Quality Dentistry for Discerning Adults®

Up Silver Amalgam

Direct Restorations are custom formed in the mouth by your dentist, and placed directly into a treated tooth without any intervening laboratory steps.

Selecting the appropriate direct restoration to meet the needs of the patient and the individual tooth depends on a large variety of factors.  Each material has different advantages and disadvantages as a consequence of different properties. The weight of scientific evidence is that all of these materials are safe and effective for their intended use.

The following chart illustrates some common considerations your dentist takes into account when determining which material is best for a particular tooth needing a Direct Restoration:

Comparison of Direct Restorative Dental Materials

FACTORS

SILVER
AMALGAM

COMPOSITE
RESIN (Direct)

GLASS IONOMER

RESIN-
IONOMER

General Description A mixture of mercury and silver alloy powder that forms a hard solid metal filling. Self-hardening at mouth temperature. A mixture of tiny glass filler particles and acrylic that forms a solid tooth-colored restoration. Self- or light–hardening at mouth temperature.  Self-hardening mixture of fluoride containing glass powder and organic acid that forms a solid tooth-colored restoration able to release fluoride. Self or light- hardening mixture of sub-micron glass filler with fluoride containing glass powder and acrylic resin that forms a solid tooth colored restoration able to release fluoride.
Principal Uses Dental fillings and heavily loaded back tooth restorations. Esthetic dental fillings and veneers. Small non-load bearing fillings, cavity liners and cements for crowns and bridges. Small non-load bearing fillings, cavity liners and cements for crowns and bridges.
Leakage and Recurrent Decay Leakage is moderate, but recurrent decay is no more prevalent than other materials. Leakage low when properly bonded to underlying tooth; recurrent decay depends on maintenance of the tooth-material bond. Leakage is generally low; recurrent decay is comparable to other direct materials, fluoride release may be beneficial for patients at high risk for decay. Leakage is low when properly bonded to the underlying tooth; recurrent decay is comparable to other direct materials, fluoride release may be beneficial for patients at high risk for decay.
Overall Durability Good to excellent in large load-bearing restorations. Good to fair in small-to-moderate size restorations free of biting forces. Fair to poor durability when subject to biting forces.  Good to fair in non load-bearing restorations, but poor in load-bearing areas (biting surfaces). Fair to good in non load-bearing restorations; poor in load-bearing areas (biting surfaces).
Cavity Preparation Considerations Requires removal of tooth structure for adequate retention and thickness of the filling.  Adhesive bonding often permits removing less tooth structure.  Adhesive bonding usually  permits removing less tooth structure. Adhesive bonding usually permits removing less tooth structure.
Clinical Considerations Tolerant to a wide range of clinical placement conditions, moderately tolerant to the presence of moisture during placement. Must be placed in a well-controlled field of operation that is totally & completely dry.  But very little tolerance to presence of moisture during placement, which compromises bond strength to the tooth and increases risk of leaking or recurrence of dental caries..
Resistance to Wear Highly resistant to wear. Moderately resistant, but less so than silver amalgam. Poor resistance to wear when placed on chewing surfaces. Not well suited to such applications.
Resistance to Fracture Brittle, subject to chipping at filling edges, but with proper placement technique has good bulk strength in larger high- load restorations for back teeth. Moderate resistance to fracture in high-load restorations. Low resistance to fracture. Low to moderate resistance to fracture.
Biocompatibility Well-tolerated with rare occurrences of allergenic respose.
Post-Placement Sensitivity Early sensitivity to hot and cold possible. Sensitivity to heat & cold rarely occur.  A more common problem when material is not placed properly or when bond of  restoration to the underlying tooth fails. Low. Occurrence of sensitivity highly dependent on ability to adequately bond the restoration to the underlying tooth. Rarely a problem with modern materials.
Esthetics Silver or gray metallic color does not mimic tooth color. Close to natural tooth color and translucency, but can be subject to staining and discoloration over time. (Porcelain restorations have more natural appearance). Mimics natural tooth color, but lacks translucency making restorations look opaque and "paste-like". Mimics natural tooth color, but lacks translucency making restorations look opaque and "paste-like".
Relative Cost to Patient Generally lower; actual cost of fillings depends on their size. Moderate; actual cost of fillings depends on their size and technique.  Moderate; actual cost of fillings depends on their size and technique. Moderate; actual cost of fillings depends on their size and technique.
Average Number of Visits To Complete One. One. One. One.

Comparison of Restorative Dental Materials Reference List

1. US Public Health Service. "Dental Amalgam: A Scientific Review and Recommended Public Health Service Strategy for Research, Education and Regulation." January 1993 (Section on Dental Materials for Restoring Posterior Teeth.)

2. US Public Health Service. "Dental Amalgam: A Scientific Review and Recommended Public Health Service Strategy for Research, Education and Regulation." January 1993 (Table 2: Selected Characteristics of Posterior Restorative Materials.)

3. American Dental Association, Council on Dental Materials, Instruments and Equipment. "Choosing Intracoronal Restorative Materials." JADA 1994; 125:102-3.

4. American Dental Association, Council on Scientific Affairs; Council on Dental Benefit Programs. "Statement on Posterior Resin-Based Composites." JADA 1998; 129:1627-8.

5. Douglass CW. "Future Needs for Dental Restorative Materials." Adv Dent Res 1992; 6:4-6.

6. Reich E. "Risks and Benefits of Direct Restorative Materials as Alternatives to Amalgam." Dental Amalgam and Alternative Direct Restorative Materials, Oral Health, Division of Noncommunicable Diseases, World Health Organization, Geneva 1997; 1-15.

7. American Dental Association, Division of Communications. "Answers to Your Questions About Silver Fillings." 2000.

8. American Dental Association, Division of Communications. "Dental Materials." 1993.

9. US Public Health Service, "Update Statement by the U.S. Public Health Service on the Safety of Dental Amalgam." Annex A and Appendix B, 1995 & 2001.

10. Burgess JO, Norling BK, Rawls HR, Ong JL. "Directly Placed Esthetic Restorative Materials - The Continuum." Compendium 1996; 17:731-748.

11. US Food and Drug Administration, "Consumer Update: Dental Amalgams February 2002." http://www.fda.gov./cdrh/consumer/amalgams.html, February 8, 2002.

12. Mackert, J.R., Berglund, A. "Mercury Exposure from Dental Amalgam Fillings: Absorbed Dose and the Potential for Adverse Health Effects." Ctir Rev Oral Biol Med 1997; 8:410-436.

13. Smith, C.T., Gold as a Historic Standard and its Role for the Future, Operative Dentistry 2001;Suppliment 6:105-110.

14. Peutzfeldt, A., Indirect Resin and Ceramic Systems, Operative Dentistry 2001:Suppliment 6:153-176.

NOTE: The information in this chart is provided to help dentists discuss the attributes of commonly used dental restorative materials with their patients.  The chart is a simple overview of the subject based on the current dental literature.  It is not intended to be comprehensive.  The attributes of a particular restorative material will vary from case to case depending on a number of factors. Chart above modified from a chart published by the American Dental Association, 2002.

 

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David J. Fox, D.M.D., P.C.

Quality Dentistry for Discerning Adults ®

Telephone: (215) 481-0441

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