I heard about this recently, is it true are they getting rid of amalgam for good? anyone know why ?
No more amalgam at NYU
- Thread starter mmasurf
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sounds to me as though they are still going to teach it, but no longer require competency exams for it and no longer "default" to recommending amalgam for posterior restorations. Amalgam seems to be going slowly in the direction of gold foil. Boards exams used to require that you do gold foil restorations, but now it is taught as an elective, if at all. Modern composites, including glass ionomer, are very good and require much less removal of tooth structure. Like gold foil, amalgam is still a good restorative material, but I think it will eventually be the exception instead of the rule. In a dental school clinic setting, you're likely to get more low-income patients and so you may be more likely to default to an amalgam filling instead of resin as the first choice. I personally hate doing amalgams and only really like it as a core build-up material on a tooth that still has all 4 walls.
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There are a few dentist office around here (Michigan) that no longer do amalgam fillings. I shadowed at one and was told it has nothing to do with the mercury. The main reasons he mentioned were composite fillings require less tooth to be removed, it doesnts expand and shrink like amalgam (this causes teeth to crack), it doesn't discolor the surrounding tooth overtime, and cosmetically there is no comparison.
The only draw back he said is it takes a little bit longer to do composites.
This dentist doesn't think amalgam fillings will be around in ten years with the way materials are improving.
Maybe NYU is thinking the same thing as this guy is?
The only draw back he said is it takes a little bit longer to do composites.
This dentist doesn't think amalgam fillings will be around in ten years with the way materials are improving.
Maybe NYU is thinking the same thing as this guy is?
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I'm stuck with some big dogs in my molars, some of which are 20 years old. And the whole loss of tooth structure and expansion and cracking and whatever means I'm forced to slowly switch them out to crowns now. Composite was pricey back then and with 7 kids, I don't blame my parents for going with amalgam.
Pricing is less of an issue now and the poster above mentioned the other benefits. But where I've seen it a lot...almost exclusively...is in public clinics our out on the Indian reservations. The doctors have explained to me that they are more concerned with function than aesthetics. I don't know if it's true, but they tell me given the patient's obvious poor track record of care, they want something strong and long-lasting and say it's a little more resistant to bacteria. Is any of that true?
I've attempted preps for composite and amalgam on plastic teeth (which cut like butter...or burn) and tinkered with the material. But I obviously know nothing. But to those who have done the real thing, how different are the preps and working working (shaping?) the material?
Pricing is less of an issue now and the poster above mentioned the other benefits. But where I've seen it a lot...almost exclusively...is in public clinics our out on the Indian reservations. The doctors have explained to me that they are more concerned with function than aesthetics. I don't know if it's true, but they tell me given the patient's obvious poor track record of care, they want something strong and long-lasting and say it's a little more resistant to bacteria. Is any of that true?
I've attempted preps for composite and amalgam on plastic teeth (which cut like butter...or burn) and tinkered with the material. But I obviously know nothing. But to those who have done the real thing, how different are the preps and working working (shaping?) the material?
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Placing a composite is way more technique sensitive than amalgam.
It's an interesting policy. I still think it should be taught because it is entirely possible NYU grads could end up in settings where amalgam is the primary material of choice - just like the IHS and public clinics you mentioned.
When I was in school, we had a bridge requirement in clinic. People really struggled to find a patient who needed a bridge. I did a Maryland bridge on a patient and had to beg to get it to qualify as my "bridge." In my last semester a patient with a 30 year old Nesbitt partial walked in desiring something more permanent so I got to do a "real" bridge but you get the point. I think not doing a GV Black style amalgam prep when a small conservative composite prep would suffice is a good idea for the clinic patients.
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I haven't placed an amalgam since dental school. It is a terrific restorative material but the pros and cons have been beaten to death. Public health puts in a boat load of amalgam as it costs less per restoration to place.
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That's sad...but it does sound like they will still have and teach and use amalgam, just not in the clinical setting as much unless it is deemed the best material for that case.
There are still times amalgams are far better restoratives in practical clinical dentistry. In an idealized environment, which is what a lot of dental school teach, you won't see it as often, but in the real world, when a long term patient can't afford a crown lengthening and crown and just wants a fix of a deep proximal that can't be isolated, well, there's the need.
I don't do many amalgams anymore, but I'm glad I have it in my back pocket. I hope NYC still plans to teach the material, just not require the competency. I think hand tying dentists in training so that we don't have the skills we might need in practice is a bad idea.
There are still times amalgams are far better restoratives in practical clinical dentistry. In an idealized environment, which is what a lot of dental school teach, you won't see it as often, but in the real world, when a long term patient can't afford a crown lengthening and crown and just wants a fix of a deep proximal that can't be isolated, well, there's the need.
I don't do many amalgams anymore, but I'm glad I have it in my back pocket. I hope NYC still plans to teach the material, just not require the competency. I think hand tying dentists in training so that we don't have the skills we might need in practice is a bad idea.
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As long as I have patients walking in my door who need say #31 lingual restored, all of whom seem to have some degree of macroglossia and also coincidentally enough seem to have a salivary flow rate similar to that of the flow rate of water over Niagra Falls, amalgam will be in my office!
By far and away, amalgam ISN'T my primary direct restorative material these days, but there are certain clinical situations where until an alternative restorative material can be invented where moisture control during it's placement is essentially irrevelevant, there are plenty of cases where amalgam is the best, most cost effective material that we as dentists can use
By far and away, amalgam ISN'T my primary direct restorative material these days, but there are certain clinical situations where until an alternative restorative material can be invented where moisture control during it's placement is essentially irrevelevant, there are plenty of cases where amalgam is the best, most cost effective material that we as dentists can use
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Or rope-like saliva that your assistant goes to suction and then drags along the suction as she comes out and perfectly falls right into the preparation you just bonded.
There's always gold...
As I recently joked with a nurse I was working on who asked me about both mercury and BPA...I could just fill all your teeth with gold and gold foil. How does 2.5 hours in the chair for 5 fillings at a cost of $2500 sound?
I've never done a gold foil in my life...I have no idea how long it takes or what is a reasonable charge...I just felt like joking about it with all the recent BPA news
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I just LOVE sometimes to semi "freak out" one of those amalgam paranoid patients that show up, typically with multiple google serach pages of info about how someone had all of their amalgams replaced and all of the sudden the "found the meaning of life/won the lottery/cured cancer/etc/etc/etc" 🙄 I just tell them that sure if they want I can replace all their "mercury" fillings with ESTROGEN fillings 😉 More often than not, that shock to their psyche is often enough for me to then engage them in a RATIONAL conversation about the pros and cons of the various restorative materials we have today
