are doing the right procedure, does not make it so. It should be backed in science.

It is dangerous, IMHO to put on a forum of dental students that one material is better than another, based on how a particular provider places it. I am just stating that a statement should be based in fact or at least supported by it.

 

[toofshucker]

This is what my patients are looking for. A provider that is educated and makes decsions based on research and experience. I want to give my patients the best possible treatment.

That is the point. While you just throw out research, others here are saying that it is important to also use your own experience. Go back and read my above posts to show where the research may be faulty and certainly not applicable to every patient.

And you would take the clinician's advice, just cause he said so...hmmm, sounds to me like you may not be geting the best possible treatment if you just blindly believe what he says as fact. Just because a clinician says they are doing the right procedure, does not make it so. It should be backed in science.

Most people in most situations (us included) don't understand enough of the science that is going on to logically/educationally make a educated decision about their treatment. That is why we go to doctors. If we knew, then doctors/lawyers/etc wouldn't be needed. If the doctor is licensed and in good standing in that state, then it is NOT a bad assumption to make that the doctor's decision is backed in science.

It is dangerous, IMHO to put on a forum of dental students that one material is better than another, based on how a particular provider places it. I am just stating that a statement should be based in fact or at least supported by it.

This is why the debate between amalgam and composite is not a good one. Neither is better/worse than the other in every situation. There are some where composite is by far the better material and visa versa. That is why you and I are doctors (or I will be)....we get to help our patients make the right decisions in regards to their health.

 

[abcdefghijklm]

how much does that run?😱