What kind of amalgam do you use?

[GoGatorsDMD]

We're just starting our final operative course where we are learning to replace cusps & do WFT amalgams. Our school provides us with Dispersalloy (admixed) because of the longer setting time, but you really have to condense the crap out of it. If not, cusps and marginal ridges can come off during carving, which I just love.

Does anyone use something like Tytin (spherical amalgam) that's easier to get a dense amalgam? Does it work better for complex restorations?

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[DcS]

I like sybralloy, sets faster.

 

[buddy_in]

I like sybralloy, sets faster.

ME TOO BUDDY

 

[ItsGavinC]

I use the white composite kind that is cured with a light.

 

[Zurik5]

We use tytin and valiant phd. I like to work with valiant better, but apparently some docs were getting pissed because the mercury in the capsules was separating during trituration.

 

[dientesfuertes]

We use all Tytin.

 

[aphistis]

I use the white composite kind that is cured with a light.

I gotta say, Gavin, you sound like you're becoming one of the guys who make their careers out of scoffing at amalgam. Are prosthodontic metal copings next on the hit list? Cast posts & cores? Heck, implants?

 

[ItsGavinC]

I gotta say, Gavin, you sound like you're becoming one of the guys who make their careers out of scoffing at amalgam. Are prosthodontic metal copings next on the hit list? Cast posts & cores? Heck, implants?

Come on now, implants are state-of-the-art. Don't lump them with other archaic materials.

 

[aphistis]

Come on now, implants are state-of-the-art. Don't lump them with other archaic materials.

That's not a bad attempt at dodging, but you're not getting off the hook that easily.

 

[ItsGavinC]

That's not a bad attempt at dodging, but you're not getting off the hook that easily.

Well, my straight answer is that I don't think there are many situations where composite cannot be used successfully.

One might say that the huge surface areas of the posterior teeth can't take composite well, but I don't think that is always the case. Certainly there are times when composite should not be used in the posterior--but I'm also rather amazed by the large number of absolutely huge amalgams I've seen in the posterior, and I'm not a fan of large posterior restorations that simply weaken the tooth further, so I'm inclined to offer a crown for those cases anyway.

And certainly there is a great deal of sensitivity that results from large posterior amalgam composites, due partly to material shrinkage and poor margins, but probably more due to the thermal conductivity of the amalgam.

Anyway, I'm not anti-amalgam in any fashion, and I believe there are situations that call for it, but I also believe that it will one day be below the standard of care as composite materials continue to increase in durability and other characteristics. Who knows when that day will be, however.

 

[DcS]

I'm also rather amazed by the large number of absolutely huge amalgams I've seen in the posterior, and I'm not a fan of large posterior restorations that simply weaken the tooth further, so I'm inclined to offer a crown for those cases anyway.

Just playing devil's advocate, but have you ever thought that there is a reason you are seeing a lot of large posterior restorations with huge amalgams? That should tell you they last. I guess for your case it would make more sense to say you see most people with full crown and bridge in the posterior, asserting the amalgams fail. The fact that you say you see a lot of large amalgams is just proof really that they do hold up in those instances.

 

[gryffindor]

...So I'm inclined to offer a crown for those cases anyway.

I offered crowns out the wazoo to every patient who needed a huge posterior or anterior filling during my residency. But seeing as 95% of them couldn't afford, they got a huge state-funded amalgam or composite instead.

Crowns only work when people have $$$ and see a value in saving their teeth. I would have loved to have done more crowns instead of huge fillings during residency, but there was just no way it would happen with the patient population we worked with.

 

[J2AZ]

I use the white composite kind that is cured with a light.

Just out of curiosity...does AZ not teach amalgams or not emphasis their need when doing missionary work in underserved areas? Based on your post I gather that is the case. To me not teaching them is a direct contradiction to the message they promote. They claim to be out to train dentists with a desire to provide care to underserved communities. From what I have seen amalgam is the best material for that mission. It is less expensive and has a wider scope of use as demonstrated by many navy dentists. I have seen former sailors with amazing 20 year old amalgam "fillings" on teeth that needed a crown. Amalgam is less technique sensitive and much more practical when doing missionary work with limited tools and less than ideal operatory conditions.

So, if AZ does not teach amalgam how do they expect you guys to practice in underserved communities (small towns) where when a pt is told they need a BU and crown they most likely will say "doc just pull the damn tooth".

 

[ItsGavinC]

Just playing devil's advocate, but have you ever thought that there is a reason you are seeing a lot of large posterior restorations with huge amalgams? That should tell you they last. I guess for your case it would make more sense to say you see most people with full crown and bridge in the posterior, asserting the amalgams fail. The fact that you say you see a lot of large amalgams is just proof really that they do hold up in those instances.

I should have clarified a bit and said I'm seeing a lot of failing amalgams (huge ones) in the posterior.

Of course, everything fails, and some of those are failing after 25 years which is a great time frame and certainly have probably met or exceeded patient expectations.

I think we'll see a shift, if we aren't already, towards more and more composite fillings, even in the posterior.

 

[ItsGavinC]

Just out of curiosity...does AZ not teach amalgams or not emphasis their need when doing missionary work in underserved areas? Based on your post I gather that is the case. To me not teaching them is a direct contradiction to the message they promote.

So, if AZ does not teach amalgam how do they expect you guys to practice in underserved communities...

I never said they don't teach them. We learned it, and we use amalgam in the clinic all the time. Also, an "underserved community" does not mean (although it might) a community in a remote civilization. Downtown Phoenix, the 5th largest city in the US, is grossly underserved. Your points in your post are well taken, however, in regards to longevity and cost of amalgam vs. composite.

And just for the sake of clarification, the message the school promotes is the school's business--students don't always agree with it.

 

[J2AZ]

Gavin,

good points, thanks for the answer.