While this rebuttal probably will do little to win over the hard-core amalgamists, I am prompted to respond to the recent letter from Dr. Fredrick L. Rosen and his unabashed support of the amalgam restoration. Dr. Rosen states, "Amalgam is the restoration of choice in many clinical situations." To which I can only say, "Name one, please!"
Frankly, I am tired of hearing amalgamists repeat the dogma, "Amalgam has been used for 100 years and has stood the test of time." So has the horse and buggy, the kerosene lamp and the typewriter. Would anyone support the notion that we return to these technologies?
Amalgamists, sensing the corner they are being backed into, usually counter with, "But the wear rates of amalgam are less than that of composites." I fail to understand this never-ending debate over a few millimicrons when the cuspal fracture characteristic of amalgam is well-known and observed almost daily in every general dental practice.
Dr. Rosen complains that not to offer amalgams is not giving your patients a choice. Yet, what choice does he offer his patients: amalgams or castings? What choice is that?
We have not placed an amalgam restoration in four years. I can say that in placing thousands of direct posterior composites, they have been far less troublesome than amalgams. In all that time, I have seen a total of two teeth return with fractured cusps following a bonded (direct or indirect) restoration. Not a week passes, however, when one or more patients with amalgam-restored teeth appear in my chair with fractured cusps. What more proof do you need?
In a recent article, Dr. Gordon J. Christensen stated: "Many dentists still are reluctant to use Class II resins ... they have not learned how to do them rapidly enough; they have not mastered contact areas or finishing. Every article we publish that seems pro-resin will get nasty letters from dentists saying amalgam still is the best; forget resin. There still is a heavy anti-bonded-restorations voice out there. Herculite (Kerr) and Heliomolar (Vivadent) have proven over nearly 10 years now in our own studies to be as good as or better than silver amalgam."
And so, Dr. Rosen, I challenge you on two counts. First, what choice are you giving your patients when you can offer only amalgams and castings? Secondly, I would like to know where amalgam might be "the restoration of choice."
Richard H. Erickson, DDS
Marietta, GA
