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Dental Materials Restorative Dentistry

Do the newer amalgam non-corrosion alloys fill with corrosion products and seal better as they age?

This question was submitted by a general dentist: Do the newer amalgam non-corrosion alloys fill with corrosion products and seal better as they age?

Dr. Anuradha Prakki, Restorative Dentistry Assistant Professor, in the Faculty of Dentistry at the University of Toronto, has provided this quick initial response

Drafted by Alexandra Rabalski, JCDA Oasis Summer Intern

Amalgam filling

This depends on the material used for the restoration and the size of the initial gap at the amalgam/tooth interface.

High-copper, corrosion-resistant amalgam with a small initial interfacial gap between the amalgam and tooth structure seal as rapidly as the lower copper alloys.

 

Reference

Mahler DB, Pham BV, Adey JD. Corrosion sealing of amalgam restorations in vitro. Oper Dent. 2009;34(3):312-20.

 

7 Comments

  1. Shep secter August 22, 2013

    Who would want amalgam in their own mouth or anyone else’s mouth anyway?

    Reply
  2. Jamie Bumbac August 28, 2013

    I hope that’s a joke shep. If not, I’m willing to bet that you’re a new grad. Wait a few years…you don’t know what you don’t know. White isn’t always right.

    Reply
    1. Shep Secter August 29, 2013

      I graduated in 1976, was a tucker study club participant, have a Cerec machine, have studied with Pascal Magne and I definitly agree, I don’t know what I don’t know. But I do know that I have not used Amalgam for over 25 years and have NO regrets! I use gold, cerec made resins bonded with heated composite and do immediate dentin sealing, and I use porcelain restorations. It is ridiculous for dental schools to be still teaching amalgam. It is a banned product in most of Europe and most new grad and existing dentists never place amalgam after they graduate. Spend the time teaching students what they are going to use and what their patients want. Resin fillings used in the correct circumstances can last a long time and provide a great service. Even though I am old, I have kept up my learning, and I can tell you Amalgam is a thing of the past. Have an open mind and go read the research of Pascal Magne and others. Forget the toxicity issues of amalgam if you want. I have NEVER removed a large amalgam that didn’t reveal a cracked tooth under it!
      Don’t assume I am a new grad. From your letter I assume you have done very little research on this issue. Welcome to 2013!

      Reply
      1. jamie bumbac August 31, 2013

        with all your experience, i would have assumed that you would have considerable respect for a material like amalgam. it’s quite a shame that your stance is as it is. so you follow one guy and his theories on amalgam…ok. banned in most of europe? maybe you should be doing your research. do you know why amalgam was banned in certain european countries? do you know that it has been re-introduced? never removed an amalgam that didn’t have a crack under it? wow, this is just laughable…how can you even have a control group with this statement (ever seen a 40 year old resin that you can even compare this to?). i am not anti-resin, but i can’t stand the arrogant dentist that seems to think that materials have become useless just become they don’t use them any longer in their practice. wake up shep, there’s still alot that you don’t know. all you have to do is go over to dentaltown to see this arguement go on, and on, and on, and on…there is no resolution, but you can have a bit of respect for those of us using a perfect legal, ethical, prudent material that is still a standard of care (regardless of if you like it or not). amalgam has a 150 year track record and you are ready to throw it under the bus because you now use cerec and resin everywhere. your attitude is very narrow-minded and hurts the thought processes of younger dentists who could actually benefit from having ALL the materials in their arsenal. your ideas on this material is also very misleading to general public, who is unaware and relies on us being open and non-bias in our thoughts for treatment, not simply using our own likes and dislikes to say what is “good” treatment. you also make your collegues like myself foolish because we don’t practice as you do. there is more than one way to accomplish excellent, long-term treatment shep

        Reply
        1. Craig Young September 3, 2013

          Interesting discussion.

          I have been in practice for 26 years, and have not used amalgam since I graduated. I have rarely experienced issues placing gold, composite or ceramics. Our patient retention is extremely high…I even have patients who started with me when I was in dental school, so I have seen the long term outcomes of these materials.

          I have also seen poor outcomes using these materials, as well as with amalgam. The majority of the reason for failure that I see is unfortunately due to operator issues, and not necessarily with the material.

          I agree with Shep, there is no real reason to use amalgam in this day and age, IF (capitalized) adequate attention has been given to soft tissue management, load on the restorations, proper placement technique, adequate curing lights, and even freshnesh of all materials (there are expired dates), etc, etc.

          Dr. Bumbac, you mentioned that you don’t know what you don’t know. I would say that holds true for everyone. Currently, you may not know that there is much greater understanding of heavy metal toxicity issues, both environmental, and biological. It is now understood why some people have issues with heavy metals, and some don’t.

          There are genetic differences within the population. Single Nucleotide Polymorphism (Genetic SNps) at the PTGS2 site for cyclooxygenase -2 (COX2) and Methylene tetrahydrofolate reductase MTHFR sites(Mainly C677T and A1298T site) renders a body unable to eliminate heavy metals, especially Mercury.Theses SNPs occur in btwn 6-21% of the population depending on race. That could be almost a quarter of your patients that are affected!

          Several of the ways mercury influences a person has also been identified. One of the most significant is that mercury binds several enzymes in the citric acid cycle, reducing the production of ATP. The symptoms will vary based on which cells have their mitochondria buggered up the most. No ATP, no pumps, no pumps, no cellular function. This is why the symptoms can appear so random.

          So, as you said, you don’t know what you don’t know…and we’re learning more all the time. It would be beyond arrogance to think that any of us knows all that there is to know. I can spend days discussing this, but hopefully, this creates enough opening to allow us all to continue to investigate the merits of any material ourselves, rather than blindly following dogma.

          The disadvantage to materials other than amalgam is the precision and attention to detail required.
          The advantage to amalgam is the fudge factor it has…but at what cost.

          Informed consent regarding materials is paramount. The reality is that we all must keep up with current knowledge in order for us to actually give proper informed consent.

          As I learn more, I am more convinced that amalgam advantages are very outweighed by the disadvantages, and other restorative options have become much more predictable.

          Craig

          Reply
          1. Craig Young September 4, 2013

            Also, if you are going to look into this further, Glutathione issues and Catechol-O-methyl transferase(COMT) SNP problems are extremely important with respect to patients having problems with mercury…and if you throw in 1B1 you really can have a problem. And if you throw in ApoE4 we are really doing a dis-service to our patients…have we fully informed them of these risks when using amalgam?

            Are we actually caring for our patients health, wellbeing and longevity or are we just filling holes? In my opinion, dentistry needs to be leaders in our populations health. We can do much better than we have been. We are more than capable!

            Reply
  3. shep Secter August 29, 2013

    Authors’ affiliations:
    Pascal Magne, The Don & Sybil Harrington
    Foundation Chair of Esthetic Dentistry, Division of
    Restorative Sciences, The Herman Ostrow School of
    Dentistry, University of Southern California Los
    Angeles, CA, USA
    Elisa Oderich, Luı´s Leonildo Boff, Antoˆnio Carlos
    Cardoso, Department of Dentistry, Federal University
    of Santa Catarina – UFSC, Floriano´polis, SC, Brazil
    Urs Christoph Belser, Department of Prosthodontics,
    School of Dental Medicine, University of Geneva,
    Switzerland
    Corresponding author:
    Dr Pascal Magne
    Division of Restorative Sciences
    The Herman Ostrow School of Dentistry
    University of Southern California
    3151 S. Hoover St
    Los Angeles, CA 90089 7792
    Tel.: þ213 740 4239
    Fax: þ213 821 5324
    e-mail: magne@usc.edu
    Key words: adhesion, CAD/CAM, composite resin, dental implant, fatigue resistance, implant
    abutment, porcelain
    Abstract

    Reply

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